Postpartum Levonorgestrel-releasing Intrauterine System and Breastfeeding

• Women ages 18-45
• Pregnant and equal to or more than 24 weeks of estimated gestational age
• States an intent to breastfeed for at least 6 months
• States a plan to use the LNG-IUS postpartum
• Anticipates a vaginal delivery
• HIV negative
• Intend to stay in the Chapel Hill area for at least 6 months after birth
• No medical or personal conditions which in the judgment of study staff preclude participation in the study
• Have no allergies to any component of the LNG-IUS
• No known uterine anomalies
• Fluent in English
• No history of ectopic pregnancy
• No known or suspected carcinoma of the breast
• No known acute liver disease or liver tumor (benign or malignant)
• No known or suspected uterine or cervical neoplasia or unresolved abnormal pap smear
• No active pelvic inflammatory disease
• No known hypersensitivity to any component of the LNG-IUS
• No genital bleeding of unknown etiology
• No history of solid organ transplantation

Additional eligibility criteria for entry into the randomized trial, as assessed postpartum

• No endometritis or chorioamnionitis
• Membranes ruptured for less than 24 hours prior to delivery (O'Hanley, Hayes)
• No fever greater than or equal to 38°C during the intrapartum or postpartum period
• Did not receive medications other than pitocin and/or misoprostol to control postpartum bleeding
• Did not have a documented estimated blood loss of greater than 750mL intrapartum
• Did not receive a blood transfusion for a diagnosis of postpartum hemorrhage
• Did not have a third or fourth degree laceration at delivery.
• The infant must be greater than 35 weeks EGA at birth as determined by physical exam at birth
• The infant must weigh at least 2727 grams
• Must have been a singleton birth
• Infant not in the intensive care nursery
• The infant has not been diagnosed with a condition which would preclude long term feeding