Clinical Considerations

Assessing patient candidacy

Immediate postpartum LARC is safe and effective for most women and should be offered routinely as an option for postpartum contraception, regardless of breastfeeding status.

This section contains published guidance, including assessing patient candidacy and contraindications to immediate postpartum LARC placement.

Expulsion

Despite the higher expulsion rate of immediate postpartum IUD placement over interval placement, evidence from clinical trials and from cost-benefit analyses strongly suggest the superiority of immediate placement in reduction of unintended pregnancy, especially for those at greatest risk of not having recommended postpartum follow-up visit.

This section addresses research and guidance on immediate postpartum IUD expulsion.

Breastfeeding

Systematic review findings show that progestin-only contraceptives do not appear to adversely affect a woman’s ability to successfully initiate and continue breastfeeding or an infant’s growth and development. Given available evidence, women who are considering immediate postpartum hormonal LARC should be counseled about the theoretical risk of reduced duration of breastfeeding, but that the preponderance of the evidence has not shown a negative effect on actual breastfeeding outcomes.

This section addresses research and guidance on immediate postpartum hormonal LARC use and breastfeeding.

Insertion & Removal

Insertion of IUDs immediately postpartum requires a different set of skills than for interval placement. The technique for implant placement immediately postpartum does not differ from that for interval insertion.

Follow up may be required for women who have received LARC immediately postpartum for routine or special cases.

This section reviews methods for placing IUDs following both vaginal and caesarean birth, and how to receive the FDA required training for implant insertion. It also includes information on removal of LARC devices placed immediately postpartum.

Learn more about IPP LARC

Learn more about LARC Clinical Challenges