Efficacy of a new postpartum transition protocol for avoiding pregnancy

Introduction: the postpartum period is a challenging time for family planning,especially for women who breastfeed. breastfeeding delays the return of menses (lactational amenorrhea),but ovulation often occurs before first menses. for this reason,a protocol was developed to assist women in identifying their return of fertility postpartum to avoid pregnancy. methods: in this prospective,12-month,longitudinal cohort study,198 postpartum women aged 20 to 45 years (mean age,30.2 years) were taught a protocol for avoiding pregnancy with either online or in-person instruction. a hand-held fertility monitor was used to identify the fertile period by testing for urinary changes in estrogen and luteinizing hormone,and the results were tracked on a web site. during lactational amenorrhea,urine testing was done in 20-day intervals. when menses returned,the monitor was reset at the onset of each new menstrual cycle. participants were instructed to avoid intercourse during the identified fertile period. kaplan-meier survival analysis was used to calculate unintentional pregnancy rates through the first 12 months postpartum. results: there were 8 unintended pregnancies per 100 women at 12 months postpartum. with correct use,there were 2 unintended pregnancies per 100 women at 12 months. conclusion: the online postpartum protocol may effectively assist a select group of women in avoiding pregnancy during the transition to regular menstrual cycles.