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Birth Control While Breastfeeding

You probably used some form of birth control before having your baby. But contraception can be a whole different ball game for new moms who are breastfeeding. Here are your major birth control options -- and what they mean for you and your breastfeeding baby.

There are no limitations to a breastfeeding mom who decides to go with a nonhormonal method of contraception, such as a barrier method, family planning, or surgical sterilization. These nonhormonal methods are optimal for breastfeeding women -- they don't affect breastfeeding or pose even a theoretical risk to the infant. Barrier methods of birth control include:

  • Male and female condoms
  • Diaphragm
  • Copper intrauterine contraceptive devices
  • Cervical cap
  • Vaginal sponge
  • Spermicidal cream, jelly, or foam

Women who decide to use a diaphragm must be remeasured by their ob-gyn after giving birth. Pregnancy may change the size or shape or your vagina or cervix, so your old diaphragm may no longer be effective.

Family planning, also known as the "rhythm method" or "safe period," is the oldest form of birth control around -- women have been using it for centuries. It involves abstaining from sexual intercourse during a woman's fertile period each month. This can be a bit complicated for breastfeeding women -- they're fertile before they get their first period after giving birth. It's highly recommended that you attend a class on family planning before relying solely upon this method.

If you're looking for a more permanent type of birth control, sterilization (vasectomy for a man, tubal ligation for a woman) may be the right option for you. Similar to barrier methods, these surgical options pose no risk to breastfeeding.

Birth Control & Breastfeeding
Birth Control & Breastfeeding

This is where the subject of birth control and breastfeeding gets slightly more complicated. There's no definitive answer as to whether hormonal methods of contraception pose any risk to breastfeeding women. Contradictory lines of thought have resulted in conflicting recommendations from generally authoritative sources. Therefore, a woman should seriously consider all her options before deciding on hormonal contraception if she's lactating. Here's what the American College of Obstetricians and Gynecologists (ACOG) advises breastfeeding women who wish to go with hormonal methods of birth control:

  • Progestin-only contraceptives: This is the method of hormonal birth control recommended by ACOG for breastfeeding women. This includes "minipills" and Depo-Provera. Progestin-only contraceptives are not thought to affect the quality of breast milk -- in fact, they may slightly increase the volume of milk while breastfeeding compared with nonhormonal methods. Because it may have some effect on breast milk, lactating women should not begin taking these contraceptives prior to two or three weeks postpartum.
  • Combination estrogen-progestin contraceptives: Any contraceptives containing estrogen have been shown to reduce the quantity and quality of breast milk. The World Health Organization recommends that the breastfeeding woman wait at least six months after childbirth to start using these pills. And their labels, written by the Food and Drug Administration, currently read, "If possible, the nursing mother should be advised not to use oral contraceptives but to use other forms of contraception until she has completely weaned her child." But it can be argued that these warnings are a result of earlier studies, when combination pills used higher doses of estrogen. The lower-dose tablets used today probably have less effect on the quality and quantity of breast milk. As a result, there is no definitive answer regarding if and how much a combination pill taken today may affect breast milk.

If there are strong reasons that you would prefer to start using combined estrogen-progestin contraception, it's important to understand and weigh the potential disadvantages. Since most women experience reduced milk as a result of taking combination pills (and this may be dealt with more easily after breastfeeding skills and patterns are established) a woman who chooses to breastfeed should not begin taking these pills prior to six weeks postpartum. If you begin to take them following that six-week period, it's recommended that you meet regularly with your ob-gyn or a lactation specialist for a breastfeeding evaluation.

Breastfeeding doesn't have to be a hindrance to birth control. In fact, it could be your main method of birth control! In some ways, lactation is a natural method of contraception, often known as the Lactational Amenorrhea Method (LAM). If your breastfeeding pattern meets all these criteria, you may not need to use any other form of birth control for the first six months postpartum:

  • You plan to breastfeed six months or longer
  • Your baby is getting at least 90 to 95 percent of its food intake from breast milk
  • You breastfeed at least every four hours during the day and six hours at night
  • You have not gotten your period yet

LAM can actually provide you with more than 98 percent protection in the first six months after giving birth. This effectiveness rate is higher than that of most nonhormonal methods of birth control! However, if you're not sure that your breastfeeding habits meet all the criteria, or if you're not sure that you'll stick with breastfeeding for the long haul, you might want to consider other forms of birth control as well.

Source: American College of Obstetricians and Gynecologists

Reviewed 11/02 by Elizabeth Stein, CNM

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.