Postpartum

Period
Puerperium/Postpartum – refers to the six-
week period after delivery of the baby
during which the reproductive system and
the body returns to normal

Principles of Postpartum Care- to promote

healing and return to normal (involution)
of different parts of the body.

Involution - return of the reproductive

organs to their pre-pregnant state.
Immediate postpartum- first 24 hrs after birth
Early postpartum- first week
Late postpartum- 2nd to 6th week

A. Assessment
Nursing Assessments for Postpartum Care
B - Breasts
U - uterus
B - bowels
B - bladder
L - lochia
E - episiotomy/laceration/c-section incision
HE
Homans’ sign is often used in the assessment for
deep venous thrombosis (DVT) in the leg. To
assess for Homans’ sign, the patient’s legs should
be extended and relaxed. The examiner grasps
the foot and sharply dorsiflexes it . No pain or
discomfort should be present. The other leg is
assessed in the same manner. If calf pain is
elicited, a positive Homans’ sign is present. The
pain occurs from inflammation of
the blood vessel and is believed
to be associated with the
presence of a thrombosis.
B. Specific body changes on the mother
1. Cardiovascular changes
a. The 30%-50% increase in total cardiac
volume during pregnancy will be re-
absorbed into the general circulation
within 5-10 minutes after placental
delivery.
Implication: The first 5-10 minutes after
placental delivery is crucial to
gravidocardiacs because the weak heart
may not be able to handle such workload.
b. White blood cell count increases to
about 20,000-30,000/mm3.
Implication: The WBC count, therefore,
cannot be used as an indication or sign
of post partum infection because with or
without infection, all newly-delivered
mothers have a high WBC count.
c. There is extensive activation of the
clotting factors, which encourages
thrombo- embolization.
This is the main reason why:
* Ambulation is done early for 4-8
hours after normal vaginal delivery.
When ambulating a postpartum patient
for the first time, the nurse should hold
on to the patient’s arm.
* Exercises are recommended:
* Kegel and abdominal breathing on
postpartum day one (PPD1)
* Chin-to-chest – on PPD2 to tighten and firm
up abdominal muscles.
* Knee-to-abdomen – when perineum has
healed, to strengthen abdominal and gluteal
muscles
* Massage is contraindicated because it can
dislodge a clot.
d. All blood values are back to prenatal levels
by the third or fourth week postpartum.
e. Blood volume goes rapidly from
hypervolemia to hypovolemia. Blood loss in
vaginal delivery is about 400-500cc and 700-
1000 cc C/S.
• Blood pressure at first is usually
increased then decrease
• It increases during uterine
massage/pain
• Orthostatic hypotension may occur
when the patient moves from a supine to
a sitting position It is common during
the first 48 hours after delivery
• Physiologic bradycardia of 40-50 bpm
during the first 24-48 hours
2. Genital changes
a. Uterine involution is assessed by measuring
the fundus by fingerbreadths.
Within the first 12 hours postpartum, the
fundus usually is approximately 1 cm above
the umbilicus.
• On PPD1, the fundus is one fingerbreadth
(1cm) below the umbilicus
• On PPD2, 2 fingerbreadths below and so forth
• Until on the tenth day postpartum, it can no
longer be palpated because it is already behind
the symphysis pubis.
* Subinvoluted uterus- uterus which does not
return to its usual size and shape as expected,
accompanied by vaginal bleeding with clots.
Since blood clots are good media for bacteria,
a subinvoluted uterus, therefore, is a sign of
puerperal sepsis.
b. Lochia- uterine discharge consisting of
blood, decidua, WBC, mucus and some
bacteria.
Pattern:
* Rubra – first 3 days postpartum; red and
moderate in amount.
* Serosa – next 4-9 days; pink or brownish
and decreased in amount
* Alba – from 10th day up to 3-6 weeks
postpartum; colorless and minimal in
amount.
Characteristics
* Pattern should not reverse; rubra, serosa
and alba in sequence.
* It should approximate menstrual flow
(However, lochia increases with activity and
decreases with breastfeeding)
* It should not have offensive odor. It
has the same fleshy odor as menstrual
blood. Otherwise, it means either poor
hygiene or infection.
** It should not contain large clots;
otherwise, it could mean puerperal
sepsis.
** It should never be absent, regardless
of the method of delivery. Lochia has
the same pattern and amount, whether
CS or vaginal delivery.
c. Afterpains/afterbirth pains – strong
uterine contractions felt by the newly-
delivered woman as the uterus goes
back to its usual size and shape.
• Felt only by multis, those who
delivered twins or large babies or who
had polyhydramnios or are
breastfeeding their babies.
Management of Afterpains
* Never apply heat on the abdomen of
newly-delivered mothers because heat
causes vasodilatation and will not only
cause bleeding due to uterine atony but
will also retard involution. An ice cap is
advisable instead.
* Give analgesics, as ordered.
* Explain that it is normal and
rarely lasts for more than 3 days.
d. To encourage the return of the
uterus to its usual anteflexed
position, advise mother to assume
prone position more often and do
knee-chest exercises when
perineum has healed.
e. Pain in perineal region may be relieved by:
* Sim’s position – minimizes strain on the
suture line
* Perineal heat lamp or warm Sitz bath twice
a day – vasodilatation due to heat increases
blood supply and, therefore, promotes
healing.
* Application of topical analgesics or
administration of mild oral analgesics.
f. Sexual activity – maybe resumed by the
third or fourth week postpartum if bleeding
has stopped and episiorrhapy has healed.
•Decreased physiologic reactions to
sexual stimulation are expected for the
first 3 months postpartum because of
hormonal changes and emotional factors.
g. Menstruation – if not breastfeeding,
return of menstrual flow is expected
within 6-8 weeks after delivery. If
breastfeeding, menstrual return is
expected in 3-4 months; in some women,
no menstruation occurs during the entire
lactation period
Important: Amenorrhea during lactation is
no guarantee that the woman will not
become pregnant. She may be ovulating; the
absence of menstruation may be her body’s
way of conserving fluids for lactation.
Implication: She should be protected against
a subsequent pregnancy by observing a
method of contraception, except the pill.)
h. Postpartum check-up – should be done
after the sixth week postpartum to assess
involution.
3. Urinary changes
a. There is marked diuresis within 12
hours postpartum to eliminate excess
tissue fluid accumulation during
pregnancy.
b. Should void within 6-8 hours after
delivery especially if IV fluids were given.
c. Some newly-delivered mothers may
complain of frequent urination in small
amounts: this is due to urinary retention
with overflow.
Other woman, however, may have difficulty
voiding because of decreased abdominal
pressure or trauma to the bladder. In this
case, voiding may be initiated by pouring
warm and cold water alternately over the
vulva, or encouraging the patient to go to
the comfort room and let her listen to the
sound of running water.
If these measures fail, catheterization, done
gently and aseptically, is the last resort on
doctor’s order.
4. Gastrointestinal changes – delayed bowel
evacuation postpartally may be due to:
a. Decreased muscle tone
b. Lack of food (NPO, in fact) + enema
during labor
c. Dehydrating effects of labor
d. Fear of pain from perineal tenderness
due to episiotomy, lacerations or
hemorrhoids.
e. Normal bowel elimination usually returns
2 to 3 days PP
5. Vital signs
Vital signs are typically monitored every
15 minutes during the first hour after
childbirth, then every 30 minutes
during the second hour, once during the
third hour, and then every 8 hours until
discharge or until they are stable.

a. Temperature may increase because of

the dehydrating effects of labor.
Implication: Any increase in body
temperature during the first 24
hours postpartum is not necessarily a
sign of postpartum infection.
b. Bradycardia is common for 6-8
days postpartum.
c. There is no change in the
respiratory rate.
d. Orthostatic hypotension during
the first 48 hours is expected
6. Weight
• There is an immediate weight loss
of 10-12 pounds representing the
weights of the fetus, placenta,
amniotic fluid and blood.
• Further weight loss will occur
during the next days due to
diaphoresis.
Psychological Changes on the Mother
Reva Rubin, a researcher who examined
maternal adaptation to childbirth in the
1960s, identified three phases that can help
the nurse understand maternal behavior after
delivery.

Reva Rubin’s Three Stages of the Postpartum

1. Taking in
2. Taking hold
3. Letting go (taking over)
1. Taking-in phase – Passive-dependent
stage that usually occurs during the first
1-2 days postpartum
• Mother is passive and relies on others to
care for her and her newborn.
• Keeps on verbalizing her feelings
regarding the recent delivery
• Focused on self (not infant)
• Vulnerable physically and emotionally
(dependent on others for help in care)
2. Taking-hold phase – Transition Phase
• Dependent-independent stage that extends
from 3rd to 10th day postpartum
• Mother begins to initiate action and makes
decision.
• Maybe insecure but want to be independent
• Needs praise and encouragement
• Believed to be the best time to talk about
family planning and other teachings.
• This may also be the time for postpartum
blues (an overwhelming feeling of sadness
that cannot be accounted for)
3. Letting-go Phase- 10th day up to 6th
week when the mother achieves
independent, realistic role transition.
• Interdependent stage in which the mother
redefines her new role
• Learns to accept baby as a separate
person and establishes new norms for self.
• Giving up previous role
• See self as separate from infant
• Give up fantasy delivery and baby
• Depression and grief work
Postpartum Blues- a transient disorder
that occurs within 2-3 days after
delivery, peaking on the fifth day and
usually resolves within 10-14 days.
• It is characterized by mild mood swings
that begins to develop when the patient
arrives home.
• Tends to be worse in primis.
• Cause- believed to be caused by the
sudden hormonal changes that occur
after delivery.
Signs and Symptoms
1. Feeling tired and overwhelmed, irritable
2. Overly sensitive
3. Sadness
4. Bouts of crying
5. Anxiety
6. Poor concentration and insomnia

Management
1. PPB is self limiting and has the effect on the
ability to carry out normal functions.
2. Medication is not required
3. Provide supportive care
a. inform that it is normal
b. encourage to discuss her feelings
c. recommend to seek assistance in baby
care and other household activities to
ease the feelings of being overwhelmed
and avoid excessive fatigue.
C. Health education
1. Bowel eliminations
Constipation may be due to;
• Relaxing hormones of pregnancy
• Lack of activity/immobility
• Lack of food intake; dehydration
a. encourage early ambulation
b. increase fluid and roughage intake; encourage
intake of fresh fruits
c. promote regular bowel habits; administer
Dulcolax suppository, as ordered if bowel do
not move before the third morning after delivery
2. Episiotomy care
a. Cold or ice pack- it provides
vasoconstriction effect thereby reducing
edema and discomfort and provides
an anesthetic effect thus minimizing
pain.
b. Dry-heat with peri-lamp- it can be
done for 20 minutes with the lamp
positioned 20 inches away from the
perineum for 3 times a day as ordered.
At home, a 40-watt bulb can be an
effective heat lamp.
c. Provide moist heat with a sitz bath
twice a day or more. The temperature of
the water is maintained at 38 ˚C to 42 ˚C

d. Anesthetic sprays, ointments and

analgesics for relief of pain.
e. Evaluate episiotomy or perineal
laceration for REEDA
Redness
Edema
Ecchymosis
Drainage
Approximation
3. Perineal care
a. Perineal hygiene -the principles in perineal
cleansing should be the same, whether it is
performed by the care giver or the client.
• Remove and apply sanitary pad from front to back.
• Stroke from front to back using one cotton ball each
stroke.
• Observe frequent changing of sanitary pads.
• No “pour-off” technique if the patient has vaginal
packing: use moist cotton balls or towelettes.
• Provide antiseptic, analgesic perineal as ordered.
b. Application of dry heat: perilamp
c. Application of wet heat: sitz bath
d. Diet
4. Nutrition
a. The daily caloric requirement of the
postpartum mother is 2,500- 2,700 kcal
per day for most women. Another 500
calories should be added if she is
breastfeeding.
b. For puerpera, protein is not only for
healing of perineal wounds, but also for the
support of breastfeeding. A 20 g/day
increase in protein over non-pregnant
needs is recommended. A total of
64-66 g/day.
c. Vitamins, especially vitamin C, for various
reasons:
1. Collagen formation and adequate wound
healing
2. Protection against infection
3. Iron absorption
d. Iron to replace loses
• The RDA for nonpregnant women is 18 mg/day
• The RDA is higher in pregnancy and lactation
(30-60 mg/day)
• The postpartum mother may continue to take
prescribed iron to replace blood lost during
delivery and to prevent anemia.
5. Breast care and breastfeeding
RA 7600- Rooming-in and Breastfeeding Act
of 1992- infants born in the hospitals be
roomed-in to promote breastfeeding and
ensure safe and adequate nutrition.
R.A. 10028- The Expanded Breastfeeding Act
of 2009
E.O. 51- The Milk Code of the Philippines
Breastfeeding- is the feeding of an infant or
young child with breast milk directly from
female human breasts not from a baby bottle
or other container.
The Three E’s of Breastfeeding
1. Exclusive breastfeeding- means that
the baby should receive only breast milk
for the first 6 months of life. Breast milk
already contains almost everything the
baby needs.
2. Early start -breastfeeding should be
started immediately after delivery. This is
a good time for the baby to learn to suck.
3. Extended breastfeeding-
breastfeeding can continue for as
long as the mother feels comfortable
doing it. However, the baby will need
other foods in addition to breast milk
upon reaching the age of 6 months.
Colostrum - the yellowish or clear in
color. It is the breast milk that
women produce in the first few days
after delivery.
- contains antibodies and more white blood
cells than white milk. It protects the body
from infection.
- besides colostrum, milk also contains an
element which helps make special bacteria
grow in the baby’s intestines. These
bacteria prevent diarrhea.
- Baby’s “first vaccine” (high in IgA
antibodies)
- Nutrient dense → only small amounts
needed
- Transitional milk days 3 - 6
- Mature milk day 6 onwards
Advantages to Breast Feeding
- Promotes bonding between mother &
baby.
- High nutritional value for infant.
- Promotes uterine involution thru
release of oxytocin from posterior
pituitary.
- Reduces cost of feeding & preparation
time.
Physiology of Lactation
- Body prepares for lactation during
pregnancy; stores fat & nutrients; provide
energy, vitamins, minerals in breast milk.
- Early pregnancy, ↑ estrogen (placenta)
stimulates growth of milk glands & size
of breasts.
- Colostrum at middle of pregnancy &
day 1-3 PP,
- Thin, watery pre-lactation secretion.
- Rich in antibodies; passes to baby in
1-3 days.
- Breasts begin to get tender; fill up with
milk.
Breast milk by 3rd to 4th day is in response to:
- Falling levels of estrogen & progesterone >
delivery of placenta.
- ↑ production of prolactin by anterior pituitary
- Milk ducts become distended & fluid turns
bluish-white
- Infant suckling on breast produces more
prolactin, which in turn stimulates more milk
production.
- Finally, oxytocin released after delivery of
placenta causing mammary glands to send milk
to nipples (let down reflex).
Progesterone levels drop after delivery which
leads to ↑ milk production.
Pathway of Droplet of Milk
Milk → mammary ducts → reservoirs behind
nipples (lactiferous sinuses)→ infant’s mouth
Foremilk - constantly accumulating.
“Let-down reflex” –lets foremilk be available
right away. Triggered by sound of baby crying
Hind milk - forms after let-down reflex. Has
most calories; Feed until breast empty.
Breast Milk - Provides complete nutrition for
1st 6 mos of life.
After 6 months, iron-fortified cereal.
Breast milk easier to digest than formula.
Iron in breast milk absorbed better than iron
in formula.
Care of the Breast
Before breastfeeding the baby, the
mother should clean her breast with
a wet piece of cloth or cotton. She
should not use soap or alcohol on
her breast as this can cause
irritation.
In case the mother takes a bath daily,
there is no need to clean her breast
before every breastfeeding.
6. Return visit- 4-6 weeks after delivery
7. Family planning counseling
Modern methods of family planning refers to
safe, effective, non-abortifacient and legal
methods, whether natural or artificial, that are
registered with the FDA, to plan pregnancy.
Natural family planning refers to a variety of
methods used to plan or prevent pregnancy
based on identifying the woman’s fertile days.
These are methods that do not involve
chemical or foreign material being introduced
into the body.
Fertility Awareness-Based Methods-
are FP methods that focus on the
awareness of the beginning and end of the
fertile time of a woman’s menstrual cycle.
A variety of methods that can be used to
help a woman tell which days she is most
likely to get pregnant and involves
observing and writing down natural signs
of fertility.

All FAB methods are above 95% effective

a. Fertility Awareness-Based Method
1. Cervical mucus/Billings ovulation
method
2. Standard days
method
3. Basal body
temperature
4. Sympto-thermal method
5. Lactational amenorrhea method
1. Cervical Mucus (Billings) Method-
before ovulation each month, the
cervical mucus is thick and does not
stretch when pulled between the thumb
and finger.Just before ovulation, cervical
mucus increases. With ovulation,
cervical mucus becomes copious, thin,
watery, and transparent. It feels slippery
and stretches at least one inch before the
strand breaks. (Spinnbarkeit)
All these days the mucus is copious
and the 3 days after the peak day are
considered to be fertile days.
Standard Days Method (SDM)- is
based on the calculated fertile and
infertile period for menstrual cycle
lengths that are 26-32 days. If qualified,
they should abstain from sexual
intercourse on days 8-19 to avoid
pregnancy.
Coupled of this method is the use of the
“Cycle Beads” to mark the fertile and
infertile days of cycle.
Basal Body Temperature Method- the basis
of the BBT method is that just before the day
of ovulation, a woman’s BBT falls about half
a degree. At the time of ovulation, her BBT
rises a full degree. The higher level is then
maintained for the rest of her menstrual cycle.
The woman takes her temperature each
morning immediately after waking, before
she undertakes any activity. This is her BBT.
As soon as she notices a slight dip in
temperature followed by an increase, she
knows she has ovulated.
She refrains from having sex for the next 3
days. (the life of the discharged ovum) Works
well if combined with the calendar method.
Infertile days- from the 4th day of high
temperature reading up to last day of cycle.
Fertile days- start of the menstrual cycle up
to the third high temperature reading.
Symptothermal Method- combines the
Cervical Mucus and the BBT methods.
The woman takes her temperature daily,
watching for the rise in temperature that
marks ovulation. She also analyzes her
cervical mucus daily. The couple must
abstain 3 days after the rise in
temperature or the 4th day after the peak
of mucus change because these are the
woman’s fertile days.
This method is more effective than
BBT or Cervical Mucus Method
alone.
Lactational Amenorrhea Method
(LAM) - is the method that takes
advantage of the normal physiologic
response of the woman’s body to a
suckling infant, which is to inhibit
ovulation.
•Makes use of “full or almost full”
breastfeeding immediately after giving
birth until 6 months after delivery
provided the mother has no menses yet.
LAM is dependent on 3 requirements
that include;

1. Within 6 months from delivery

2. Mother is amenorrheic
3. Infant is fully or almost fully
breastfed.
Calendar (Rhythm) Method- requires a
couple to abstain from coitus on the days
of a menstrual cycle when the woman is
most likely to conceive (3 days before to 3
or 4 days after ovulation).
A woman should keep a diary of six menstrual
cycle. To calculate “safe” days, she subtracts
18 from the shortest cycle documented. This
number represents her first fertile day. She
subtracts 11 from her longest cycle. This is her
last fertile day. To avoid pregnancy, she should
avoid coitus during these days.
Abstinence- the most effective way to
protect against conception .
0 % failure rate
Most effective way to prevent STDs
Adolescents may find it difficult to
comply with
In moments of passion, responsible
people may fail to consider this as an
option.
Ovulation Awareness Kit- is the use of an
over the counter ovulation detection kit. The
kits detect the midcycle surge of luteinizing
hormone that can be detected in urine 12 to
24 hours before ovulation. Such kits are
about 98% to 100% accurate in predicting
ovulation. Expensive.

Coitus Interruptus- is one of the oldest

known methods of contraception. The
couple proceeds with coitus until the
moment of ejaculation.
The man withdraws and spermatozoa are
emitted outside the vagina. Ejaculation may
occur before withdrawal is complete and,
despite care used, spermatozoa may be
deposited in the vagina.
(sperm might be
present in the
pre-ejaculation
fluid)
Needs control and Kl
experience to work.
Advantages of NFP
1. No chemical agents nor objects
placed in the body
2. No invasive procedures like
injections or surgery
3. No side effects
4. High method effectiveness either
for spacing or achieving a pregnancy
4. Ensure safe motherhood
5. Provides value-based marital
bonding
6. Does not transgress any religion,
cultural considerations of
practitioners.

Disadvantages
1. Periodic abstinence
2. Requires daily charting/recording
Hormonal Method
Hormonal Contraceptive Methods-the
three hormonal contraceptive methods
included in the PFPP are the oral
contraceptives (combined and progestin
only) and the progestin only injectable.

Mechanism of action
1. Prevents ovulation
2. Causes thickening of the cervical
mucus
Oral Contraception commonly known
as the pill or COCs (combined oral
contraceptives)- are composed of
varying amounts of synthetic estrogen
combined with a small amount of
synthetic progesterone.
They are 99.7 % effective in preventing
conception.
Typically used, 92%. Typical failure
rate is 8%
Low dose combined estrogen-
progestin pills- are one of the
most popular reversible
contraceptive combination
developed to date. It contain
hormones similar to the woman
natural hormones; estrogen and
progesterone. They are taken daily
to prevent contraception.
Types of pill packets
1. 28 pills packet- with 21 active pills
containing hormones and seven inactive
pills.

2. 21 pills packet- contain 21 active

hormone containing
tablets.
Types of pills
1. Monophasic pills- provide the same
amount of estrogen and progesterone in
every hormonal pill.
2. Biphasic pills- have the first 10 pills with
one dosage and the next 11 pills having
another level of estrogen and progestin.
3. Triphasic pills- have the first seven pills
or so with one dosage, the next seven have
another dosage and the last seven pills with
yet another dosage.
Side effects
Spotting, amenorrhea, nausea, breast
tenderness, headache
Warning signs (JACHES)
1. Jaundice
2. Abdominal pain (severe)
3. Chest pain
4. Headache (severe)
5. Eye problems such as seeing flashes of
light
6. Severe leg pain
Progestin-only pills-contain small
amount of progestin-only. They are
highly recommended oral
contraceptives for breastfeeding
women because it does not interfere
with milk production.
• Very effective for BF women
• 99% for typical use
• 99.5% for perfect use
• 28 tablet package
Progestin-only injectable
contraceptives- are also progestin only
preparation given intramuscularly.

POIs available in the Philippines

1. Depot Medroxyprogesterone Acetate
(DMPA)- every 3 mos.
2. Norethisterone enanthate (NET-EN)-
every 2 mos.
Mechanism of action
1. Prevents ovulation
2. Thickens the cervical mucus

Effectiveness if perfectly used is 99.7%

Possible side effects

1. Amenorrhea
2. Menstrual irregularities such as
spotting and breakthrough bleeding
Barrier
Male Condom- is one of the barrier
methods of contraception. Barrier
methods include the male condoms,
female condoms, diaphragm, cervical
caps, and spermicides that mechanically
or chemically prevent fertilization.

The male condom is the only barrier

method included in the PFPP.
Condom is effective in preventing
transmission of HIV and other STIs.
Condom is a sheath made of thin, latex
rubber designed to fit over a man’s erect
penis.
Mechanism of action
1. Prevents entry of sperm in the vagina
2. Sperm and disease causing organism
including HIV do not pass into the intact
latex rubber
3. Some condom have spermicidal effect
Effectiveness is 98% if consistently and
effectively used

Causes of condom failure

1. Inconsistent use
2. Incorrect use
3. Having intercourse first, then stop to
put condom before ejaculation
4. Failure to hold the rim when
withdrawing
Long Acting Methods-IUD and
Implants are long acting and temporary.
Implant (Norplant)- a thin single rod,
releases progestin that inhibits ovulation
and thickens cervical mucous to prevent
sperm penetration.
It is effective for 5 years but seldom
advocated for use because it is usually
expensive.
Side effects: irregular menstrual periods,
and amenorrhea.
Implants are placed in the body filled
with hormone that prevents pregnancy
Physically inserted in simple 15 minute
outpatient procedure. A plastic
capsules the size of paper matchsticks
inserted under the skin in the arm
99.95% effectiveness rate
Intrauterine Device (IUD)- is one of the
FP method provided by the PFPP. It is one
of the most effective child spacing methods
available to woman in the country.

Types of IUD
1. Copper bearing which include TCu380A
with safe load and TCu200, the multiload,
MLCu250 and Cu375, and the Nova T
2.Medicated with a steroid hormone such as
Mirena@, the levonorgestrel-releasing
intrauterine system (LNG-IUS)
The TCu380A or Copper T
1. Widely used
2. Effective for at least 12 years
3.Known for its effectiveness, ease of
insertion and removal

Mechanism of action
1. Prevents fertilization
2. Copper decrease sperm motility
and alter the uterine and tubal fluid
environment
Health benefits- Non-hormonal IUDs
such as copper T protect against
endometrial and cervical cancer.

Potential health risk

1. Uterine perforation
2. Expulsions
3. Infection
Possible side effects
1. Menstrual changes
2. Changes in bleeding patterns such as
spotting/light bleeding between periods
3. Discomfort or cramping/pain during
insertion

Warning signs
1. Missed period and has signs of
pregnancy
2. IUD may be out of place
3. Symptoms of infections such as pain in
lower abdomen, pain during sexual
intercourse, unusual vaginal discharge,
fever, chills, nausea and/or vomiting.

PAINS
1. Period late
2. Abdominal pain
3. Infection
4. Not feeling well
5. Strings missing or longer
Permanent
Vasectomy- is known as the male
sterilization as it provides
permanent contraception for men
who decide they will not want any
more children.
The procedure involves tying and
cutting a segment of the two vas,
which carries sperm.
No scalpel vasectomy-is a small
puncture on the scrotum to get the
vas. This is the DOH approved
procedure for vasectomy.
Bilateral tubal ligation (BTL)-is known
as female sterilization as it provides
permanent contraception for women who
do not want any more children.
It is a safe and simple
surgical procedure
to tie and cut the two
fallopian tubes located
on both sides of the
uterus.
Effectiveness- 99.5%
END