An visit when inserted during the childbirth stay(6,7).


An IUCD is a small, “T-shaped”
intra uterine contraceptive device which is placed in a woman’s uterus. It is
also known as the IUD, loop or coil. Post-partum IUCD is an intrauterine
contraceptive device which is inserted during the postpartum period (up to 48
hours after birth, optimally within10 minutes of delivery of the placenta.
IUCDs are prepared of flexible plastic with a coating of thin copper wire. It
has one or two soft threads on the last part. These thin threads hang through
the opening at the entrance of the uterus into the top of the vagina(1).Copper-bearing
IUDs come in a variety of designs the IUD recommended by WHO for bulk obtaining
is the TCu380A it works primarily by causing chemical changes that prevent
fertilization. Studies show that the copper IUD effectively interrupts the
reproductive process before implantation and pregnancy and it does not act by initiating an abortion, as
has sometimes been suggested(2). Renewed interest in the
intrauterine device (IUD), a highly effective, long-acting reversible
contraceptive (LARC) that is safe for breast feeding women, has encouraged some
programs to add postpartum IUD services to their PPFP options (3)
. Ethiopia in collaboration with Maternal and Child Health Integrated Program
(MCHIP) started PPIUCD program in 2012, PPIUCD services were initiated as one
FP option for postpartum clients(4, 5).

The most successful PPFP programs will
focus on providing PPFP counseling to women at every opportunity. In low-income
countries, increasing emphasis on antenatal care and childbirth in a health
care facility has created an opportunity to counsel women about family
planning. The health benefits of contraception and birth spacing for women and
their infants are remarkable. Insertion before discharge from the birthing
facility ensures that the woman is not pregnant at the time of insertion and is
protected against pregnancy prior to resuming sexual activity(3).

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Intra uterine devices (IUDs) are
cost-effective, can be inserted in a matter of minutes by a trained provider,
and do not require an additional facility visit when inserted during the
childbirth stay(6,7). Immediate postpartum IUCD
insertion has a higher retention rate if the IUCD is inserted post placentally,
but the IUCD can be inserted safely at any time up to 48 hours after delivery
or during a cesarean delivery. PPIUD insertion may avoid discomfort associated
with interval insertion (insertion 4 weeks or more after delivery), and
bleeding from insertion will be disguised by postpartum lochia (the normal
discharge from the uterus after childbirth). (6,7). Appropriate times for IUCD
insertion in the postpartum periods include the post placental IUCD insertion,
the immediate postpartum IUCD insertion and the transcesarean IUCD insertion.
The post placental IUCD insertion is done within 10 minutes after expulsion of
the placenta, following a vaginal delivery. 
The immediate postpartum IUCD insertion is done after the post placental
period, but within 48 hours of delivery and the transcesarean IUCD insertion is
when the insertion takes place following a cesarean delivery, before the uterus
incision is sutured (5,8).

These periods are recommended because it
is possible to use instruments or manual insertion as the cervix is open and
limp and an IUCD can easily be placed high in the fundus, either manually or
using forceps. Furthermore it continues to be possible to insert an IUCD with
an instrument for up to 48 hours postpartum. After this period, the cervix is
not open enough to allow for an easy and relatively painless instrument
insertion (8).
After birth, as the uterus returns to normal size (involution), uterine
contractions expel retained placental tissues and blood clots and may have a
similar effect on any foreign body introduced into the uterus. IUCDs inserted
postplacentally have a much lower expulsion risk than those inserted later in
the postpartum period, although the expulsion is still higher than for interval
insertions (about 42 days after childbirth). However, the benefits of providing
highly effective contraception immediately after delivery often outweigh the
disadvantage of the higher postpartum expulsion rates. Pregnancy rates do not
differ by timing of IUCD insertion(8).