INTRAUTERINE DEVICE:

Very widely used. This can be applied on outpatient basis without anaesthesia. Easy to apply it after a delivery or abortion. Most commonly used Intrauterine device is Copper T (CuT) This is ‘T’ shaped with copper incorporated in the transerse limb of the T. This is applied into the uterine cavity. Once applied can be kept for 2-3 years. Usually ‘CuT’ is applied 6-8 weeks after delivery or abortion.

SIDE EFFECTS

– irregular menstruation

– excessive bleeding during the next 2-3 cycle

– abdominal pain

– Discharge per vagina and infection

– ‘CuT’ can get displaced or expelled

95 % carry on without any side effects. While 3 to 5% may have any of the above complication.

MODE OF ACTION

CuT T’ acts as a foreign body in the cavity-endometrium of the uterus. This produces certain changes in the uterine lining (i) It interferes with sperm capcitation and transport up into the uterine cavity (ii) alters the uterine and tubal fluids which impair the ability of the gamete to fertilize (iii) prevents implantation of the fertilized ovum.

Some Christians do not accept this as a mode of contraception.

B – PERMANENT METHOD: VASCETOMY

This an OPD procedure done under local anaesthesia. 2-3 cms of the tube through which the sperm passes out is tied and cut off. This is a very safe procedure. The belief that the man loses his masculinity is Folk story’ and not

true. Many Christian men have come forward to adopt this method. Hurray. They have understood Eph. 5:28.

NOTE:

The couple will have to adopt some other method of contraception for 3 months after vasectomy as it takes ‘3’ months for all sperms in the tube to be drained off.

TUBECTOMY

Compared to vasectomy this is a major procedure as the abdominal cavity is opened into. Except soon after delivery when Iocal anaesthesia is used, all other spinal or general anaesthesia need to be used. Here, 2-3 cms of tube that carries the ovum from the ovary into the uterine cavity is cut and tied off at the cut ends. This prevents the ovum from entering the uterine cavity and thus, preventing fertilization with the sperm. Even though there are many false rumours as to the side effects, this is one of the best methods of permanent contraception after delivery specially if it is an abdominal delivery (Caesarean Section).

PRACTICAL ADVICE:

A. WHEN TO HAVE THE FIRST CHILD:

Newly wed couples need time to adjust with one another. and with the extended family and the new environment, before launching into pregnancy and the added strain with it. Pregnancy can be delayed by 6 – 12 months. The best contraceptive for this is ()) using barrier contraceptives (Nirodh) along with safe period. (ii) oral contraceptive pills for 6 – 12 months (consult a doctor before use)

WARNING

Delaying pregnancy so as to enjoying life for 3-5 years or going in for ‘abortion’ because the. pregnancy is early according to the couples’ calculation has led many couples into marital, obstetrical and gynaecological problems later. Many lived to regret all their life of the infertility and tubal block that happens after sub clinical infection of the tubes. lt is my sincere advise, please do not resort to abortion or delay your first pregnancy too long. I had my baby within the first year of marriage. Inspite of the stress and strain of adjustment and living in a ‘single room’” apartment in an intern’s hostel,l mess food and hectic work as intern, we both learnt to love, accept, help and bear each other’s problems.

SPACING:

A gap of 3- 5 years is absolutely essential. (i) Safe period along with barrier contraception (Nirodh) (ii) Cu ‘T’ in- sertion (iii) OCP. oral contraceptive pills – after consulting a gynaecologist.

AFTER COMPLETING THE FAMILY

Vasectomy or Tubectomy depending on the mode of delivery complications and understanding between the husband and the wife.

If adopting temporary methods,

— Cu ‘T’ changing every 3 years until 1 year after menopause

— Safe period with Nirodh in women with regular cycle.

May need consultation with a gynaecologist around menopause as there may be menstrual irregularities.

Contraception until 1 year after complete cessation of menstruations is essential to prevent conception around menopause.

-Dr. Jessie Lionel