PT - JOURNAL ARTICLE AU - Bouchard, Thomas AU - Fehring, Richard J. AU - Schneider, Mary TI - Efficacy of a New Postpartum Transition Protocol for Avoiding Pregnancy AID - 10.3122/jabfm.2013.01.120126 DP - 2013 Jan 01 TA - The Journal of the American Board of Family Medicine PG - 35--44 VI - 26 IP - 1 4099 - http://www.jabfm.org/content/26/1/35.short 4100 - http://www.jabfm.org/content/26/1/35.full SO - J Am Board Fam Med2013 Jan 01; 26 AB - Introduction: 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. Conclusion: The online postpartum protocol may effectively assist a select group of women in avoiding pregnancy during the transition to regular menstrual cycles.