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The CDC issues new guidelines for contraceptive use in older postpartum moms

Dominika Osmolska Psy.D.'s picture

The CDC has come out with new guidelines for older moms who had just given birth regarding contraceptive use: skip the pill that contains contraceptive estrogen. The guidelines also apply to women who have had a C-section.

By older, the CDC – and the medical profession in general – means over 34 years of age. By the time a pregnant woman is 35, she is classified as having “advanced maternal age.” Although 35 is culturally accepted as a relatively young age, biologically, many healing factors in our bodies slow down considerably. There are also increased risks for complications associated with any medical condition, or with pregnancy.

Contraceptives containing estrogen have long been associated with a small risk of blood clots and other cardiovascular events, particularly for smokers. Now the CDC recommends eschewing estrogen-containing contraceptives immediately postpartum for older women because it has been found that clotting factors change during pregnancy and for a few weeks after the baby is born. While that change is advantageous in preventing postpartum hemorrhaging, it may prove a liability for older women, in whom the clotting tendency may be even more elevated by virtue of their age.

The guidelines also make sense for women who have had C-sections, which necessitate longer periods of immobility. Immobility after surgical procedures is a known risk factor for blood clots.

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All new moms are advised not to take oral contraceptives for three weeks after delivery. The new guidelines specify that women in the risk categories mentioned not take estrogen-containing contraceptives for at least six weeks after birth.

Blood clots, if they travel to the lungs or the brain can lead to serious complications, including stroke, shortness of breath, or even death, said one of the guideline’s authors Dr. Naomi Tepper, an ob-gyn in the CDC’s division of reproductive health.

Tepper and her colleagues analyzed a host of recent studies to determine whether birth control pills raised the risk of blood clots in new moms.
“The evidence we looked at showed that the risk was really much higher than we previously thought,” Tepper said. “That is what spurred the change in recommendations.”

Women of reproductive age are normally at very low risk for blood clots, but because of pregnancy, those odds go up - about 50 out of 10,000 recently delivered women develop a clot each year.

Health care providers generally advise to wait 4 to 6 weeks after delivery to resume sexual activity, which, in theory, should make the new guidelines a moot point. As the Mayo Clinic suggests: “This allows time for the cervix to close, postpartum bleeding to stop, and any tears or repaired lacerations to heal.” It is admittedly difficult to imagine wanting to engage in sexual activity due to these factors, as well as the overwhelming fatigue involved in the care of a newborn.

Health experts also recommend spacing pregnancies at least one year apart, for the improved outcomes of both mother and baby. Second pregnancies within the year are associated with pre-term labor and low birth weight, for example. Preventing pregnancy six weeks post-partum should not pose a problem, as standard contraceptives can then be safely taken.