Birth Control after Pregnancy - What are My Options?

Birth Control after Pregnancy 

    Congratulations on your new baby! The first few months are exciting but exhausting times. Whether this is your first baby or your fourth, it is normal for every mom to feel stressed, worried and overwhelmed.  There is so much to think about and decide. Two things you know for sure though, are that you are not ready to get pregnant again, and you want to breastfeed the baby.  So what birth control after pregnancy options are even available to you??

1. Breastfeeding as Birth Control

    This is sometimes referred to as LAM (Lactational Amenorrhea Method) and is a natural way to prevent pregnancy after giving birth. It is effective, (only 1 in 100 will become pregnant if this method is used correctly), safe, convenient, and free. You can do this for up to six months after giving birth. In order for this to be effective, a mother needs to breastfeed her baby exclusively. When a mother breastfeeds continuously, a hormone that leads to ovulation is suppressed. She must breastfeed every 4 hours during the day and every 6 hours at night. When the baby is 6 months old, another form of birth control should be started.

2. Options Containing Estrogen

    The birth control after pregnancy options that have the hormone estrogen in them include:

  - combination birth control pills (taken daily)

  - the NuvaRing (3 weeks intravaginally, one week out before inserting a new one)

  - patch (change the patch weekly x 3 weeks, then 1 week off)

    Usually, but not always, the estrogen in different forms of birth control options can decrease your milk supply. Breastfeeding mothers will usually want to stay away from these estrogen containing choices, as they have the potential of curbing of their milk supply. Should you choose an estrogen type birth control anyway, or if you still had great milk supply in a previous pregnancy while on this type of birth control, these can still be prescribed to you, however you need to wait until at least 6 weeks postpartum (to decrease the chance of a blood clot while in the already hypercoagulable state of pregnancy.)

 

3. Options Containing Progesterone

    Numerous studies have shown that taking exogenous progesterone does not affect milk supply, which is great news for breastfeeding moms. There are many choices of progesterone only birth control, including:

  - progestin-only oral contraceptive pills ("mini-pill") taken daily

  - Intrauterine device (Mirena, Skyla) effective for 3-5 years

  - Nexplanon implant,effective for 3 years

  - Depo Provera shot, given every 3 months

    These progesterone only forms can be started immediately after giving birth, and vary depending on your doctor's preference. I tend to start the depo provera in the hospital, or give a prescription for the mini pill upon discharge. The Mirena IUD or Nexplanon implant can be inserted during the 6 week postpartum visit

4. Copper IUD

    This type of IUD does not have any hormones and is effective for up to 10 years after insertion. The copper does not affect milk production.

5. Barrier Methods

    Condoms - Can prevent pregnancy if used the right way every time and can be combined with a spermicide (does not have hormones), that decrease chance of pregnancy further.

    Diaphragm - Although not as popular as in the past, a diaphragm also prevents pregnancy and can be combined with a spermicide. Your doctor can fit you for it after 6 weeks postpartum to give your body time to heal and get back to normal after childbirth.

    Cervical cap - This device covers the cervix and can also be fitted at your 6 week postpartum visit or later.

6. Permanent Birth Control Methods

    Some women know that they do not want any more children after the birth of their baby and are interested in permanent forms of birth control. These options include:

    - Tubal Ligation - Some practitioners will do a postpartum sterilization after the baby is born during the same hospital stay, others (like in my practice) will wait until at least 6 weeks postpartum and have the patient come back for an outpatient procedure. This will most likely be done laparscopically. The tubes will either be cut off, coagulated or clipped. It can also be done at the same time as a cesarean section, whether it is a scheduled or emergency section. Recent studies have shown that ovarian cancer often begins in the fallopian tubes and a tubal ligation will decrease the chance of getting ovarian cancer.

    - Vasectomy - Thought of as less invasive than a tubal ligation, some families will prefer this permanent option.

    Although there are tubal reversal surgeries and vasectomy reversal surgeries, they are not always successful and there are risks with any surgery. Therefore, before a tubal ligation or vasectomy is performed, the patient should be 100% sure that they do not want any more children.

    Your prenatal visits are a great time to discuss birth control after pregnancy. This will give you and your doctor adequate time to discuss your reproductive goals, and to pick the type of birth control after pregnancy that is the best fit for you and your family. Discussing your options beforehand will also give you one less thing to worry about after the baby is born.

    Please contact your OBGYN with any questions you have. That is why we are here!

    Dr. Jessica Katz, MD is an obstetrics & gynecology doctor who practices in Cleveland, OH.

    Nurtured Foundation Doula Services is a full service doula agency. To learn more about everything we offer, please feel free to contact us here, or call is at 216-409-5403