Intrauterine contraceptive device (IUCD) or ‘coil’ insertion at caesarean section

This leaflet explains more about insertion of an intrauterine contraception device or ‘coil’ at caesarean section including the benefits, risks and alternatives.

If you have any further questions, please speak to a doctor or midwife caring for you.

What is the coil?

The coil is one of the most effective ways of preventing or spacing pregnancies. They are more than 99% effective at preventing pregnancy.

Coils are known as long-acting reversible contraceptives (LARCs) since you do not need to remember to take them every day and they do not affect your fertility. It is possible to have a coil fitted at the time of a caesarean section. It is inserted through the opening in the womb after the placenta (afterbirth) has been removed.

There are two types of coils offered at caesarean section: one that contains a hormone (progestogen), such as the Mirena®, or one that does not contain hormones, the copper coil. The Mirena® coil lasts for five years. The copper coil can last for up to ten years. (The copper coil with typical use has a success rate of 99.2%, the Mirena coil with typical use has a success rate of 99.8% within the first year of use.)

It is important to remember that coils do not protect against sexually transmitted infections. You might need to use a condom as well.

Reasons to have an intrauterine contraception fitted at the time of caesarean section:

• It is a safe procedure
• Provides contraception straight away (it is possible to become pregnant as soon as three weeks after having your baby)
• Painless – you will already have an anaesthetic for the caesarean section
• Quick – it only takes a few minutes
• Convenient – you do need another visit or examination to have a coil inserted at a later date
• Both the Mirena® and copper coils are safe to use while breastfeeding
• Most people can have a coil. Your doctor or midwife will take a medical history to make sure a coil is suitable for you.

What are the risks?

If you have the coil inserted at your caesarean section, the following risks are slightly higher:

• ‘Lost threads’ – threads from your coil should hang out of your cervix into your vagina so that the coil can easily be checked and removed later by a healthcare professional. These may not be visible at your check-up (discussed below), but this does not necessarily mean the coil has fallen out or will affect how effective the coil is as a contraceptive and most coils can be removed easily.
• Expulsion – after any coil fitting, there is a 1 in 20 chance that the coil may fall out of the womb. This is slightly more likely after a caesarean section, especially if this is during labour (because your cervix is more open). Signs/symptoms of an expulsion can include: inability to see or feel the coil threads, increase in vaginal bleeding or seeing the coil come out.

These are the risks of having a coil, whether or not it is inserted at caesarean section:

• Infection – the risk is very low but see your GP if there are any signs of infection (such as lower abdominal pain, abnormal vaginal discharge possibly with a foul odour, pain when urinating, pain during sexual intercourse or fever).
• Perforation or injury to the womb – this is very uncommon (less than 1 in 1000)

• Ectopic pregnancy – coils are very effective. However, if you do become pregnant, there is an increased risk of an ectopic pregnancy. Compared to someone without a coil the overall risk of pregnancy followed by an ectopic pregnancy is much lower; but once pregnant with a coil, the risk of an ectopic pregnancy can be as high as 50%.

If you think you might be pregnant and you have a coil, you should seek immediate medical attention to rule out an ectopic pregnancy.

What happens after a coil is inserted during a caesarean section?

The threads from your coil are not cut when the coil is inserted during the caesarean section. They are trimmed at the follow-up appointment because your womb will now have returned to its normal pre-pregnancy size. If the threads cannot be seen you will have a scan and if it has fallen out, it is now safe to be offered another one.

Are there any alternatives to having a coil?

Other forms of contraception can be provided after you have delivered your baby/babies. Please discuss these with your midwife, doctor (GP or obstetrician) or at your local contraception service.

Asking for your consent

It is important that you are and feel fully involved in decisions about your care. Before a coil is inserted at the time of your caesarean section, you will be asked to sign a consent form to say you agree and that you understand what it involves. You can change your mind at any time, even if you have said ‘yes’ previously.

For more information

Contraception advice is on the Faculty of Sexual Health and Reproductive Healthcare website www.fsrh.org
Advice about contraception, pregnancy and sexual and reproductive health is available from the national sexual health charity FPA www.sexwise.org.uk/contraception/contraceptive-choices-after-youve-had- baby
More information about the hormone and non-hormone containing coils can be found at the NHS website NHS website – Intrauterine device (IUD), Your contraception

Contacts

To discuss the possibility of having a coil at your caesarean section speak to your midwife and/or the doctors in the antenatal clinic during your appointment(s).