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Dr Pendo Mlay

Dr Pendo Mlay, Consultant O&G clinician at the Kilimanjaro Christian Medical Centre and Leading Safe Choices National Lead, Tanzania, writes...

We’re so excited to be part of Leading Safe Choices and are already starting to see the benefits for women.

A patient was referred to me with a history of recurrent miscarriage and perinatal death. She is a nurse, and as soon as she became pregnant, she wanted to make sure that everything possible could be done to ensure that this pregnancy was a success.

I first met her in the initial month of her pregnancy and started the conversation about post-partum family planning. She agreed that she would like to go ahead with a post-partum IUCD, as soon as her baby was born.

As a result of being involved in Leading Safe Choices, I knew that best practice was to provide a long acting method of contraception within 10 minutes of the placenta being delivered and that this was safe and extremely effective. A post-partum IUCD needs to be placed high in the uterus, meaning that the strings do not stick out through the vagina but will drop down as the uterus contracts over a few weeks.

I was not convinced that the strings of the IUCD would eventually ‘drop’, so that the patient could check them and know that the IUCD was in place.

However, I had faith in what I had learned. I delivered the baby by C-section, inserted the IUCD and told the patient to return after six weeks and I would trim the strings to a more comfortable length. Then I waited.

After four weeks, I was surprised to receive a message from the patient saying she needed to see me. At first I thought that something was wrong, but she told me “I can feel the strings, they are out”. I could not believe it. She came into my clinic, I examined her and there they were. After only four weeks. I called my registrars and the Director of the hospital and we were all amazed. I was so happy.

Now she has a beautiful baby girl and a reliable method of contraception that will last her several years. We all learned a great deal and are happy to be offering this service to more patients. Our doctors and midwives will now be trained in post-partum family planning, including IUCD insertion.