title: Efficacy of a new postpartum transition protocol for avoiding pregnancy.
abstract: BACKGROUND
  The postpartum period is a challenging time for family planning, especially for women who breastfeed. Breastfeeding delays the return of menses (lactational amenorrhea), but ovulation often occurs before first menses. For this reason, a protocol was developed to assist women in identifying their return of fertility postpartum to avoid pregnancy.
  
  
  METHODS
  In this prospective, 12-month, longitudinal cohort study, 198 postpartum women aged 20 to 45 years (mean age, 30.2 years) were taught a protocol for avoiding pregnancy with either online or in-person instruction. A hand-held fertility monitor was used to identify the fertile period by testing for urinary changes in estrogen and luteinizing hormone, and the results were tracked on a web site. During lactational amenorrhea, urine testing was done in 20-day intervals. When menses returned, the monitor was reset at the onset of each new menstrual cycle. Participants were instructed to avoid intercourse during the identified fertile period. Kaplan-Meier survival analysis was used to calculate unintentional pregnancy rates through the first 12 months postpartum.
  
  
  RESULTS
  There were 8 unintended pregnancies per 100 women at 12 months postpartum. With correct use, there were 2 unintended pregnancies per 100 women at 12 months.
  
  
  CONCLUSIONS
  The online postpartum protocol may effectively assist a select group of women in avoiding pregnancy during the transition to regular menstrual cycles.
authors.affiliation: Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada. thomasbouchard@gmail.com
authors.forename: Thomas
authors.initials: T
authors.lastname: Bouchard
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Fehring
authors.forename: Mary
authors.initials: M
authors.lastname: Schneider
mesh_terms: D000328:Adult; D000568:Amenorrhea / Q000652:urine*; D001942:Breast Feeding; D002985:Clinical Protocols; D004967:Estrogens / Q000652:urine; D005260:Female; D046910:Fertile Period / Q000652:urine*; D006801:Humans; D020407:Internet; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D007986:Luteinizing Hormone / Q000652:urine; D008875:Middle Aged; D012252:Natural Family Planning Methods / Q000295:instrumentation / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care; D010061:Ovulation Detection / Q000295:instrumentation / Q000379:methods*; D010342:Patient Acceptance of Health Care; D049590:Postpartum Period / Q000652:urine*; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D011446:Prospective Studies
chemical_list: D004967:Estrogens; D007986:Luteinizing Hormone