Postpartum Contraception

Think through your post-baby birth control plan now--you won't have time to worry about this in a few weeks.
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There's been so much going on these past months that you probably haven't given contraception a thought. (If anything, you may have been relieved not to have to think about contraception.) And who'd have time for sex with a baby in the house?

It may take weeks, or even months, before your desire returns after childbirth. But when the mood does hit, you don't want to get caught unprepared. Spontaneity will be both more difficult and more necessary after adding a new child to your life! So take some time now to consider your family planning options.

Breastfeeding is not birth control. It's true that nursing your new baby will lower your chance of conceiving. However, if you cut back on breastfeeding at all, you may ovulate even if you haven't had a period yet, so you can't count on nursing hormones to keep you safe from another pregnancy. Use this method only if you really don't mind having your children very close together.

Natural family planning. This is a less reliable contraceptive method that requires you to pay constant attention to your menstrual and ovulation cycles. You also have to be willing to abstain from lovemaking or use another method of birth control during those fertile times. You can keep track of when you ovulate with a basal thermometer: Use it to chart the rise in temperature that accompanies ovulation. Examine changes in your cervical mucus as well. You can also invest in an ovulation predictor kit. This method is about 60 percent effective, so 40 out of 100 couples will conceive in one year.

Condoms. Some patients choose condoms over birth control pills because of a concern about using hormones while breastfeeding. With typical use, condoms are 85 percent effective; they also protect against sexually transmitted diseases.

Diaphragm. If you used a diaphragm before getting pregnant, you might be able to use the same one. Be sure to get refitted by your midwife or obstetrician, though, in case your vagina has changed shape following childbirth. Be aware that even when the diaphragm is used correctly--that means inserting it correctly, using spermicide, and leaving it in for at least 6 hours after intercourse--it isn't a perfect solution. Its effectiveness is 94 percent at the best of times, and for women who use the diaphragm with less attention to detail, that effectiveness rate plummets to 80 percent.

IUD. Worldwide, IUDs (intrauterine devices) are the most popular form of birth control because they're 99 percent effective, never interfere with spontaneous lovemaking, and can be easily removed by a health care provider. They're even safe to use while breastfeeding. Talk with your health care provider about the pros and cons of different IUD brands. There are certain IUDs that can be left in place for 5 years, while others last as long as 10; however, be aware that the IUDs left in place longer may give you a greater risk of increased menstrual bleeding. You are a good candidate for the IUD if you are in a long-term, monogamous relationship and have had no recent STDs. Pelvic inflammatory disease from STDs can be more severe in women with IUDs. The type of IUD your provider will recommend for you will depend on your personal gynecological history.

Birth control pills. Even women who suffered side effects from birth control pills in years past might want to give them another try after having a baby. There are now dozens to choose from, and most have significantly lower hormone levels than pills manufactured in the past. The bottom line is this: If one birth control pill gives you side effects like headaches or breast tenderness, ask your doctor about switching to another. Of course if you're over 35 or a smoker, you'll want to choose another form of contraception since the Pill can heighten the chances of having a stroke.

Many providers suggest a progestin-only pill (the "minipill") while you are breastfeeding because the estrogen in combination pills may decrease your breast milk supply. This minipill is slightly less effective than regular birth control pills, however; for maximum effectiveness, it must be taken at the same time every day. Even then you might have some breakthrough bleeding. If you forget to take a pill, use condoms as a backup.

The Patch and vaginal ring. Like birth control pills, the Patch and vaginal ring rely on combinations of progestin and estrogen to keep you from ovulating and getting pregnant. Because the estrogen might interfere with milk production, these options are usually not prescribed for breastfeeding mothers. The skin patch is a tiny square of thin plastic that you wear on your upper arm, upper back, hip, or belly. Each patch lasts a week; you wear one patch at a time for 3 weeks in a row, then skip wearing a patch for a week to have your period.

The NuvaRing is a bendable 2-inch ring that you insert in your vagina for 3 weeks, then remove for 1 week; your period typically starts a few days later and lasts for a shorter time than your normal menstrual cycle. Then you insert a new ring and start the process over.

Both of these methods may have fewer side effects than the Pill because they release a slower, steadier stream of hormones. The same women who shouldn't take the Pill -- smokers, women with heart conditions, or women over 35 -- should look to another contraceptive method because they're more prone to strokes, heart attacks, and blood clots on these hormones.

Sterilization. If you and your partner are absolutely certain that this should be your last child, then you may want to consider either a tubal sterilization for you or a vasectomy for your male partner.

A tubal sterilization involves getting your fallopian tubes tied or having tiny, springlike devices inserted into them that trigger scarring and prevent sperm from traveling upward to meet your eggs. Both methods can be done in the delivery room after childbirth. Tubal sterilization typically requires anesthesia and a hospital stay. On occasion, tubal sterilization fails and you are at increased risk for ectopic pregnancy; after your tubes are tied, be sure to get a pregnancy test if your period is more than 2 weeks late. Vasectomies are simpler surgeries than tubal sterilizations because all that's involved is cutting the vas deferens, the tube that supplies sperm to semen. It's an outpatient procedure and your partner can usually go home the same day.

Both of these are considered permanent sterilizations, so it may be best to wait until after the birth of your baby, when your hormones have stabilized and your life has smoothed out somewhat, before making any final decisions.

Originally published in You & Your Baby: Pregnancy.

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