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Early postpartum CHC — DFSRH MCQ

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HardContraception in special circumstancesEarly postpartum CHCDFSRH

Ten days after emergency caesarean birth, a breastfeeding woman with BMI 36 and postpartum haemorrhage requiring transfusion requests a COC. She wants highly effective contraception before discharge. What is the best plan?

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Correct answer: A — Avoid CHC and offer an immediately suitable non-oestrogen method

The best answer is “Avoid CHC and offer an immediately suitable non-oestrogen method”. CHC is contraindicated in the first 21 days postpartum, and her caesarean birth, obesity and haemorrhage further increase VTE risk. Breastfeeding does not make oestrogen safe at day 10, and a patch remains CHC. Effective contraception can still be provided promptly using a medically suitable progestogen-only or intrauterine method; aspirin is not a workaround for CHC-related risk.

Reference: CoSRH/FSRH, Contraception After Pregnancy: https://www.cosrh.org/Public/Public/Documents/contraception-after-pregnancy-guideline-january-2017.aspx