Mom's Guide to Birth Control After Pregnancy
You didn't believe it as a kid, but now you know the truth: Being a mom does not disqualify you from a sex life. However, unless you want a newborn in nine months, you’ve got to use some form of birth control. (A woman’s odds of having an “oopsy pregnancy” rise after each birth, per the Centers for Disease Control and Prevention.) Just be aware that what worked for you pre-kids may not be a match now. Consider the Pill: Taking it every day at precisely 8 a.m. was probably NBD when you ran your mornings, but now that your baby’s in charge, time is a bit of an abstract concept. Or perhaps you used to be fairly chill about birth control, but these days you, ahem, crave ninja-level sperm protection. Here, moms divulge the pitfalls and perks of the birth control methods they've tried after pregnancy, and experts share the info you need to make the right choice for yourself.
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“I didn’t respond well to hormones. Turns out there’s an app for that.” —Phylicia Sadsarin, 32, Denver, Colorado
Her story: I was on the Pill in college, but I never liked it. I had a lot of mood swings, and my heavy periods became even heavier. In 2010, I became more conscientious about what I put into my body. I went vegetarian and, shortly after that, stopped taking the Pill.
My husband and I got married two years later and started using the fertility awareness method, or FAM. I tracked my ovulation with an app I found called Pink Pad. It was easy. I just input the dates of my period, and the app calculated when I should expect to ovulate. (It actually sends a notification that says “Flowers are blooming” when you’re about to ovulate. Getting it always makes me giggle.) When my flower was blooming, my husband and I would lay off sex for a little over a week. If we couldn’t resist, we used a condom.
In 2016, we began trying to conceive. I tracked my cycle with Pink Pad, had unprotected sex during my June ovulation, and bingo: I got pregnant. After our daughter was born, I used another natural technique known as the lactational amenorrhea method, or LAM. If your baby is under 6 months and exclusively breastfed (meaning from the breast, on demand, with no solid foods), and your period hasn’t returned, you can rely on nursing, which lowers estrogen, to prevent ovulation. When I’m done nursing, we’ll go back to FAM, but for now, I’m loving having no cycle.
The Doc's take: “I usually advise patients to follow their menstrual cycle closely for a few months to identify a pattern before using FAM,” says Aparna Sridhar, M.D., assistant professor of obstetrics and gynecology at the David Geffen School of Medicine at UCLA. “As for breastfeeding, it can be used as birth control after pregnancy, but only if at least 85 percent of your infant’s feeds come from breastfeeding, and your period hasn’t resumed. Pumping may or may not offer the same protection. The jury is still out.”
“My tubes are tied, and I love not having to worry.” —Ashley Barber, 31, Springfield, Missouri
Her story: When I was 17, I decided to try the DepoProvera shot. It seemed great because I only had to think about it once every three months, and I could hide it from my parents. But I gained weight and felt moody, so a year in, I switched to the patch. Applying a new one every week wasn’t too bad, but it kept peeling off in the shower, which was annoying. In 2006, I began dating the man I would marry, and we used condoms to successfully avoid pregnancy until our first son was conceived—on purpose—in 2007. I got pregnant with our daughter two years later.
However, five months into my second pregnancy, I was diagnosed with a blood-clotting disorder, and my doctor told me that I’d have to opt for birth control with zero or minimal hormones in the future. Unfortunately, my husband and I were just starting divorce proceedings. It was a tough time, and I didn’t know if I’d remarry and want more kids. After all, I was only 22! So at my six-week postpartum checkup, I got a Mirena IUD, which contains progestin (the synthetic form of progesterone), but no estrogen, and is effective for up to five years.
As it turned out, I did meet someone, and we got hitched in 2015. Since my Mirena was about to expire, I had it removed and tried DepoProvera again in the hopes of buying us some fun time before trying for a baby. But the same symptoms I dealt with before having kids came roaring back, and as a mom, I found the anxiety, depression, and moodiness much harder to manage. I stopped the shots, and we conceived quickly. In 2016, I gave birth to my third baby. Eight weeks later, I had my tubes tied in a quick, in-and-out procedure. I haven’t looked back. My husband and I have five kids between us. We’re done!
The Doc's take: “Women who can’t take estrogen have a lot of options: progesteroneonly pills, Depo-Provera, a hormonal or copper IUD, the Nexplanon implant, barrier methods like condoms, and sterilization,” says Dr. Sridhar. “Tying your tubes takes one to two hours, and we can do it the day you deliver.”
“Withdrawal worked great for us ... until it didn’t.” —Amy Hurlston, 41, Asheville, North Carolina
Her story: When my husband and I married in 2005, we weren’t trying, but we weren’t not trying. To be blunt: He would pull out right before finishing. One night in 2007, we decided to just go for it and he didn’t pull out. Our daughter Audrey was born nine months later. I got a Mirena IUD at my six-week postpartum checkup and loved not having to think about birth control, so much so that after it expired five years later, I had another one put in.
As I neared 40, I started freaking out about my age and the fact that we only had one child, so I had my IUD removed. Mae was born in 2016. We have a good friend who is a urologist, and he offered my husband a free vasectomy as a gift. We decided we’d take him up on it—eventually. After Mae’s birth, my sex drive was nil, so it was easy to put the surgery off. However, one night in July of 2017, my husband thought he had pulled out in time… but he hadn’t. The long-awaited vasectomy took place a few months later. Our third child, Sawyer, arrived the following March!
The Doc's take: “If you opt for a vasectomy, you’ll need to practice safe sex for about two months afterward or 20 ejaculations to make sure no more sperm are left,” says David Hepps, M.D., a urologist in Pittsburgh. He also notes that the big V should be reserved for couples who are certain they’re done having kids. “Don’t go in thinking, ‘Hey, we can always reverse this.’ Reversal is expensive and way more complicated than the vasectomy itself,” he says.
“I use the Pill because I like having a period.” —Khalidah Mohiuddin, 33, Charlotte, North Carolina
Her story: When I was 19, I went on the Pill to help regulate my cycle and wound up staying on it for more than a decade. I went off it when I married my husband and we started trying for a baby—with success. At my six-week postpartum checkup, my doctor rattled off lots of options, including the IUD and NuvaRing, but I knew I wanted to go back on the Pill. My thinking: If it’s not broken, why fix it? Also, I wanted something really reliable—the thought of having another baby close to my first was terrifying. I liked the idea of having my period because it would be a monthly reminder that I wasn’t pregnant. So I started back on the progestin-only Pill, which is compatible with nursing. When I weaned our daughter at age 1, I switched back over to my usual combination estrogen and progestin Pill. Soon my period returned, and in three months, my cycle had regulated. These days my period lasts three days max and is superlight.
The Doc's take: “For three weeks after giving birth, moms should avoid all forms of birth control that contain estrogen, because they can increase the risk of blood clots. The progestin-only minipill, however, is safe to take immediately after delivery,” says Dr. Sridhar. “Just remember that it needs to be taken every day at the exact same time. Being late by even three hours can change efficacy. This can be especially hard if you’re trying to sleep when the baby sleeps!”
“After infertility, I didn’t think I needed birth control.” —Beth Janes, 40, Evanston, Illinois
Her story: After 13 happy years of light, predictable periods on the Pill, I went off it when my husband and I decided to try to have a baby. My period returned immediately—and it sucked. The cramping was horrible. As month after month went by and my period kept rearing its ugly head, it felt like a double whammy: Not only was I in pain, but I also wasn’t pregnant. After a year with no success, we began fertility treatments. Sadly, they resulted in one miscarriage, but then I conceived our first son, Freddy, who was born in July of 2013.
At my six-week postpartum checkup, my obstetrician asked about birth control after pregnancy. I replied, “Why would I use birth control? I couldn’t get pregnant on my own.” He said some women who initially struggle to conceive can do so easily after giving birth, but added that when I was ready for another baby, I should go back to the fertility center instead of wasting time with the old-fashioned way. My takeaway, for better or worse, was, “Meh, why bother with birth control?” He gave me a prescription, and I never filled it.
Six months later, my period came back, and within weeks, I conceived. I felt so conflicted: We knew we wanted a second child, and we were so grateful to not have to go through fertility treatments again. Still, I was just starting to feel like myself! But my shock soon turned to joy, and Desi was born in 2014.
My husband and I both felt our family was complete with two kids, but we weren’t ready to take the final plunge of a vasectomy, so I showed up at my second six-week checkup knowing I wanted an IUD. I love it: I’ve only had one period since 2012.
The Doc's take: Although you can have an IUD inserted right after you deliver (whether you did so vaginally or via a cesarean), there’s a slightly greater chance that your body might accidentally expel it. “It’s better to wait until your post-delivery visit to your doctor to get your IUD,” says Dr. Sridhar.
This article originally appeared in Parents Magazine as 'I'm #dunzo."