NORCET 2 - 2021 (shift-1)
Obstetrics & Gynaecology
Easy
Which hormonal contraceptive method should not be used in a breastfeeding mother?
Appeared in: NORCET 2 - 2021 (shift-1)
Explanation
- Combined Oral Contraceptives (OCPs) contain both estrogen and a progestin.
- The estrogen component is contraindicated during breastfeeding because it can suppress prolactin and lead to a reduction in milk supply.
- Estrogen also increases the risk of venous thromboembolism (VTE), which is already higher in the postpartum period.
- Guidelines recommend avoiding estrogen-containing contraceptives for at least the first 6 months postpartum in breastfeeding women.
Why Other Options Were Wrong
- Option A: Mini pills contain only progestin and do not have the negative effects on lactation associated with estrogen. They are considered a safe and suitable option for breastfeeding mothers.
- Option C: DMPA (Depot Medroxyprogesterone Acetate) is a progestin-only injectable contraceptive. It does not affect lactation and is considered a safe and effective option for breastfeeding mothers, typically initiated 6 weeks after delivery.
- Option D: This option is incorrect because there is a specific hormonal contraceptive method, Combined OCPs, that should not be used by breastfeeding mothers due to its estrogen content.
Related Visual
- Visual 1: Chart: Comparison of Hormonal Contraceptives for Breastfeeding Mothers - A table showing different methods (Combined OCP, Mini-pill, DMPA), their hormonal content (Estrogen + Progestin vs. Progestin-only), and their recommendation status (Recommended vs. Not Recommended) with brief reasons.
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Hormonal Contraception in Lactating Mothers as background academic context rather than a clinical decision trigger.
- Nurses must provide accurate counseling to postpartum patients about contraception, ensuring the chosen method is safe, effective, and compatible with breastfeeding.
- It is a critical patient safety issue to avoid prescribing estrogen-containing contraceptives to breastfeeding mothers due to the risk of decreased milk supply and VTE.
- Nurses should assess the patient's individual needs, preferences, and medical history before recommending a contraceptive method.
How to Approach the Question
- First, identify the key elements of the question: it asks for a hormonal contraceptive that should NOT be used by a breastfeeding mother.
- Recall the different types of hormonal contraceptives listed in the options and their main components.
- Differentiate between combined (estrogen + progestin) and progestin-only methods.
- Apply the clinical rule: Estrogen-containing contraceptives are generally contraindicated during breastfeeding because they can negatively affect milk supply and increase thromboembolic risk.
- Evaluate each option based on this rule: Mini pills (progestin-only) are safe. Combined OCPs (estrogen + progestin) are not. DMPA (progestin-only) is safe.
- Conclude that Combined OCP is the method that should not be used.
Concept Tested & Keywords
- Concept Tested: Hormonal Contraception in Lactating Mothers
- Stem keywords: hormonal contraceptive, breastfeeding mother, not be used
- Lead-in keywords: not
- Negative lead-in flag: The question asks which method should NOT be used.
Question ID
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Practise the full NORCET 2 - 2021 (shift-1)
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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