David Turok, MD talks about the role of family planning and speaking to patients about immediate postpartum (IPP) long-acting reversible contraception.
17 Steps for Immediate Postpartum IUD Insertion:
- Cleanse the vulva, vagina and cervix with hibaclens or betadine for disinfection.
- Use sterile gloves reduce infection risk.
- Place a clean drape underneath the buttocks and on the abdomen.
- Insert a speculum, retractor or gloved hand into the vagina and visualize the cervix.
- Prep the cervix and the vagina with a liberal application of an antiseptic solution, allow time for the antiseptic to work.
- Gently grasp the anterior lip of the cervix with ring forceps. (Do not use a toothed tenaculum because it may tear the cervix)
- Grasp the IUD with Kelly placental forceps or with a second pair of standard ring forceps. The IUD should be held by its vertical arm, the horizontal arm of the IUD should be slightly out of the ring in the same direction of the rings and slightly sided. This will facilitate the liberation of the IUD in the fundus, decreasing the risk of pulling it out will removing the forceps.
- Exert gentle traction towards you of the cervix-holding forceps.
- Insert the forceps holding the IUD through the cervix and into the lower uterine cavity. Avoid touching the walls of the vagina with the IUD.
- As the IUD passes through the cervix, release the hand that is holding the cervix-holding forceps and move this hand to the abdomen placing it over the uterine fundus.
- With the abdominal hand, stabilize the uterus with firm downward pressure through the abdominal wall. Prevent the uterus from moving upward in the abdomen as the IUD is inserted.
- Move the IUD-holding forceps IUD in an upward motion toward the fundus (in an angle towards the umbilicus). Remember that the lower uterine segment may be contracted and therefore some slight pressure may be necessary to advance the IUD and achieve fundal placement.
- If the client has delivered vaginally after a previous cesarean delivery, take care to avoid placing the IUD through any defect in the previous incision by maintaining your ring forceps pressured against the posterior uterine wall.
- By feeling the uterus through the relaxed abdominal wall, confirm with the abdominal hand that the tips of the forceps reach the fundus.
- Open the forceps, releasing the IUD.
- Slowly remove the forceps from the uterine cavity, keeping it slightly open, and sweeping the forceps slightly laterally to avoid entanglement with the string.
- Examine the cervix.