Birth control may be the absolute last thing from your mind if you have just given birth. But some healthcare providers will ask you about it before you even leave the hospital from your postpartum stay, and almost all will ask what method you’re using when you are seen for your postpartum follow-up office visit.
Having pregnancies very close together can be taxing on a woman’s body. Experts recommend waiting at least 18 months between babies to allow your body to recover. In fact, the average in the US is about 30 months between births.
So, chances are, you will decide you want to use some form of contraception in the months after your baby is born. What your healthcare provider might not tell you is that if you are a breastfeeding mom, your choice could impact your breastfeeding relationship.
Hormonal birth control containing estrogen can decrease milk supply and, thus, shorten the duration of breastfeeding. This includes not only the pill, but some injectable contraceptives, patches and IUDs. There are forms of hormonal birth control that may be safer for breastfeeding moms. The “mini-pill,” which is progestin-only, is safer for breastfeeding moms because it’s less likely to contribute to low milk supply. Progestin only birth control may also in the form of an injection, IUD or implant. If you’re not sure how your body will react to the hormonal contraceptive, you may want to steer away from injections since they cannot be reversed. If you are taking the pill and your milk supply drops, you can stop taking it, nurse more often, and use a backup form of birth control.
Barrier methods (condom, diaphragm) are, of course, compatible with breastfeeding, even if a spermicide is used. Male sterilization (vasectomy) will not impact breastfeeding, though female sterilization (tubal ligation, or “having your tubes tied”) can. Separation from your baby for the length of surgery and any potential post-surgical complications can mean less breastfeeding. While this may be easier with an older nursling who isn’t feeding often, it can cause supply problems when you are breastfeeding a newborn.
Natural Family Planning (and other forms of charting body changes to track fertility) is another method compatible with breastfeeding. Keep in mind, though, that some of your body’s signals may be a bit changed after birth and with breastfeeding.
Some people think breastfeeding itself can’t possibly be a form of birth control, but used correctly, the Lactation Amenorrhea Method (LAM) is as effective (if not more so) as the Pill or a condom. LAM has a 99.5% effectiveness rate when used perfectly, and a 98% effectiveness rate as it is typically practiced. In order to use LAM, you must be able to answer ‘yes’ to all three criteria:
- Your baby is younger than six months old.
- You have not started having your periods again.
- Your baby is breastfeeding often (day and night) and gets no other food or drink.
Once any of these three can be answered ‘no’, then you need to choose another method to prevent pregnancy.
It’s also important to note that some women ovulate before their first period. So it is definitely possible to get pregnant again without every experiencing a period. But for most women, the first menstrual cycles are anovulatory – no egg is released. This is especially true during the first six months postpartum. If you are nursing your baby frequently day and night, are not using a pacifier and comfort nursing, are not using any bottles, and are keeping your baby physically close throughout the day, your chance of pregnancy is almost non-existent in the first 3 months postpartum, and continues to very low for the entire time you are practicing this parenting style (as long as your periods have not returned). Once your periods return, you can assume your fertility has, as well, and you will likely need to choose some form of contraception.
Points to consider as you decide on a contraceptive choice include:
- How old is your baby? A younger baby is breastfeeding more often which may suppress your ovulation, but also a younger baby is more dependent on your milk and any decrease in supply can be problematic. Waiting until your baby is at least 6 weeks old before starting any type of hormonal contraceptive is recommended.
- Have your periods returned? If so, you’re likely fertile and the risk of pregnancy is increased.
- What contraceptives have you used in the past? Was it easy to use and were you happy with your choice at the time? Or do you feel you need to try something different?
- Have you had previous breastfeeding problems? If you experienced low milk supply with a previous baby, or if you have had prior breast surgery or any medical problems that impacted your milk supply, you may want to avoid any type of hormonal contraceptive to lessen the potential for problems.
- What are your future childbearing plans? If you don’t plan to have more children, you may choose a permanent means of contraception. But discussing child spacing with your partner is an important step in choosing the right contraceptive for your family planning needs.
Berens P, Labbok M. (2015). ABM Clinical Protocol# 13: Contraception During Breastfeeding, Revised. Breastfeeding Medicine 10(1): 3-12.
Riordan J, Wambach K. (Eds.). (2010). Breastfeeding and human lactation. Jones & Bartlett.
Van derWijden C, Brown J, Kleijnen J. (2003). Lactational amenorrhea for family planning. Cochrane Database of Systematic Reviews, Issue 4.
World Health Organization. (2015). Family planning / contraception. Fact sheet number 351. Accessed online at http://www.who.int/mediacentre/factsheets/fs351/en/.