Birth Control

Although most women are not thinking about contraception directly after giving birth, it is still a topic that must be given consideration. You are able to get pregnant again within a short period after the delivery. Below you will find more information about contraception provided by Verloskundigen Vida.

When can you start contraception after giving birth?

For a woman giving formula milk, the first menstruation occurs an average of 6 weeks after the delivery. The woman ovulates two weeks prior to the first menstruation, at which point she is already fertile. For a woman exclusively breastfeeding, the chance of pregnancy is small (2%). As soon as the women decreases the frequency of breastfeeding, pumps milk, gives formula milk or supplemental milk, the chance of pregnancy increases. Once menstruation returns you are fertile again, even if you are still breastfeeding. Regardless of when you resume sexual intercourse we advise you to start thinking about contraception after giving birth.

Which contraception method do you choose?

Your choice of contraception method is dependent on your own preference and situation. This may be different after your pregnancy than it was before. For more information on which contraception method is right for you, refer to https://www.seksualiteit.nl and http://www.keuzehulpanticonceptie.nl. Verloskundigen Vida provides prescriptions for all types of contraception methods. In addition, we also perform insertions of intrauterine devices (IUDs) and implants during our contraception consultation hours. Below you will find a description of the various types of contraception methods.

More information?

Costs can be found here.
You can find information about IUD here
You can find information about implanon here pagina vinden

If you would like more information about the different types of contraception you can refer to the links below or contact one of the midwives.

• https://www.seksualiteit.nl/veilig-vrijen/anticonceptie-na-bevalling
• www.keuzehulpanticonceptie.nl
• www.spiraalplaatsen.nl
• www.anticonceptie.nl
• www.thuisarts.nl/anticonceptie
• www.sense.info
• www.ggd.amsterdam.nl/infectieziekten/soa-hiv-sense/

STD-test

If there is a possibility that you have contracted a sexually transmitted disease (STD) or if you have abnormal discharge (different color/odor), we will advise you to take an STD-test. We can perform the STD-test for you prior to the insertion of the IUD. You are also able to do a self-test at home. The materials needed for the test are available at our practice in Reigersbos. Unlike many “home-tests” that are available, the tests we offer are reliable.

The results of the test take 5 business days. The results are sent to the midwifery practice and we will then call you if there is an abnormal result. The costs of this are between 35-40 euros and depending on your insurance may or may not be covered. You will receive an invoice from the laboratory. All women younger than 25 years old can receive free STD-testing from the GGD. You can make an appointment for this via the GGD website (http://www.ggd.amsterdam.nl/infectieziekten/soa-hiv-sense). If you are older than 25 years old you can do a self-test at home.

More Information:

http://www.ggd.amsterdam.nl/infectieziekten/soa-hiv-sense/

Contraception

An IUD is a flexible, plastic device (2 to 3,5 cm long) that is placed inside of your uterus by a midwife or doctor to prevent pregnancy.

There are two strings attached to the IUD that will hang through your cervix. These strings are necessary in order to later remove the IUD. There are two types of IUDs: the hormone-free copper IUD, in which copper is wrapped around the plastic device, and the hormonal IUD, in which hormones (levonogestrel) is added into the device.

When can an IUD be inserted?

An IUD can be inserted 10 to 12 weeks after giving birth. After a c-section an IUD can be inserted after 12 weeks. If you have never given birth, the IUD is ideally inserted within 7 days of the first day of your menstrual period. It is then immediately effective at preventing pregnancy. If the IUD is inserted at another point during your menstrual cycle, then you must use an additional method of contraception (condoms) for the first 7 days after insertion.

What is the insertion procedure like?

The insertion of an IUD takes place in our main location in Reigersbos. We start the consultation by explaining the insertion procedure (for more information you can visit https://spiraalplaatsen.nl). The insertion can be a sensitive procedure. We therefore advise that you take 2 paracetamol (1000mg) or 1 ibuprofen (400mg) 1 hour prior to your appointment. If you are breastfeeding, please take paracetamol (1000mg). For the insertion procedure it is best if your bladder is not completely empty. Prior to the appointment you must pick up the IUD yourself at the pharmacy and bring it with you to the appointment. You may feel some aching in your lower abdomen after the insertion. This is usually for a short period. You may also experience irregular blood loss for the first few months.

Hormonal IUD: Mirena or Kyleena

Both IUDs contain one hormone: levonogestrel, a type of progestin. Small amounts of this hormone are continuously released in the uterus. The lining of the uterus does not sufficiently build up and becomes unsuitable for pregnancy, and the cervical mucus becomes tougher making the passage of sperm difficult. Sperm cells that are able to enter the cervix and uterus become inactive and have very little mobility. This decreases the chances of fertilization. For some women ovulation is suppressed. If no egg is released, fertilization cannot take place. If fertilization does occur, the fertilized egg is unable to implant due to the unsuitable uterine lining.

Advantages

• Very effective contraception 99%;
• 5 years of protection against pregnancy;
• Gradual and continuous release of hormones, without daily peaks or dips;
• Can be used while breastfeeding;
• Fertility returns quickly after removal;
• Majority of women (75%) maintain their natural cycle;

Disadvantages

• There may be changes to menstruation;
• You are unable to regulate your menstrual period;
• There is a chance of intermittent blood loss;

Copper IUD: T-safe or Etherena

T safe

The T-safe is a T-shaped copper intrauterine device (IUD). This is a hormone-free contraception method. The T-safe works in the same way as other copper IUDs. The copper ions demobilize the sperm, preventing fertilization of the egg.

The lining of the uterus also changes when using the T-safe IUD so that any potentially fertilized egg can not implant in the uterine wall.

Duration: The T-safe can be used for up to 10 years. The T-safe is immediately effective after insertion.

Costs: The T-safe costs € 70.96

There are both advantages and disadvantages, Just as with any other copper IUD.

The T-safe offers immediate protection after insertion. In this way it can also be used as a “morning after” IUD (emergency contraception) if it is inserted within 5 days after unprotected sex.

After removing the T-safe you are immediately fertile again.

Advantages

• Very effective contraception 99%;
• 5 years of protection against pregnancy, T-safe is effective for up to 10 years
• Does not contain hormones;
• Can be used while breastfeeding;
• Fertility returns quickly after removal;
• Majority of women (75%) maintain their natural cycle;

Disadvantages

• There may be increased and/or irregular blood loss and abdominal cramps during the first 3 months after insertion;
• There is a chance of longer-lasting increased blood loss during menstruation. Around 15% of women experience more blood loss than prior;
• You cannot schedule or skip your menstruation;

Implanon

The Implanon, also known as the hormonal implant, is approximately the size of a matchstick. It is 40mm long and has a diameter of 2mm. The Implanon is inserted in the upper arm, just below the skin, and is effective for three years.

Implanon contains one hormone called progestin. The implant prevents pregnancy by suppressing ovulation and thickening the cervical mucus, which limits the passage of sperm. Progestin also causes changes to the lining of the uterus that make it an unfavorable environment for a pregnancy.
During the first three months after insertion of the Implanon there may be irregular blood loss, usually in small amounts, also called spotting. After three to six months this will subside and there may occasionally be very light bleeding or the menstrual periods may stop altogether; this is not harmful.

When can an Implanon be inserted?

If you are breastfeeding, the implant can be inserted 3 to 4 weeks after giving birth. If you are not breastfeeding then the implant can be inserted directly after delivery. The exact timing of insertion is decided together with your midwife/primary care doctor/gynecologist.

What is the insertion procedure like?

The Implanon is inserted in the upper arm, just below the skin, which is numbed with an anesthetic prior to insertion. The insertion of the implant will therefore not be felt. In the days following insertion there may be some bruising or swelling by the insertion site.

If the Implanon is inserted during menstruation then it is immediately effective. If the Implanon is not inserted during menstruation then you must use an additional method of contraception for the first seven days after insertion.

Advantages

• You only need to think about contraception one time in three years.
• The implant is very effective.
• The implant contains relatively few hormones.
• Menstrual periods almost always decrease in terms of blood loss, duration, frequency and pain.
• It can be used while breastfeeding.
• After removing the implant, fertility returns after 1-2 weeks.

Disadvantages

• The insertion and removal of the Implanon must be done by a doctor or midwife.
• There may be unpredictable and irregular blood loss, called spotting.
• Headaches may occur during the first weeks after insertion of the implant; these resolve on their own.

Costs

Costs of Contraception Methods

If you are younger than 21 years old, the costs of contraception are covered by insurance, including the insertion and/or removal procedures. Contraception for women over 21 years old is not covered by insurance in the basic package (“basisverzekering”). If you have supplemental insurance then costs of contraception may be covered. Please note, the costs may have to be paid from your own risk and you will still receive an invoice from your health insurance for this. Contact your insurance provider for more information on what you may need to pay out-of-pocket. If you are not insured you must pay for contraception yourself.

Purchase of both the spirals and the Implanon goes through us, we place the order for the spiral or Implanon that you have chosen via Anticonceptionportaal.nl. You will only receive a payment request via iDeal by email, which you must pay within 3 days, so that we receive the spiral on time at our practice.

Costs of insertion–removal and follow-up

The insertion and removal procedure of an IUD and/or Implanon is covered by insurance in the basic package. If you are not insured, you will need to pay the cost of the procedure yourself. You can pay for the costs of insertion and removal of contraception during your appointment (pin card payment only). The follow-up ultrasound of the IUD must also be paid yourself (pin card only). You can submit the invoice to your insurance provider. Depending on your insurance the invoice may be reimbursed.