Hesperian Health Guides

Inserting the IUD

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HealthWiki > A Book for Midwives > Chapter 21: How to insert an IUD > Inserting the IUD


There are different types of IUDs, and each type is inserted in a different way. Before you insert an IUD, you must find out how to insert the type that you have. Most IUDs come with directions. These are the steps you should follow no matter what type of IUD you are inserting:

  1. Ask the woman to urinate.
  2. Sterilize all the tools you will need to insert the IUD
    and put them on a sterilized cloth or paper.

    MW Ch21 Page 392-2.png
    plastic
    gloves
    speculum
    ring forceps and gauze or a long swab to clean the cervix
    tenaculum
    scissors
    uterine sound



    You will also need:

    a flashlight.
    MW Ch21 Page 393-2.png
    MW Ch21 Page 393-3.png
    a good source
    of light
    bowl of antiseptic
    like betadine or
    Hibiclens
    IUD and IUD inserter
    inside sterile package


    There are many types of IUDs. Three common types are the Copper T (or T380A), the Multiload, and the Gyne-Fix. All of these IUDs are safe and effective.

    MW Ch21 Page 393-4.png
    MW Ch21 Page 393-5.png
    MW Ch21 Page 393-6.png
    Copper T
    IUD
    Multiload
    IUD
    Gyne-Fix
    IUD

    In this book, we only give information on how to use one type of IUD — the Copper T. We talk about this type because it is effective, safe, and popular. Other types of IUDs are inserted in a similar way as the Copper T. But be sure to read any instructions that come with the IUD you use.


  3. Load the IUD into the insertion tube.

    Loading the Copper T  IUD

    The Copper T IUD comes in a sterilized package. Put the package on a clean table, paper side down. This way, you can see the IUD through the clear plastic cover.
    MW Ch21 Page 393-7.png


    Inside the package there are 3 parts:

    IUD insertion tube rod
    an IUD with parts labeled.
    arms
    string
    an insertion tube with movable gauge.
    gauge
    MW Ch21 Page 393-10.png

    These instructions tell you how to put the IUD into the inserter while it is still inside the package. If you load the IUD into the tube while it is still inside the package — and you do not touch the IUD — it will stay sterile even if you do not have sterile gloves. Do not ever touch the IUD, or the end of the tube or rod that will go inside of the woman’s womb, unless you are wearing sterile gloves.

    Put the IUD into the tube when you are almost ready to insert the IUD. If the IUD
    MW Ch21 Page 394-1.png
    stays in the inserter tube for more than about 5 minutes, it will not work — the arms will not open inside the womb.
    MW Ch21 Page 394-2.png


    Open the package halfway, starting on the side away from the IUD, and push the rod to the side of the package to get it out of the way.

    MW Ch21 Page 394-3.png

    With one hand, hold the inserter tube steady. With your other hand, hold the IUD through the plastic while you load the arms into the tube. Put your thumb on one arm, and your forefinger on the other, and squeeze them together and down. Squeeze the folded IUD into the top of the tube.

    Put the rod into the other end of the tube and run it along next to the strings. Stop when it touches the bottom end of the IUD, and hold it steady there.

    The IUD is now ready to be inserted.


    MW Ch21 Page 394-4.png
  4. Have the woman lie on her back with her knees bent and open.

  5. Help the woman relax. You can try taking deep breaths with her, speaking quietly, or putting a reassuring hand on her shoulder.

  6. MW Ch21 Page 395-1.png
  7. Scrub your hands with soap and water. Let your hands dry in the air and then put on sterilized gloves.

  8. 2 gloved fingers in a woman's vagina while another hand presses on the belly.
  9. Feel the woman’s womb.
    • Find the position and size of the womb.
    • Make sure the woman is not pregnant.
    • Make sure the womb is not enlarged or in pain

  10. Gently insert a sterilized speculum.
  11. MW Ch21 Page 395-3.png


    MW Ch21 Page 395-4.png
  12. Clean the cervix with antiseptic. You can use a long swab or a ring forceps and sterile gauze dipped into antiseptic.
  13. MW Ch21 Page 395-5.png



  14. Grasp the cervix with a tenaculum and close the tenaculum slowly. Pull the cervix gently to straighten the womb. The womb must be straight while you are inserting the sound and while you are inserting the IUD. If this is painful for the woman, stop. Take a break and ask her to tell you when she is ready to go on.

  15. Measure the womb by inserting a sterile sound through the opening of the cervix and into the womb.

    You must hold the sound only by the handle, and carefully insert it into the cervix. Do not let it touch anything but the cervix. The sound will not be sterile if it touches anything — even the woman’s vagina.
    MW Ch21 Page 396-1.png


    Insert the sound gently and firmly. If it is difficult to push the sound through the cervix, turn it as you push. Do not push too hard. This could push the sound so far that you could puncture the womb. This is very dangerous.

    MW Ch21 Page 396-2.png


    Once the sound is through the cervix, gently push the sound until you feel it touch the back of the womb.

    The sound has marks on it that are 1 centimeter apart. When you pull the sound out, it will be wet up to a mark. This tells you the size of the womb.


  16. When you know the size of the womb, you can set the inserter so it will be the same length as the womb.
    using the sound to set the gauge on the inserter tube.
    The sound is wet up to this point . . .
    . . . so move the gauge to the same distance from the end of the tube.

    Look at the IUD inside the package. The inserter tube has a small movable gauge on it in the package. Move the gauge on the tube to the same size as the womb. Do this by pushing on the gauge while the sterile IUD is still inside the package.

  17. MW Ch21 Page 396-4.png
  18. Now open the package all the way, take the inserter tube out of the package, and insert the IUD into the womb. Keep the IUD sterile! Do not let it touch anything, even the side of the vagina.
    MW Ch21 Page 397-1.png



    Hold the cervix steady with the tenaculum, and slowly push the tube with the IUD in it into the opening of the cervix. Never force the IUD into the womb, even if it is difficult to insert.

    MW Ch21 Page 397-2.png




    Push the tube and IUD all the way to the back of the womb. When the gauge stops against the cervix, you have pushed the IUD to the back of the womb. If you feel resistance, do not push any farther.

    Hold the rod steady. This will keep
    the IUD in place. Without letting
    the rod move, slowly pull the tube
    toward yourself.
    When the tube comes out of the
    cervix, you can pull the rod toward
    yourself and out of the cervix.
    MW Ch21 Page 397-3.png
    Hold the rod still.
    Pull the tube toward yourself.
    MW Ch21 Page 397-4.png
    Then remove both the tube
    and the rod.


  19. MW Ch21 Page 398-1.png
    MW Ch21 Page 398-2.png
    Leave about 2 centimeters of string outside the cervix.
    2 cm
  20. Cut the strings so that about 2 centimeters hang out of the cervix. Gently remove the tenaculum and the speculum.

  21. Put all the instruments and gloves in bleach solution or another chemical disinfectant.

  22. MW Ch21 Page 398-3.png
    MW Ch21 Page 398-4.png
  23. Throw away the trash including the gauze
    and IUD inserter.

  24. Wash your hands with soap and water.