Postpartum contraceptives -timings

Then what option we have to offer to women coming for postpartum check up at clinic/OPD?? What exactly than the time of postpartum initiation of Contraceptive:

Care should be exercised in individualizing such timeframe one should remember that sperm retain fertilizing capacity in the female genital tract five days after intercourse. Thus, it would had been appropriate if women could have assessed first postpartum ovulation process 3-5 days prior to the occurrence of ovulation. So that appropriate contraceptive method may be initiated prior to first ovulation. Unfortunately till date there is no such subjective symptom or Laboratory test exist which can detect ovulation 5 days prior to ovulation. Thus individualizing of initiation of contraceptive and possibly to some extent unscientific.

The degree of lactation induced inhibition of ovulation is difficult to assess from  history and only a grass is possible. For instance, if frequent and prolonged breastfeeding is going on then early use of contraceptives may constitute and unnecessary double protection i.e. L.A.M. along with some other contraceptive what should be then, the take home message?

The international guideline is that a) for fully breastfed women (not giving any artificial milk, fruit juice honey etc.). Who has not yet started menstruation contraception should be commenced after six months of delivery. There is only two percent chance of conception during the last two months i.e. fifth and six month of postpartum period. One can use some contraceptive in those two months if one intends to avoid the said 2% risk though that is not the usual recommended protocol. B) Nonlactating women on the other hand and who partially breastfed they should definitely start contraceptive by two and four months after childbirth respectively unless the start menstruating earlier. C) After an abortion (spontaneous a induced) one should start using contraception after two weeks and not later. Before this timeframe for all practical purpose pregnancy is very unlikely though not impossible.

One may ask why not to initiate contraceptive from the very first sexual act in postpartum period? There is no harm if one opts using a contraceptive from the very first coital act after childbirth. But one has to consider that no contraceptive is 100% effective. If one accepts this philosophy of occasional ‘contraceptive accidents’, which is not uncommon, then above mentioned guideline is possibly more acceptable to couple rather than very early initiation of contraceptive.