Ngừa thai sau sinh là một trong những mối quan tâm hàng đầu đối với những cặp vợ chồng vừa mới sinh con, chưa muốn có con lại sớm vì nhiều vấn đề: kinh tế, sức khỏe…
Lựa chọn một biện pháp ngừa thai an toàn và tối ưu cho từng trường hợp cần có sự tư vấn của bác sĩ chuyên môn cũng như dựa trên thói quen, suy nghĩ và lựa chọn của cả hai vợ chồng.
Việc lựa chọn biện pháp ngừa thai cũng tùy vào trường hợp mẹ có cho con bú hay không cho con bú, ngừa thai sau sinh mổ hay sinh thường. Sau đây mình trình bày sơ lược vài nét về một số biện pháp ngừa thai chắc chắn dành cho từng trường hợp.
CÁCH NGỪA THAI KHI CHO CON BÚ
Thường thì giai đoạn sau sinh và đang cho con bú nhiều mẹ sẽ ở vào trạng thái không có kinh nguyệt, việc này thường đồng nghĩa với việc bạn sẽ không thể có thai, giai đoạn này có thể dài ngắn tùy vào sự hồi phục của trục hạ đồi tuyến yên buồng trứng của người mẹ, có mẹ giai đoạn vô kinh cho con bú có thể kéo dài đến 21 tháng.
Vấn đề đáng lo ngại là các mẹ sẽ chủ quan rằng mình chưa có kinh thì sẽ không thể có thai!
Nhưng sự thật vào tháng các mẹ có rụng trứng lại thì lúc ấy các mẹ vẫn chưa hề ra kinh, và vì có những mẹ có thể có kinh lại ngay vào tháng thứ 2 sau sinh nên có rất nhiều trường hợp bị mang thai ngoài ý muốn khi mà buồng trứng hoạt động lại quá sớm khi đã có rụng trứng chu kỳ đầu tiên và dính thai ngay.
- Đối với các mẹ sinh thường thì việc sinh em bé tiếp theo quá gần với em bé trước đó mang lại nhiều khó khăn như sức khỏe suy giảm, có thể không đủ sữa nuôi cùng lúc 2 con, áp lực về kinh tế và stress.
- Đối với cá mẹ sinh mổ thì việc có thai sớm trước khi vết mổ trên cơ tử cung lành lặn có thể dẫn đến những hệ lụy trong đó nặng nề nhất là vỡ tử cung khi đang mang thai.
Vậy nên theo khuyến cáo ngay từ tháng thứ 2 sau khi sinh các mẹ nếu có quan hệ lại sớm thì nên chú trọng đến các biện pháp ngừa thai.
1/ Thuốc ngừa thai dạng viên chứa progestin liều thấp
Đây là loại thuốc chỉ chứa một loại hormon đơn thuần là progestin liều thấp còn được gọi là MINI-PILLS hay POPs hay còn gọi là thuốc ngừa thai dành cho con bú ở Việt Nam, uống mỗi ngày một viên đúng thời điểm, thuốc không làm giảm tiết sữa và được khuyên dùng sau 6 tuần hậu sản. Nếu sử dụng đúng thì tỷ lệ thất bại trong năm đầu tiên chỉ 0.3%.
Cớ chế là làm đặc chất nhầy cổ tử cung làm cản trở tinh trùng di chuyển lên đường sinh dục trên và hạn chế một phần sự rụng trứng.
Việc làm đặc chất nhầy cổ tử cung chỉ xảy ra sau khi uống thuốc 2-4 giờ và kéo dài đến 22 giờ sau khi uống nên nếu các mẹ uống thuốc trễ hơn 3 tiếng thì coi như mất tác dụng làm đặc chất nhầy cổ tử cung của thuốc và có thể có thai ngoài dự kiến.
Nhược điểm là gây vô kinh nên đôi khi các mẹ lo lắng không biết mình vô kinh do thuốc hay có bầu, nhiều trường hợp gây xuất huyết rỉ rả kéo dài nên làm các mẹ khó chịu, giảm tần suất giao hợp vì ra huyết.
2/ Chích DMPA (DEPO-PROVERA) – mỗi 3 tháng
Tiêm bắp1cc chất lỏng kết tinh chứa 150mg depot medroxyprogesterone acetate mỗi 13 tuần. Tỷ lệ thất bại nếu dùng đúng tuyệt đối trong năm đầu 0.2%.
Cơ chế: ức chế rụng trứng, làm đặc chất nhầy cổ tử cung, giảm nhu động vòi tử cung và làm mỏng niêm mạ tử cung.
Sau 1 năm sử dụng, 50% phụ nữ bị vô kinh, 80% bị vô kinh sau 5 năm sử dụng. Thời gian đầu sau khi sử dụng kinh nguyệt không đều đôi khi rong huyết hoặc chảy máu rỉ rả gây khó chịu.
3/ Cấy que ngừa thai
Một que cấy dài 4cm, đường kính 2mm có 1 màng bao bằng ethylene vinyl acetate copolymer và 1 lõi chứa 68mg etonogestrel. Khởi đầu progestin phóng thích với tốc độ 60 microgam mỗi ngày giảm dần xuống 26-30 mcg/ngày vào cuối năm thứ 3. Que cấy có hiệu quả ít nhất 3 năm.
Nếu cấy từ ngày 1 đến ngày 5 của chu kỳ kinh và chắc chắn rằng người phụ nữ không có thai trước đó, thủ thuật đúng và sản phẩm đúng chất lượng thì việc ngừa thai hiệu quả 99.95%.
Nên cấy que ít nhất sau 21 ngày hậu sản. Que không ảnh hưởng đến lượng sữa tiết của mẹ.
Cơ chế: làm đặc chất nhầy cổ tử cung, ức chế rụng trứng, teo nội mạc tử cung.
Nhược điểm: vô kinh, thiểu kinh, rong huyết, sạm da, nổi mụn, tăng cân, thay đổi tâm trạng.
Ưu điểm: giảm lượng máu kinh nếu phụ nữ cường kinh, giảm đau bụng kinh.
4/ Đặt dụng cụ tử cung
Việc đặt dụng cụ tử cung bằng đồng hay dụng cụ tử cung chứa nội tiết đều sử dụng được đối với phụ nữ cho con bú. Phụ nữ sinh thường thì có thể đặt sau 42 ngày hậu sản, đặt ngay không cần chờ có kinh lại mới đặt miễn loại trừ chắc chắn không có thai.
Đối với mẹ có vết mổ trên tử cung lần đầu tiên thì nên chờ ít nhất 3 tháng mới được đặt dụng cụ tử cung, mổ trên 2 lần thì nên chờ tối thiểu là 6 tháng mới nên đặt.
Dụng cụ tử cung chứa đồng hay nội tiết đều không ảnh hưởng đến việc cho con bú.
Hiệu quả ngừa thai cao gần 100% nếu được đặt đúng vị trí và tuân thủ theo lịch tái khám của bác sĩ để đảm bảo không bị tụt vòng đối với dụng cụ tử cung chứa đồng. Đối với dụng cụ tử cung chứa nội tiết thì đôi khi có thể nằm hơi thấp trong buồng tử cung nhưng không ảnh hưởng đến hiệu quả ngừa thai vì thuốc vẫn được phóng thích mỗi ngày.
CÁCH NGỪA THAI KHI KHÔNG CHO CON BÚ
Đối với phụ nữ không cho con bú có thể sử dụng tất cả các biện pháp ngừa thai dành cho phụ nữ cho con bú, ngoài ra còn có thể sử dụng được thuốc ngừa thai hàng ngày viên kết hợp liều thấp có chứa cả estrogen và progesterone. Việc uống thuốc nên bắt đầu sau giai đoạn hậu sản 21 ngày để giảm thiểu nguy cơ thuyên tắc do huyết khối sau sinh.
Tuy nhiên phụ nữ cho con bú vẫn có thể sử dụng được viên thuốc ngừa thai kết hợp liều thấp dù có thể giảm tiết sữa vì lợi ích nó mang lại vẫn nhiều hơn nguy cơ.
Chúc các bạn lựa chọn cho mình một biện pháp thật hiệu quả để có thời gian nhiều hơn dành cho chồng và con nhé!
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