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Initiating postpartum contraception will protect both mother and baby. About 50% of new mothers return to sexual intercourse within six weeks after delivery. In non-breastfeeding mothers, ovulation can occur again as early as 3 to 4 weeks post-delivery. The likelihood of an unintended pregnancy occurs if reliable postpartum contraception is not initiated before discharge from the hospital, and that is why postpartum family planning programs, like PPIUCD services, that provide support from major medical manufacturers such as SMB Corporation of India which offer postpartum contraceptive products, including copper IUDs and other related products, benefit the health of women in their reproductive years.
Three different clinical optimal time frames exist for the placement of a PPIUCD (postpartum intrauterine contraceptive device). The three different time frames to insert a PPIUCD include: immediately after placental delivery, during an intra-cesarean section, and between 24 – 48 hours post-delivery. The three time frames for placement affect the patient's risk for complications associated with the insertion procedure of the device, as well as their degree of discomfort and device expulsion rate; thus, the best time frame for placement is dependent upon various factors that are unique to each patient.
Following childbirth, the uterus remains enlarged due to pregnancy and is soft in the immediate postpartum period. As uterine involution occurs over the next several days (approximately 2–5 days post-delivery), the uterus gradually contracts and ascends higher within the abdominal cavity.
Additionally, the cervix is naturally dilated post-delivery, allowing quicker IUD placement with little discomfort to the woman.
In addition, Copper IUDs exert a spermicidal effect through the release of copper ions. The effectiveness of Copper IUDs has been demonstrated in numerous global post-partum IUD studies and projects; they are hormone-free, safe while breastfeeding, and provide immediate contraception protection.
However, timing matters: as the uterus undergoes involution over days, improper timing increases the chance of displacement or expulsion.
Insertion occurs immediately after vaginal delivery, before significant uterine contraction.
The IUD is inserted manually through the hysterotomy, placed directly at the fundus.
Insertion anytime within 48 hours postpartum, if earlier opportunities were missed.
The FIGO PPIUD initiative has shown that when Kelly's forceps insertion technique is performed correctly, it places the IUCD high in the fundus and Results in expulsion rates as low as 2-3%. Midwives, Nurses and Doctors were able to insert IUCDs successfully; this is evidence that Task sharing can significantly improve access while still maintaining safety.
Dedicated postpartum inserters exist, but may require follow-up appointments sooner than their regular appointment to cut off any lengthy excess string.
Providers must:
At 6 weeks, clinicians should check for:
Missing threads may require a thread retriever or ultrasound confirmation, as described in recent postpartum IUD research.
For more info read our blog on What should you do if the strings of an IUD are not felt?
Proper timing is an essential element for effective use and long-term continuation of PPIUCDs. With appropriate application, provider education, and utilization of evidence-based timing guidelines, PPIUCDs are considered to be among the most reliable postpartum forms of long-acting reversible contraceptives. Organizations such as SMB Corporation of India provide resources to ensure that quality IUDs remain available for distribution by healthcare systems and thus, contribute to strengthening postpartum family planning and improving maternal health worldwide.
