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Hormonal IUDs implanted after birth do not impact breast-feeding

Eve Espey

Women who have a hormonal intrauterine device implanted immediately after birth can still lactate and breast-feed, according to findings recently published in the American Journal of Obstetrics and Gynecology.

“Unplanned pregnancy is a major problem in the U.S. — a lot of women become pregnant again shortly after having a baby; however, most of those women actually would like to space out their pregnancies more than that or might not even want more children,” researcher Eve Espey, MD, MPH, chair, department of obstetrics and gynecology, University of New Mexico School of Medicine, told Healio Family Medicine in an interview. “But since it’s hard to get to a postpartum appointment 6 weeks later or because women get pregnant in the meantime or several other factors, getting the IUD immediately after birth can be a great option for women.”

Espey and colleagues studied 132 women who had a levonorgestrel IUD inserted immediately after birth and 127 women who underwent insertion 4 to 12 weeks after their pregnancy. The primary outcome was breast-feeding continuation at 8 weeks, and the secondary outcome was time to lactogenesis.

Results revealed that breast-feeding at 8 weeks was noninferior in the immediate group (79%; 95% CI, 70%-86%) compared with the delayed group (84%; 95% CI, 76%-91%). Time to lactogenesis in the immediate group (65.3 ± 25.7 hours) was also noninferior to the delayed group (63.6 ± 21.6 hours). In addition, 24 expulsions took place in the immediate group compared with two expulsions in the delayed group (19% vs. 2%; P < .001).

“We conducted this research to make sure that getting [an IUD] right away wouldn’t have a negative impact on breast-feeding, which is very important for the health of the baby,” Espey said.

In addition, Espey offered some suggestions for medical professionals on how to discuss IUD use after pregnancy with patients.

“It’s the doctor’s job to make sure this comes up during the prenatal care visits,” she said. “Many doctors don’t know that you can put in an IUD immediately after birth. A doctor could make the discussion easier by telling a woman that placing an IUD immediately after birth might be an option, and that it is usually not painful, particularly if the woman had an epidural during labor or had it placed right after a [cesarean section]. She could also tell the patient that [immediately after birth is] a convenient time to have it done and doesn’t interfere with breast-feeding.

“The primary care doctor should not tell patients that she can always get it done,” Espey continued. “There are a few reasons you might not be able to get it done: Insurance doesn’t cover it; you develop an infection or hemorrhage during or shortly after birth; and if the doctor or midwife who delivers the baby doesn’t know how to do it.” – by Janel Miller

Disclosures: Turok reports he is a consultant for Bioceptive and Contamed and a speaker for Allergan, Medicines 360, Merck and Teva. The other researchers report no relevant financial disclosures.