Synopsis
Offer timely contraceptive choices after birth while accounting for feeding, thrombotic risk and product timing, and provide a structured follow-up discussion after a complicated delivery.
- Discuss contraception before discharge and ensure protection is planned by day twenty-one.
- Ovulation can occur before the first menstrual bleed returns.
- Breastfeeding provides reliable contraception only when all lactational amenorrhoea criteria apply.
- Early postpartum eligibility differs between implants, pills and injectable progestogens.
- Professional insertion guidance and a specific device licence may use different timings.
- A birth discussion should answer the woman's questions and produce an actionable follow-up plan.
Key red flags
New chest symptoms or unilateral swelling before considering an oestrogen-containing method.
Fever, pelvic tenderness or offensive discharge when intrauterine contraception is requested.
Suicidal thinking, marked confusion or unusual beliefs during discussion of the birth.
Persistent heavy bleeding or severe pain that has not been clinically assessed.
Investigation priorities
Determine whether pregnancy can reasonably be excluded before initiation.
Management branches
The woman wishes to avoid pregnancy during recovery after birth.
- Discuss preferences and check postpartum eligibility, feeding plans and relevant medication interactions.
- Provide the selected method when feasible or prescribe an acceptable interim option with a definite later appointment.
- Explain when protection starts, any need for condoms or abstinence, and how to obtain help for adverse effects or a change of preference.
Key medicines
Desogestrel progestogen-only pillTake 75 micrograms orally once daily continuously without a pill-free interval. FSRH supports immediate postpartum initiation; if quick-started on or after day 21 without valid LAM protection, use additional precautions for 2 days.Assess pregnancy risk, breast cancer history, unexplained bleeding and enzyme-inducing medicines. Product labels may differ from FSRH initiation advice; document the chosen guidance and teach the specific missed-pill rules.
Nexplanon etonogestrel implantInsert one 68 mg implant subdermally by a trained practitioner; the current UK licence allows 5 years. Immediate postpartum insertion is permitted after individual assessment; insertion after day 21 requires 7 days of barrier protection.Exclude pregnancy as required, review contraindications and enzyme-inducing drugs, and confirm palpability after insertion. Give an alert card and review advice for non-palpability, troublesome bleeding or a request for removal.