Recommendations for Contraceptive Use
		Copper-Bearing Intrauterine Devices (IUDs)

Recommendations	Rationale
a) A client may have an IUD placed at the fundus during a Cesarean section prior to closure of the uterus, unless there are signs of infection.	a) Immediate insertions during Cesarean sections by a properly trained provider have a lower expulsion rate than for vaginal insertions immediately (within 10 minutes) after delivery. Studies also found that women with IUDs inserted at the time of Cesarean section had longer continuation rates. Zhou S, Chi I. Immediate post-partum IUD insertions in a Chinese hospital Ð a two year follow-up. International Journal of Gynecology and Obstetrics 1991;35:157-64. Xu J, Connell C, Chi I. Immediate postplacental insertion of the intrauterine device: a review of Chinese and the world's experiences. Advances in Contraception 1992;10:71-82.
b) If an IUD is not inserted at the time of the Cesarean section, it is recommended that the IUD be inserted no earlier than six weeks after the Cesarean section.	b) Delayed postpartum insertions should take place no earlier than six weeks after Cesarean section because of the risk of uterine perforation. Clients need careful assessment for presence of infection before insertion even at this time. McIntosh N, Kinzie B, Blouse A, editors. IUD guidelines for family planning service programs. 2nd ed. Baltimore: JHPIEGO, 1993.

Any part of Recommendations for Updating Selected Practices in Contraceptive Use may be reproduced or adapted to meet local needs without prior permission from the TG/CWG Secretariat, provided the TG/CWG is acknowledged and the material is made available free of charge or at cost.