Nowadays it is accepted for couples to resume intercourse once the lochia has diminished and the perineum has healed. Therefore, from the contraceptive point of view, the postnatal visit at six weeks may be too late. Most studies have shown that between a third and a half of women will have had intercourse before the postnatal visit (Frolich et al., 1990). The earliest potential fertile ovulation has been shown to take place around the end of the fourth week, although considerably later in fully lactating women (Guillebaud, 1988).
Clearly, contraception is needed to prevent an unplanned pregnancy occurring from the fourth week onwards, and for women who have been unable to accept advice on the postnatal ward, or who are unable or unmotivated to visit their GP or family planning clinic, other provision needs to be available. The opportunity for discussion with the district mdiwife up to the tenth day, and later with the health visitor, can be of great value. By this time, and in the privacy of her own home, she may be better able to make decisions for herself. She is sufficiently removed from the event to allow ‘debriefing’. Although defined literally as the giving of a report, debriefing has also been described as the process by which a person is allowed to relive an experience with someone else in order to make sense of it. If a woman is allowed to relive her experience of childbirth with another person she may be able to put into words feelings about the experience that she had not consciously realized that she had. If these feelings can be shared and understood she may be able to relinquish them.
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