North American Registry of Midwives (NARM) Practice Exam

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Why might postpartum combination oral contraceptive initiation need to be delayed?

To monitor breastfeeding status
To reduce risk of delayed postpartum hemorrhage
To assess uterine involution
To avoid hormonal imbalances

The correct answer is: To reduce risk of delayed postpartum hemorrhage

Initiating postpartum combination oral contraceptives may need to be delayed primarily to reduce the risk of delayed postpartum hemorrhage. After childbirth, a woman’s body goes through significant changes, including the process of involution, where the uterus returns to its pre-pregnancy size. The immediate postpartum period can be critical, as the risk of hemorrhage is heightened, especially within the first few days and weeks after delivery. Estrogen-containing contraceptives can potentially interfere with normal blood clotting and uterine contraction processes, which could increase the likelihood of bleeding. By postponing the initiation of combination oral contraceptives, healthcare providers ensure that the woman’s body has an opportunity to stabilize and that any complications related to delivery, such as hemorrhage, are effectively managed. This precautionary approach is essential in promoting the safety and health of the postpartum patient as she transitions into the postpartum phase.