Spermicides and natural family planning Where do the spermicidal preparations stand- as contraceptive methods? For use on their own, they are pretty inadequate. They are useful in supplementing the barrier methods mentioned above. Apart from disabling the spermatozoa, the common spermicide preparation (Nonoxynol) also kills most viruses, including HIV. It should not, however, be regarded as a protection against such infections. Brands available include Orthoforms® pessaries and Ortho-Creme® which, as the name suggests, is a cream. Is there a worry that spermicide creams or pessaries may increase the risk of genital infection? There is really no evidence that this is true. If one is averse to using artificial contraceptive methods, how reliable is natural family planning in the postnatal period? Natural family planning is based on identifying the fertile period and abstaining from sex in this period to avoid conception. It is also called the ‘rhythm method’. This means it depends on regular reliable cycles and being able to identify the consistency of cervical mucus indicating ovulation. Both of those are either not there or highly unreliable in this post-delivery period. If the mother is breastfeeding, even partially, she may have no periods at all. Overall, the postnatal period is not the ideal period for using natural family planning. Of course, one method of natural family planning is failsafe whenever used - total abstinence. However, this is evidently not everybody's cup of tea. What is the place of the combined oral contraceptive pill? For a mother who is breast-feeding, this is a no-no. The estrogen component of the pill will have the effect of drying out the milk. The hormones are also passed into the milk and may have unwanted effects on the baby. It is not used unless the woman gives up breast-feeding first. What is the contraceptive of choice for a woman who is not breast-feeding? This woman has the freedom of the entire spectrum. Her concern should therefore be about the convenience, effectiveness and ultimately her personal preference. The consideration of milk production or effects on the baby is not in the equation. The combined pill, the intrauterine device and the progestogen injection or implant are the most effective. Does a woman who is not breast-feeding need to start using a contraceptive straight away after delivery? Yes, more or less. If she is sexually active in the immediate postnatal period, the possibility of conceiving is ever-present. Ovulation may occur as early as four to six weeks after delivery. What about sterilisation? While only until a few years back, sterilisation immediately after delivery was very popular, it is very infrequently done nowadays. There are a number of disadvantages associated with immediate postnatal sterilisation. One is that the chances of regretting the decision are significantly higher if it is done at this time. Secondly, it is less safe as a surgical procedure as there is a higher chance of thrombosis complications. Moreover, and probably most significantly for the majority, is the fact that the failure rate of sterilisation at this time is considerably higher than at other times. Recommended is what is known as "interval sterilisation", where the procedure is performed several weeks after delivery. In the meantime, other temporary methods of contraception may be used. Unfortunately, even the six to twelve weeks interval is occasionally too long and some women find themselves pregnant before being sterilised.