The part that confuses many parents is that you don’t have to have your first postpartum period to get pregnant. You may ovulate two weeks before you even get your period, and so you may be fertile before you even realize it. And although many breastfeeding moms do experience a delay in their return to fertility, this is not always the case, Dr. Shirazian noted. All of this is why all postpartum parents should have an established and proactive birth control plan in place as soon as possible after their baby is born.
Intrauterine Devices (IUDs)
IUDs are small, T-shaped devices that are placed into your uterus. Their main job is to stop the sperm and egg from joining, and can be placed right after a vaginal or cesarean birth, or anytime in the postpartum period. There are two types of IUDs:
Hormonal IUDs release small, daily amounts of progestin into the uterus to prevent pregnancy, and can be kept in place for up to 5 years.Copper IUDs release small amounts of copper into the uterus, and can be placed longer, for up to 10 years.
Benefits
Once inserted, you don’t need to think about your IUD or remember to do anything with it. For some women, IUDs make menstrual bleeding and cramping more manageable. The hormonal IUD contains progestin, which is not known to negatively affect breastfeeding.
Side Effects
About 2 to 10% of users report that their IUD becomes dislodged or falls out depending on the type of IUD. Some women notice an increase of menstrual pain and bleeding. Hormonal IUD users may experience side effects such as nausea, increased headaches, change of mood, and breast tenderness.
Effectiveness
Typical failure rate is 0.8% for copper IUDs and 0.1-0.4% for hormonal IUDs.
Contraceptive Implants
Birth control implants are small, flexible rods about the size of matchsticks that are inserted into a woman’s upper arm. They release the hormone progestin to prevent pregnancy. Implants can be placed right after birth, or at any point in the immediate postpartum period. Nexplanon is the brand currently prescribed in the U.S.
Benefits
Contraceptive implants are a long-acting birth control method, secreting pregnancy-preventing hormones for up to three years. Implants typically don’t interfere with daily life or sex, and don’t require daily maintenance. Some women note a decrease in menstrual cramps and bleeding. The hormone secreted by implants, progestin, typically doesn’t interfere with breastfeeding or milk supply.
Side Effects
Heavy, unpredictable bleeding sometimes occurs with implant usage. Some women notice longer periods or bleeding between periods. You may experience depression, mood changes, increased headaches, or acne as well.
Effectiveness
Typical failure rate is .1% for contraceptive implants.
Birth Control Injections
Birth control injections that contain progestin can be given right after birth or in the immediate postpartum period. Shots are administered in your arm or buttocks, and must be done every 3 months. They work by inhibiting ovulation, and the most well known brand of progestin-only birth control injections is Depo Provera. There are also combined birth control injections that contain both progestin and estrogen, but these are not recommended postpartum.
Benefits
Progestin-only injections don’t interfere with sex, though it is important to remember to get a new injection every 3 months. Progestin-only injections typically don’t decrease milk supply or interfere with breastfeeding. Almost all postpartum women are able to get progestin-only injections.
Side Effects
Some women experience bone loss after using a birth control injection, though the bone loss is usually reversed once the birth control is stopped. Women who are at risk for cardiovascular disease should not use birth control injections. Some women experience headaches, weight gain, and irregular bleeding while using birth control injections.
Effectiveness
Typical failure rate is 4% for birth control injections.
Birth Control Pills
There are two types of birth control pills:
Progestin-only pills (often referred to as the “mini-pill”)Combined birth control pills (estrogen and progestin pills)
Progestin-only birth control pills are usually preferred for postpartum moms. These pills must be taken at the same time each day, and work by preventing fertilization.
Benefits
Progestin-only pills may decrease your menstrual flow or cause it to disappear altogether. They don’t interfere with sex, but you do have to remember to take them on a daily basis and at the same time each day. Skipping even one pill increases your chance of pregnancy. Progestin-only pills are often the pill of choice for breastfeeding moms, as they typically don’t interfere with milk supply.
Side Effects
There are certain women who should not take progestin-only pills, including smokers, women with a history or risk of breast cancer, migraine sufferers, and women who experience blood clots or high blood pressure. Progestin-only pills typically cause fewer side effects than combination pills; side effects may include headaches, nausea, and breast soreness.
Effectiveness
Typical failure rate is 7% for progestin-only pills.
Barrier Methods
Barrier methods work by blocking sperm from entering a woman’s body. There are five basic kinds of barrier methods: Condoms and spermicide are the only recommended barrier methods in the immediate postpartum period: cervical caps, diaphragms, and sponges usage should be delayed for about 6 weeks, until the uterus and vagina have returned to normal size. Because your vagina may have changed shape after birth, you should be refitted for your cervical cap and diaphragm.
Benefits
Condoms can protect against STDs, and all barrier methods do not include hormones, which is helpful for women who are concerned about hormonal birth control effects. Barrier methods also will not interfere with breastfeeding or milk supply.
Side Effects
Some women may be allergic or become irrigated by spermicide or condoms. Many women find that barrier methods like diaphragms and cervical caps messy and uncomfortable. For sleep deprived, distracted postpartum mothers, barrier methods may be harder to remember to use consistently.
Effectiveness
Typical failure rate is:
Condoms: 13% (male condoms), 21% (female condoms)Diaphragms and cervical caps: 17%Sponges: 14% if you have never had a baby; 27% if you have had a babySpermicide: 21%
Lactational Amenorrhea Method (LAM)
The lactational amenorrhea method (LAM) is based on the idea that the hormones of breastfeeding delay a woman’s ovulation and period. However, this is only the case if breastfeeding is exclusive, frequent (including at night), no supplemental food or formula is given, your periods have not returned, and your baby is under six months old. Even then, some women do get pregnant using this method, because all women react differently to the hormones released during breastfeeding.
Benefits
The lactational amenorrhea method (LAM) is free, doesn’t require hormones, and is quite effective for some women.
Side Effects
There are no side effects, except for the fact that the risk of failure when it comes to this method is quite high. If you begin skipping nursing sessions, spend long periods separated from your baby, or your baby begins sleeping long stretches, it is time to choose a different birth control method.
Effectiveness
In Dr. Shirazian’s experience, LAM is roughly 50% effective as not all women follow the guidelines properly, and women are usually unable to determine if they are ovulating or not.
Sterilization
Most postpartum women will not make the decision to pursue sterilization after childbirth, but depending on life circumstances, this may be a good option for you. There are two types of sterilization:
Benefits
Sterilization methods are non-hormonal, do not interfere with breastfeeding, and are permanent.
Side Effects
You have to be sure you are done having children if you are considering sterilization. Although sterilization can be reversed, reversals are not always successful.
Effectiveness
Typical failure rate is:
Tubal ligation: 0.5%Vasectomy: 0.15%
Options to Avoid
Dr. Shirazian strongly advised not using any birth control containing estrogen in the first 6 weeks postpartum, as these can strongly increase your risk of blood clots, a serious postpartum condition that can develop into a medical emergency. Estrogen-containing birth control may also decrease milk supply for some breastfeeding mothers.
Birth Control Methods Containing Estrogen
Combination birth pillsVaginal ringsBirth control patch
In addition, Dr. Shirazian cautions against Natural Family Planning birth control methods, including the Lactational Amenorrhea Method (LAM), because of the risk of misuse and user-error. If you are planning on using a diaphragm in the postpartum period, you should wait until about six week postpartum, and then make sure to get refitted.
A Word From Verywell
Wading through a long list of birth control option can feel overwhelming and confusing, especially as you are acclimating to life as a new mom. You should feel free to discuss your concerns and questions with your healthcare provider – they are there to help you. Whatever the case, postpartum birth control isn’t something you should put off, even if it feels tempting to do so. There is a suitable and user-friend method for each family, and you will gain tremendous peace of mind knowing you have solid plan in place.
