Thayer Allyson Gowdy
Doctors recommend waiting at least a year after the birth of a baby to become pregnant again (that means at least 18 months between the babies' births). This allows your body to heal and helps you avoid a heightened risk of complications such as miscarriage, low birthweight, and preterm birth.
For many moms, the key to waiting is using reliable birth control. But could it harm your baby? Or your milk supply? The good news is, there are plenty of birth control options that are safe for nursing moms and their babies. You just need to know what to avoid and what really works.
Natural Birth Control
Surprisingly, breastfeeding itself can be a form of birth control. If you're breastfeeding, you have increased levels of the hormone prolactin, which can prevent ovulation and, in turn, conception -- but only (and this is a big only!) if you meet all of this criteria:
- You're within six months of your baby's birth.
- You're breastfeeding exclusively (no formula, even as a supplement!).
- Your baby is feeding on demand around the clock, with no longer than four hours between daytime feedings and six hours between nighttime feedings.
- Your menstrual period hasn't returned postbirth.
Using breastfeeding as birth control is called lactational amenorrhea and it's considered up to 98 percent effective if you meet all the above criteria. But the American College of Obstetricians and Gynecologists (ACOG) warns that ovulation can return before you get your first postbaby period, so you run the risk of not knowing exactly when you can become pregnant again.
If you're breastfeeding and you don't meet all those criteria, if you're unsure whether you do, or if you just want more certainty, it may be best to consider another birth control method like the following prescribed and over-the-counter options.
Birth Control to Always Avoid
First, here's what breastfeeding moms shouldn't take: estrogen.
"Forms of birth control with estrogen can lower milk supply, so we try to avoid them in breastfeeding moms," explains Cristina Perez, M.D., ob-gyn at the Women's Specialists of Houston at Texas Children's Pavilion for Women. "Estrogen isn't dangerous to the baby, but most moms would rather not take something that can potentially decrease their supply."
Estrogen is in conventional combination birth control pills, in Nuvaring, and in the birth control patch, so breastfeeding moms shouldn't take those.
Prescription Birth Control
Reliability is key, and there are estrogen-free prescription options that are safe for your milk supply and are effective.
IUDs and Implants
"The most recommended birth control options for nursing moms are the hormonal IUD, copper IUD, and progestin implant," says Lisa Perriera, M.D., chief of Family Planning, Obstetrics and Gynecology at UH Case Medical Center in Cleveland. "Progestin-only pills are also used -- they're not as effective at preventing pregnancy as the IUDs and implant, but they're safe for breastfeeding."
Recent research has shown that certain IUDs and implants can be effective up to one year after the recommended expiration date.
A hormonal IUD (Mirena, Skyla, or Liletta) is a small T-shaped device that a doctor inserts into a woman's uterus. The hormone in it, progestin, thickens cervical mucus and thins the lining of the uterus to prevent egg fertilization and implantation. It can be kept in as long as three years (Skyla) or five years (Mirena). IUDs are considered over 99 percent effective at preventing pregnancy.
Liletta, an IUD that is FDA-approved and will be available soon on the market, is also safe to use while breastfeeding; it will be offered to some women at lower cost than some other IUDs, says Dr. Perriera. Makers says it's 99.45 percent effective for up to three years.
A copper IUD (ParaGard) looks and works like a hormonal IUD, but it doesn't contain hormones. Instead, the copper in it creates inflammation that prevents sperm from fertilizing the egg. Copper IUDs are as effective as hormonal IUDs and can be used up to 10 years.
A birth control implant (Implanon or Nexplanon) is often the choice for women who like the reliability and ease of an IUD, but don't like having a device in their uterus. (There's a small risk of an IUD entering the pelvis and causing problems, Dr. Perez says.) The implant is a tiny flexible rod that's inserted under the skin of the upper arm. It contains progestin, the same hormone that an IUD has, and prevents pregnancy in a similar way. "Research shows women can get an IUD or implant right after they have the baby and can leave the hospital protected," Dr. Perriera says. "Some moms have it placed after birth or at the six-week postpartum visit."
The progesterone-only pill (aka the minipill) is similar to a typical birth control pill but has only progestin, not a combination of progestin and estrogen. It's also a little less error-proof. That's because the minipill needs to be taken at the same time, within three hours, every day, to be effective, but that might be challenging for a busy new mom to keep up with daily.
If you're concerned that you might want to change your mind, note that these methods are easily reversible. So if you decide to have another baby, you can have the IUD or implant removed or you can stop taking pills. Within a month or two you can start trying to conceive, Dr. Perez says.
Depo is a birth control shot preferred by women who seek a method that is regular and easy. A user simply has to see her doctor once every 12 weeks for an injection and then forgets about birth control until her next scheduled shot. This method, which also uses progestin, is about 91 to 94 percent effective.
"It's a little controversial whether or not the Depo shot affects milk supply," Dr. Perriera says. "If you ask a lactation consultant, she'll probably say it does. If you ask an ob-gyn, she'll probably say it doesn't." Whatever you decide, keep in mind that Depo is more difficult to reverse than other birth control methods are. It can take as long as a year for your fertility to come back after ending Depo shots, Dr. Perez says.
Barrier Birth Control Methods
Condoms are the tried-and-true method for breastfeeding moms who want to forgo hormones and prescriptions. They're also an easy and affordable way to go. Both the male and female condoms are safe for nursing moms -- and they're the only method other than abstinence that protects against STDs.
Diaphragms, cervical caps, and sponges need to be inserted into the vagina. They're completely safe for breastfeeding moms, but only after six weeks postbaby, because you're still healing during that time. If you used a diaphragm pre-baby, you'll need to be refitted because your cervix position can change during delivery. But these barrier methods aren't very popular because they can be messy and inconvenient. They're also less effective than some other methods, falling in the 76 percent to 88 percent range.
Natural Birth Control Methods
As you may have guessed, natural family planning methods are okay to use while you're breastfeeding. The common idea behind these various methods is to track your menstrual cycle and bodily changes (such as basal body temperature and cervical mucus) to predict when you'll ovulate and when you're fertile.
Some of these natural methods include the rhythm method (or calendar method), the ovulation method (or Billings ovulation method), the symptom-thermal method, the standard days method, the lactational amenorrhea (LAM) method, and the basal body temperature (BBT) method.
These methods don't offer the same effectiveness or certainty as prescription and barrier methods. Plus, it might be harder to keep up with your cycle while your body is still readjusting postbirth and your menstrual cycle might not be regular or predictable yet.
Permanent Birth Control Methods
Parents who know they don't wish to have more children may choose a permanent birth control method: Women can have their tubes tied and men can have a vasectomy. Those two sterilization methods are very reliable forms of birth control -- over 99 percent effective -- but those who choose these surgeries need to be completely sure. Surgery is a significant procedure, and reversal is either impossible or extremely difficult.
In the end, whichever birth control method you choose comes down to your preferences, concerns, and comfort level. Talk to your doctor about all your birth control options and their pros and cons. "You're the boss of your body. You choose at the end," Dr. Perriera says.
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