November 8, 2022

All about postpartum birth control

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If you just had a baby or will give birth soon, here’s what you should know about postpartum birth control. 

Whether you’re trying to plan the timing of your pregnancies or are done having children, it’s important to know how soon after delivering a baby you will need contraception (birth control) and what type of postpartum birth control is best for you and your family.

Dr. Elise Boos, an OB-GYN with Vanderbilt Women’s Health, explains fertility and contraception in the days and weeks after giving birth.

“I tell people that if they’re not using a birth control method, it’s possible to become pregnant very soon after having a baby,” Boos said. “You can’t reliably use the return of menstruation as an indicator that your fertility has returned.”

If you’re not feeding your newborn exclusively by breastfeeding, ovulation is likely to start again within a few weeks of giving birth. Ovulation happens before you get a menstrual period, so it’s possible to become pregnant again before having another period, whether you are breastfeeding your infant or not.

How reliable is breastfeeding for preventing pregnancy?

“Lactational amenorrhea” refers to not having a period while you are lactating (producing breast milk). Lactation triggers hormones that discourage the body from ovulating (releasing an egg for fertilization).

Breastfeeding can postpone ovulation and therefore the opportunity for another pregnancy, for possibly as long as six months. But lactation is not foolproof birth control, Boos said. Breastfeeding is most likely to hinder ovulation and periods if you’re using breastfeeding as your baby’s only food, and nursing at least every three to four hours. As the baby goes longer between feedings at the breast, and if baby starts taking some formula or solid food, breastfeeding becomes less frequent and less reliable for preventing another pregnancy.

“If you very much want to avoid an unplanned pregnancy” shortly after having a baby, Boos said, “there are methods far more effective” at preventing pregnancy. She tells her patients not to rely on breastfeeding alone. 

When should I choose a postpartum birth control method?

The best time to choose a birth-control method is while still pregnant, Boos said. Most experts recommend waiting at least 18 months between pregnancies before having another baby. There are many options to choose from. Your doctor or midwife can review the options with you during pregnancy. Many options can be started soon after pregnancy or even started before you leave the hospital. 

What birth control is safe while breastfeeding?

All birth control methods are safe during breastfeeding. Only a few methods are not recommended in the earliest weeks after childbirth due to the small chance they may reduce your milk supply. Unless someone is already at risk of low supply, most people will not notice a difference in supply even after starting birth control, regardless of the methods.  

Long-acting reversible contraceptives that only use the hormone progestin are suitable for use during breastfeeding. These long-acting methods include intrauterine devices (IUDs) and subdermal (under the skin) implants. 

“They are highly effective and don’t depend on you having to remember to take a pill every day or change a patch each week – sometimes hard things to remember when you are also caring for a small baby,” added Boos. “These are ‘get it and forget it’ methods, which can be especially helpful in the postpartum period.” 

Birth control methods that contain estrogen — including pills, the patch and the vaginal ring — should be avoided right after birth because people who were recently pregnant have an increased risk of a blood clot in their veins (called deep venous thrombosis). These contraceptive methods can increase that risk even more. For those who are breastfeeding, it is best to avoid birth control methods containing estrogen until four to six weeks after giving birth, to give you time for your body to establish its milk supply. Birth control containing estrogen can sometimes cause a drop in milk supply, which is why you should wait to start those types of birth control until you and your baby have gotten into a breastfeeding rhythm.  

Can you get an IUD or implant at the same time you deliver your baby?

For those who want an IUD or an implant, those devices can often be placed immediately after you deliver your baby. That can be done whether you delivered vaginally or by C-section. One benefit of having either type of contraceptive placed before leaving the hospital is that you leave with a highly effective postpartum birth control method. Also, if you received pain medication during labor and delivery, that masks any discomfort that typically comes with having the IUD inserted. 

However, Boos said, “there’s higher risk of expulsion or malpositioning with IUDs that are placed in the immediate postpartum period.” You’re less likely to have the IUD shift out of place or come out if it is inserted at your six-week postpartum checkup. She suggests talking with your doctor or midwife about the pros and cons of having an IUD inserted while at the hospital or waiting until your postpartum visits. 

Tubal ligation – having the fallopian tubes blocked or cut, which is considered permanent sterilization – is also possible immediately after giving birth. Patients should discuss this non-reversible birth control strategy with their health-care providers before going into labor. Boos pointed out that some patients (depending on their insurance) will need a special consent form signed at least 30 days before their due date in order to have sterilization performed. “So it’s really important to bring this up early in your prenatal care,” Boos said. 

Patients should also check with their health-insurance plans before giving birth to find out whether their insurers cover the cost of placing the IUD or implant immediately after childbirth. 

Boos encourages anyone who wants contraception right away after childbirth, or who intends to get an IUD a few weeks later, to talk with their health-care provider about what kind of birth control is right for them in the weeks between giving birth and receiving the IUD.

IUDs and implants do not have to be placed by an OB-GYN. Many primary-care providers, midwives and adolescent medicine specialists can insert these contraceptive devices or offer other birth control methods. 

What about diaphragms?

Boos does not recommend diaphragms as a postpartum birth control method shortly after childbirth. The uterus needs to return to its normal, non-pregnant size and shape before a diaphragm is likely to work correctly, she said. 

Months after childbirth, though, a diaphragm is still more likely to prevent pregnancy than going without contraception or relying only on breastfeeding. Today there is a type of diaphragm that’s considered one-size-fits-most, Boos said. It should be used along with spermicidal jelly to work most effectively. You can get a prescription for it and pick it up at the pharmacy, but Boos recommends having an OB-GYN put it in to check that it fits well. The benefit of a diaphragm is that it does not involve hormones.

How long do you have to wait before going back on the pill? 

The progestin-only pill can be started right away after childbirth. On the other hand, pills that contain both estrogen and progesterone can be started as soon as three weeks after childbirth, once the risk of blood clot in the veins has returned to normal. Experts recommend that for those breastfeeding, they not start estrogen-containing pills, patches or rings until four to six weeks after childbirth, to avoid affecting milk supply. 

Emergency contraception after giving birth

“Emergency” contraception reduces the chances of getting pregnant after unprotected sexual intercourse. Emergency contraception can be useful if a condom breaks, you’ve used your birth control incorrectly or aren’t using a method to prevent pregnancy. 

There are differences between types of emergency contraception in how you use them and how effective they are. Emergency contraception works best the sooner it’s used after sex. These methods are not intended to replace contraception; they are intended to be used when you’ve had unprotected sex and want to reduce the risk of pregnancy, Boos said.

IUDs are the most effective method of emergency contraception. If you get an IUD for emergency contraception it can then be left in place as your long-term birth control method. The sooner an IUD is placed after unprotected sex, the better. 

There are two pill options for emergency contraception: Plan B and Ella. Plan B is a progesterone-based emergency contraceptive. It’s a one-time pill available over the counter without a prescription. It is most effective if taken within 72 hours of unprotected sex and is safe to use if breastfeeding, Boos said. Ella is also a one-time pill, but it requires a prescription. It can be taken within five days of unprotected sex. While it is safe to take while breastfeeding, you should pump and discard your milk for 24 hours after taking Ella.

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