Oxford Handbook of Midwifery (113 page)

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Authors: Janet Medforth,Sue Battersby,Maggie Evans,Beverley Marsh,Angela Walker

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This may be kept in the hospital chapel and should be on view at all times.
Invite the parents to place the baby’s name and date of birth in the book. There should also be a space for a short verse.
If the parents cannot do this themselves, the hospital chaplain may do it for them.
Memorial service
A memorial service, which may be multi-faith, may be held annually, to which all families and staff are invited, to remember newborn babies who have died.
Parents and families will decide for themselves how many years they wish to attend. They should never be excluded by time limit or other obstacles.
Counselling
Encourage parents to talk to staff about how they feel. Set aside time
to do this.
It is helpful if the maternity unit has one or two midwives, trained in counselling skills and experienced in dealing with families in this situation, to lead this work.
Home visits can be arranged, if the parents do not wish to return to the maternity unit for counselling.
Some parents may need longer counselling and psychological support than you are able to offer; in which case, establish appropriate referral mechanisms.
1
Child Bereavement Trust (2003). Available at: M
www.childbereavement.org.uk/professionals (accessed 27.2.11).
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Part 5
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Family planning
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Contraception
‌
Chapter 22
523
Contraception
524
Lactational amenorrhoea method
528
Combined oral contraceptive: ‘the pill’
530
When the pill may not be effective
532
Contraceptive patch
535
Contraceptive vaginal ring
536
Progesterone-only pill
538
Implant
542
Injectables
546
Mirena
^®intrauterine system
549
Intrauterine devices
550
Female condom
556
Diaphragms and cervical caps
560
Fertility awareness (natural family planning)
562
Coitus interruptus
564
Male condom
566
Male sterilization
568
Female sterilization
570
Emergency contraception
572
CHAPTER 22
Contraception
524‌‌
Contraception
2 Important points for the midwife to remember:
- Any discussion about contraception is both sensitive and highly personal to individual women and their partners
- You need to be knowledgeable both about the range of contraceptive methods available and the local services available to best meet the woman’s needs
- Ensure that you have up-to-date information on the full range of contraceptive methods available in the locality, access to relevant appropriate websites, NICE guidelines, and useful books that might help (b see Contraceptive methods, p. 525)
- Allow enough time for discussion, and ensure an appropriate environment to maintain confidentiality and allow a relaxed discussion, ideally in the woman’s home
- Encourage discussion
- Offer any leaflets and suitable websites available to support information given
- Remember that to be effective the chosen contraception must be used properly and therefore acceptable to the woman and, ideally, to her partner
  •
  As with any other form of treatment, informed decision making and consent is required
- Brand names of contraceptives apply to the UK, but these will vary throughout the world.
  Contraception following abortion/miscarriage
- First trimester: hormonal contraception can be commenced or recommenced immediately.
- Second trimester: hormonal contraception should not be commenced or recommenced until at least 21 days after abortion or miscarriage until uterine changes have reverted to the pre-pregnant state.
- However, there will be exceptions to consider in individual cases, when effective contraception is paramount.
  Contraception after giving birth
- Normally, hormonal contraceptive methods are not commenced until at least 21 days after birth.
- However, should the need for contraception be the paramount concern, it may be started sooner.
  Important points to remember
- Never recommend the combined oral contraceptive pill to a breastfeeding woman
  . Oestrogen will inhibit the release of prolactin and suppress her lactation within 24h.
- Giving progesterone while the postnatal vaginal loss is still present may cause an increase in the amount of blood loss and prolong the bleeding time.
- Progesterone-only methods, if started too soon in a breastfeeding mother, may also cause suppression of lactation.
  CONTRACEPTION
  525
  Contraceptive methods
  Table 22.1 lists the methods that will be discussed in this chapter.
  Table 22.1
  Contraceptive methods
  Hormonal
  Combined oestrogen and progesterone
  Combined pill
  Skin patch Vaginal ring
  Progesterone only Oral progesterone-only pill Injectables
  Implant
  Intrauterine system (IUS)
  Emergency contraception Non-hormonal
  IUD
  Oral pills Intrauterine device
  Barrier Male condom
  Female condom Diaphragm and cervical cap
  Natural Breastfeeding
  Sterilization Fertility awareness Male sterilization Female sterilization
  Useful websites
  British Association of Sexual Health and HIV: M
  www.bashh.org.uk. Faculty of Sexual and Reproductive Health: M www.fsh.org.uk.
  Faculty of Sexual and Reproductive Healthcare; UK medical eligibility criteria for contraceptive use (2009). Available at: M
  http://www.ffprhc.org.uk.org/admin/uploads/UKMEC2009.pdf (accessed 10.4.10).
  International Planned Parenthood Federation: M
  www.ippf.org.
  Journal of Family Planning and Reproductive Health Care
  : M www.pmn.uk.com/healthcare/ familyplan/home.htm.
  The Family Planning Association: M www.fpa.org.
  World Health Organization: M
  www.who.int/topics/familyplanning/en/.
  CHAPTER 22
  Contraception
  526
  Recommended reading
  Everett S (2004).
  Handbook of Contraception and Reproductive Sexual Health
  , 2nd edn. London: Balliere Tindall.
  Guillebaud J (2008).
  Contraception Today
  , 6th edn. London: Taylor and Francis.
  Guillebaud J (2009).
  Contraception: Your Questions Answered
  , 5th edn. Edinburgh: Churchill Livingstone.
  National Institute for Health and Clinical Excellence (2006). Routine postnatal care of women and their babies. Clinical guideline 37. London: NICE.
  National Institute for Health and Clinical Excellence (2007). Long acting methods of contracep- tion. Clinical guideline 30. London: NICE.
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  CHAPTER 22
  Contraception
  528‌‌
  Lactational amenorrhoea method
  How does it work?
  The lactational amenorrhoea method (LAM; Fig. 22.1) will inhibit ovula- tion if the following criteria are all met:
- Amenorrhoea
  since the postnatal vaginal blood loss ceased
- Full lactation
  : the mother is fully supplying the baby’s nutritional needs day and night
- Baby is <6 months old
  .
  In these circumstances the operating prolactin levels inhibit gonadotrophin release from the anterior pituitary gland, thus inhibiting ovulation, and the risk of pregnancy occurring is only approximately 2% (i.e. 98% effective as contraception).
  Efficacy
- A WHO multicentre study
  ¹supports this, with a reported pregnancy rate in the first 6 months after childbirth of 0.9–1.2%.
- Prolactin levels are highest during the night, and to ensure that LAM works, it is essential to continue night-time feeding as long as possible.
- The failure rate will increase if the mother is not fully breastfeeding, and in the Western world women are encouraged and motivated to
  stop night feeding as soon as possible, and the baby encouraged to sleep the night through, by giving supplementary solids in the evening.