Hello everyone. My name is Holly Blanchard, and I am a Senior Technical Adviser for Reproductive Health and Family Planning at MCHIP, a Jhpiego project. And I am here today to show you how to do a postpartum IUD and why it makes so much sense because more and more women are delivering with skilled birth attendants per the WHO recommendation, and so this is an opportunity to reach women when they know they are not pregnant, right after delivery with a very effective method.
Okay, so now we're in the delivery room with a woman. She's just had her baby. She's also received the active management of the third stage of labor or AMTSL, so I know she is not bleeding. She's been counseled beforehand for a postpartum IUD. She has three children at home, and she doesn't want any more for the moment and wants a very effective method. So we're reaching women where they deliver, and we're trying to get them before they get pregnant again to allow at least two years of no pregnancy, and the woman can breastfeed her baby.
When we're doing the trainings, we always use a checklist so providers can see, and we have a list of everything from greeting the woman to the actual insertion. So I'm going to show you the insertion right now.
So I'm just confirmed with the client that she wants to have a postpartum IUD. So I'm going to start the process now. I begin first to make sure I do not see any bleeding lacerations, nothing. And I don't see any profuse bleeding. I'm looking again at the vaginal vault. No profuse bleeding. No lacerations. I'm going to clean her cervix with betadine or povidone-iodine, and get rid of the contaminated cotton balls and now I'm going to lift the anterior lip of the cervix and just one click and now I need to load up my Kelly placental forceps which is slightly longer than a rings forceps but necessary to reach the fundus. So I've used the no touch technique to load up my IUD on the Kelly placental forceps, and you'll see that the T-Bar is right being held by the top of the Kelly placental forceps. We're making sure that I don't touch any of the vaginal walls. Insert the IUD into her cervix, I feel a little bit of resistance, so I need to even out that angle of the postpartum uterus by putting downward, upward pressure towards the mother's face, and it evens out that angle. And I reach all the way to the fundus, and I can feel with my fingertips, the tip of the Kelly placental forceps. I open the forceps, and I dump the IUD, and I very gently pull out the Kelly placental forceps along the lateral wall and no IUD. And with this teaching model, we can check to make sure its high in the fundus, and you can see that it is. So I know that she is doing well. I'm going to get rid of my instruments and put them in decontamination fluid, reassure the client that she does have her IUD in place, and not to worry, and then we're going to give her counseling on how important it is that she takes care of herself, that she watches for infection, very heavy bleeding, but all postpartum women bleed a little bit. That's normal. And that she should come back if she has any problems whatsoever, but she should even come back four to six weeks, six weeks when she brings her baby in for immunization, so we can check and cut her strings. And we need to write this down and document it, and then we're done. Very easy.