Chapter 21: How to insert an IUD
14. Cut the strings so that
about 2 centimeters
hang out of the cervix.
Gently remove the
tenaculum and the
speculum.
2 cm
15. Put all the instruments
and gloves in bleach
solution or another
chemical disinfectant
(see page 57).
Leave about 2 centimeters
of string outside the cervix.
16. Throw away trash including the gauze and
IUD inserter using the suggestions on page 67.
17. Wash your hands with soap and water.
After you insert the IUD
Explain to the woman that she may have bleeding or cramps for 1 or 2 days.
Her monthly bleeding might be heavier than usual for a few months. This is
normal. Tell her how to check her IUD and what warning signs to watch for
(see page 399).
A woman with an IUD should get regular health checkups. She must also check
her IUD to be sure it is still inside her womb and she should watch for other signs
something might be wrong. If the IUD comes out, it is most likely to happen
during a monthly bleeding, so she should check the IUD after her monthly
bleeding each month.
To check the IUD
She should wash her hands, then put a finger into her vagina and feel her cervix.
When she finds her cervix, she should feel strings coming from the opening. If she
cannot feel the strings, the IUD has been pulled up into her womb, or else it has
come all the way out of her and will not work anymore.
Signs that something might be wrong
If she cannot feel the strings, she needs medical help. A health worker must look for
the IUD using forceps to reach inside the womb or using a sonogram to see inside
the womb. Because the IUD may have fallen out, the woman must use another
method of family planning if she does not want to become pregnant.
If a woman's monthly bleeding stops or she has other signs of pregnancy, she
should see a health worker right away to have the IUD removed. Leaving it in
during pregnancy can cause miscarriage, infection, or the baby to be born too early.
Removing the IUD immediately is less likely to cause miscarriage than leaving it in.
(Remember that the Mirena IUD may cause a woman's periods to stop, so this
alone is not a sign of pregnancy for women using the Mirena.)
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A Book for Midwives (2010)