Family Planning

Every couple aspires to have a child/children at some point in their marriage. Having children is a huge responsibility. Each child’s needs can differ, even between siblings. As parents, you are not only responsible for their development and growth, but also how they are raised, educated, and integrated into society. We should ask ourselves these questions before deciding to embark on the journey of parenthood:

1. When do we want to start a family?
2. How soon before the next child?
3. How many children do we wish to have?
4. Are we medically fit or financially stable to provide for the children?

The answers to the above may affect one’s plans for finances, work location, type of accommodation, and even choice of job. Family planning is indeed an important topic to discuss between a husband and wife.

Family planning methods (birth control) or contraception can be short-acting or long-acting. These are available at GPs, polyclinics and hospitals. You should discuss your options with your doctor. Your doctor will further guide you to choose the safest and most effective contraception.

Short-Acting Contraceptives refer to contraception that require close monitoring and which need to be used before engaging in sexual intercourse, or taken daily. Such contraception includes:

1. Natural rhythm – having sexual intercourse out of the ovulation period or “high risk of pregnancy” period
2. Condoms
3. Oral contraceptive pills
4. Patch

Long-Acting Contraceptives refers to contraception that do not need monitoring on a daily basis. Fertility usually resumes once the contraception is ceased.

Options can be:

1. Reversible
   1. Intrauterine Contraceptive Device (IUCD)
   2. Implanon
   3. Depo Provera
2. Intended to be permanent and as a last resort
   1. Ligation/Sterilisation

I. IUCD

Mirena (hormone-related) or Copper (non hormone-related)

• Inserted on Day 2 to 5 of menses, OR when reliably certain that the woman is not pregnant
• Lasts for 5 years

II. Implanon

• Inserted on Day 2 to 5 of menstrual cycle, OR when reliably certain that the woman is not pregnant
• Lasts for 3 years
• Needs a small incision (cut in the skin) for removal, under local anaesthesia
• Can be inserted immediately after delivery

III. Progesterone injections – Depo Provera (3 monthly injections)

First Injection on:

• Day 2 to 5 of menstrual cycle, OR when reliably certain that the woman is not pregnant
• Within the first 5 days post-delivery if not breastfeeding
• If exclusively breastfeeding, ONLY at the sixth week post-delivery

If the time interval between injections is greater than 13 weeks, the doctor will need to determine that the woman is not pregnant before administering the injection.

IV. Laparoscopic ligation/Post-partum sterilisation (PPS)

Done under general or regional anaesthesia (spinal/epidural)

• Laparoscopic – key-hole surgery, usually done at least 6 weeks after delivery
• PPS – a small incision is made below the umbilicus, performed immediately post-delivery or at the same setting during a caesarean section
• Placement of clips on the Fallopian tubes or salpingectomy (surgical removal of Fallopian tubes)
• The doctor will ensure the patient is not pregnant before the procedure is performed
• Hormonal contraception needs to be continued for 7 days after the procedure till the next menses

Reference: KK Women’s and Children’s Hospital