Cases

Chapter 12 Contraception and family planning

Case 1: Appropriate method of contraception (1)

Margaret is a 36-year-old para 1 who had a normal birth of a baby girl. She has a family history of haemophilia. She has been married for 12 years and smokes 5-10 cigarettes a day. She is also very overweight and is breastfeeding.

Questions

• a) What advice/information would you offer Margaret about contraception on discharge from hospital?

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  Correct answer:

  • Progesterone only pill would be offered as a suitable option, providing Margaret could be compliant with the administration.
  • The combined pill would not be suitable due to breastfeeding, being overweight, over 35 years and a smoker.
  • Contraceptive injection is not offered until 6 weeks postnatal, due to increased risk of bleeding. At 36 years of age, she may wish to have another pregnancy with a short period in between, so fertility returning issues with this method may be significant. An implant would not necessarily be the most appropriate method as she may wish for another baby within a short time frame.
  • Condoms/femidom are suitable methods if used appropriately.
  • The coil would not be contraindicated with family history of haemophilia but again, this is a long-acting method which may not be suitable if Margaret is considering a short gap between children.

Case 2: Appropriate method of contraception (2)

Sally is 25 years old, she is married and has just had a normal birth of her third boy. She is asking advice about future contraception. She states she is not compliant with the pill, she has a needle phobia and is unsure if her family is complete. She is formula feeding and smokes 20 cigarettes a day.

Questions

• a) What advice/information would you offer Margaret about contraception on discharge from hospital?

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  Correct answer:

  • Sally is not suitable for the oral contraceptive pill because of her non- compliance. Contraceptive injection and implant would be contraindicated because of her needle phobia.
  • Sally could consider the coil or diaphragm/cap. She could also use a patch if she thought she would remember to change it on weekly basis. A vaginal ring could also be considered if she would be happy to try this.
  • Condoms or femidom would also be suitable.

Case 3: Appropriate method of contraception (3)

Joanne is a 30-year-old who has delivered twins, a boy and a girl, by elective caesarean section. This was an IVF pregnancy following several years of been unable to conceive. Joanne is formula feeding the babies.

Questions

• a) You are discharging Joanne on the 4th day post delivery. What advice may you offer about contraception to Joanne?

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  Correct answer:
  Depending on the reasons for IVF, Joanne could still become pregnant naturally and should be given advice about the risks of getting pregnant again in the year following caesarean section. She should have all methods including emergency contraception and sterilisation explained as she may decide this is her family complete, due to having several years of treatment to conceive. Joanne could consider alternatives to permanent sterilisation as relationships can change and the decision may be regretted in the future.