The Pros and Cons of Having an IUD Inserted Straight After Delivery

People choose IUDs because they are highly effective (99 percent), easy to use (you don’t have to remember to do anything), and last for a long time (up to 12 years with the copper IUD). Once a healthcare provider removes your IUD in a quick and easy office visit, your fertility quickly returns. That means you might not have to wait as long for ovulation post-IUD as with the Depo-Provera shot. These reasons make IUDs a popular choice for people in the midst of family-building. So popular that some people want an IUD inserted immediately after their delivery. Learn more about what the research says about the pros and cons of post-delivery IUD insertion.

All IUDs are T-shaped, slightly bigger than a quarter, and made of polyethylene plastic. In addition, IUDs come with a plastic string makes it easier to remove the IUD and for you to check to make sure it is in place each month. There are two types of IUDs available: hormonal and copper.

The first type of IUD has hormones implanted in the plastic. The hormone (called progestin) is a synthetic (chemical) version of your body’s natural hormone called progesterone. Progestins, slowly released at low levels from your IUD over time, help prevent pregnancy by keeping sperm cells away from your eggs. They thicken your cervix’s mucus, blocking the sperm’s passage into your uterus (womb). Progestins also thin the lining of your uterus so that it is less likely that pregnancy can happen. In addition, hormonal IUDs prevent some (but not all) women’s ovaries from releasing an egg (ovulation). IUDs that contain hormones may cause intermittent bleeding and spotting for the first year after insertion.

Non-hormonal IUDs contain copper, which is toxic to sperm. The copper IUD (Paragard) lasts for up to 12 years. Copper IUDs can cause heavier periods and increased cramping, although these side effects usually decrease the longer you have the IUD in place.

For people who have just given birth, IUDs expand options for contraception while breastfeeding. Progestins and copper do not impact breastmilk supply or the ability to breastfeed like other estrogen-containing contraceptives like birth control pills, the shot, the ring, or the patch.

Only exclusive breastfeeding (not supplementing your baby with any formula or food) will keep your ovaries from releasing an egg. Many people accidentally get pregnant while still breastfeeding for this reason.

If you are not breastfeeding, you can ovulate before ever having your first postpartum period. And surprise, as soon as you ovulate, you can conceive. That is why many new moms are relieved to find a highly effective birth control method that is easy to use, requires no advance preparation, and does not disrupt their milk supply.

Many people choose IUDs for their non-contraceptive benefits as well. Beyond doing a great job at preventing unplanned pregnancies, IUDs can help relieve the symptoms of common health conditions such as endometriosis, painful periods, heavy periods, and polycystic ovarian syndrome (PCOS).

You can have your IUD placed anytime within the first 48 hours of giving birth, whether vaginal or C-section. Scientists, healthcare providers, and healthcare advisory boards all agree that immediate IUD placement postpartum is a safe, convenient, and effective contraceptive choice. The Centers for Disease Control and Prevention (CDC), the American College of Obstetricians and Gynecologists (ACOG), the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the Centers for Medicare and Medicaid Services, World Health Organization (WHO), and the National Health Service (NHS) all encourage providers to make immediate postpartum IUD placement available to all pregnant people.

The pros of having an IUD inserted immediately after your delivery are numerous. First, you may already have pain medication or an epidural on board so that the insertion procedure can be painless.

Second, you can lower the chances of getting pregnant in the first six weeks after delivery. We know that closely-spaced pregnancies put women and babies at risk. The current recommendation is that people seeking pregnancy should avoid interpregnancy intervals shorter than six months and should be counseled about the risks and benefits of repeat pregnancy sooner than 18 months, according to the American College of OBGYNs (ACOG). Some of the associated complications of a shorter time between pregnancies for babies include preterm birth, low birth weight, and infants being born small for gestational age.

Research shows that women who have IUDs inserted immediately postpartum are more likely to stick with them for longer than those who wait six months or longer after their delivery to have an IUD inserted. Many fewer people return for their six-week postpartum visits than you might expect.  One U.S. study found that in actual practice, only 76 percent of commercially insured women and 62 percent of publicly insured women attended a single postpartum visit.

Thus, immediate postpartum IUD insertion can get people the contraception they desire and reduce their risk of an unplanned pregnancy as conveniently and quickly as possible. A bonus for those who go to the six-week postpartum visit with their IUD already in place is that they have more time with their provider. A twenty-minute appointment is not long enough to rehash the delivery story, screen for postpartum anxiety or depression, check in about breastfeeding, or talk about other pregnancy-related health concerns (urinary incontinence, gestational diabetes, blood pressure, for example).

The biggest con when considering immediate postpartum IUD insertion is that an IUD is more likely to fall out (called IUD expulsion) when inserted right after childbirth. Only 1-2 women out of every 100 will expel their IUD when insertion happens four weeks or longer after their delivery. That number jumps to about 27 women with a hormonal IUD and 14 for the copper IUD who need to have their IUD re-inserted after it is inserted immediately post-delivery. The risk of IUD expulsion after immediate postpartum insertions is lower for people with a cesarean than those with vaginal deliveries. The IUD can come all the way out with expulsion or just a little bit. In either scenario, you can get pregnant because the IUD is not in the right place to prevent pregnancy. If the IUD only comes out part of the way, a nurse or doctor has to remove it.

When the IUD is put in, it could push through the wall of your uterus. IUD perforation, as it is called, sounds painful and severe, but for most, it is not.  To put the risk of perforation in perspective, keep in mind that one large-scale study of more than 60,000 IUD perforations across Europe found no severe clinical consequences for any women due to the perforations. If perforation happens, you may need surgery to remove the IUD. The risk of perforation with immediate postpartum IUD insertion does rise from one out of every 1,000 insertions in non-postpartum people to 5 out of every 1,000 insertions immediately after delivery.

It’s possible to get an infection if bacteria enter your uterus during your IUD insertion. If the infection isn’t treated, it may make it harder for you to get pregnant in the future. Your risk of uterine infection is slightly increased with an IUD in your uterus in the first six weeks after delivery. Most women’s health providers advise against sex before six weeks postpartum whether you have an IUD or not, but know that going against medical advice (AMA) when you’re feeling frisky postpartum is riskier with an IUD.

Another important point to remember is that an experienced GP or nurse can fit an IUD straight after an abortion or miscarriage. You’ll be protected against pregnancy immediately.

As with any method of birth control, it is ultimately your body and your choice to decide what will work best for you. It can be overwhelming to read through all of the pros and cons above, but fortunately, pregnancy is nine months, so you have plenty of time to talk with your provider ahead about whether you want them to insert an IUD immediately postpartum. For women with complicated life circumstances that make a return visit to a healthcare provider for birth control difficult or for those who have successfully used an IUD in the past, immediate postpartum IUD insertion can be convenient, quick, and accessible.

Amy Harris
Amy Harris is a certified nurse-midwife with a Master's Degree in Maternal and Child Health from Harvard Chan School of Public Health. Her passions are health literacy and women's reproductive health. A recent two-year sabbatical with her family in Spain was the impetus for becoming a freelance women's health writer. An exercise nut, she is happiest outdoors and on adventures abroad.

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