Birth Control Postpartum: What You Need to Know
Nine months without a period was oh so nice but now that baby is here it looks like Aunt Flow is back. If choosing birth control wasn’t complicated enough before having a baby, after having a baby it can feel even more overwhelming. Post-baby, there is so much more to think about including how your body has changed, your breast milk supply and your baby are now part of the birth control conversation. But have no fear, Dr Zen is here! In today’s blog, I will be breaking down a few different birth control options that may be suitable for you weeks to months after having a baby.
Whether you loved being pregnant and can’t wait to have another baby or if after going through labor you realized you aren’t sure if you want to do that again, it is important that in order to reduce your risk of pregnancy-related complications, it is recommended to wait at least 12 months between pregnancies.
Now although shortly after giving birth you may be wondering how the heck you will ever be interested in sex again, intimacy is a really important way we connect with our partner and when the time is right, you will be ready. Your doctor will generally suggest you do not have intercourse for at least 6 weeks postpartum. That being said, since it is recommended that you wait at least 12 months between pregnancies, finding a suitable form of birth control can be helpful.
Since non-breastfeeding women can start ovulating as early as 25-27 days after birth, deciding which form of birth control you want to use is imperative to avoid unintentional pregnancies within the first 12 months postpartum. Again, not every woman will ovulate so quickly and in fact the average for non-lactating women seems to be closer to 45 to 94 days postpartum. And for my breast-feeding mamas, there is still the potential of getting pregnant while nursing. This is important because since ovulation happens two weeks before your period, you may ovulate in the same month your period returns and if you have unprotected sex, there is the possibility of getting pregnant. Since ovulation comes before your period, it is also the reason why the Fertility Awareness Method may not be as effective. If you plan on using the Fertility Awareness Method, I recommend using barrier methods in conjunction.
When Should I Start Birth Control Postpartum?
According to ACOG guidelines, it is recommended that you wait at least 6 weeks after giving birth to start any form of combined hormonal contraceptive. We suggest waiting at least 6 weeks because estrogen-containing medications (like combined birth control) may increase your risk of venous thromboembolism (VTE) which is a form of blood clots seen most commonly postpartum.
Choosing the “right” form of birth control for you is very individualized and can depend on many factors including, whether you are breastfeeding or not, medical history, and so much more. This is also why just because your friend, sister or mother-in-law did something one way, doesn’t mean that same choice is right for you. Consulting with your doctor about your unique case will better help you make the decision that is ultimately right for you.
Can Birth Control Affect Milk Supply?
Combination Hormonal Contraceptives
Birth control often comes as a combination of both estrogen (estradiol) and progestin (synthetic progesterone) and come in the delivery forms including:
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Oral Tablet
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Transdermal Patch
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Vaginal Ring
Although combination hormonal contraceptives are some of the most popular forms of birth control on the market and are likely something you have been on before having a baby, combination hormonal birth control should be taken with extreme caution, especially in breastfeeding mothers. This is because researchers believe there is a small risk that estrogen may inhibit prolactin, the hormone made by your brain to stimulate breast milk production. This is also the reason why combination hormonal contraceptives are typically not recommended for breastfeeding moms in early postpartum. And even if you are not breastfeeding, the WHO recommends delaying combination hormonal contraceptives until at least 6 months postpartum. So again, in short, chances are, combination hormonal contraceptive is not your ideal choice, especially in early postpartum.
Which Birth Control is Best for Breastfeeding Moms?
Progestin Only Contraceptive
Progestin, not to be confused with natural progesterone, is exactly as the name sounds, it is a form of birth control that contains only progestin. Progestin only birth control does not contain estrogen and is the reason it is often a preferred choice especially for postpartum mamas. Progestin can come in the form of a pill, injection or implant. It is recommended by the WHO to delay progestin-only injections until about 6 weeks postpartum. That being said, progestin-only oral tablets can be started immediately after birth and have not been shown to impact breast milk production. Again, progestin is a synthetic hormone, so for mamas looking for a non-hormonal options, this may not be their preferred choice.
Vasectomy
Let’s not forget it takes two to tango! This is something that is really important to address and could be an option depending on your future family plans. If you are not wanting any future children, a vasectomy is a surgical procedure that provides a permanent contraceptive option for men. The upside of a vasectomy includes it is highly effective (less than 1 percent failure rate) and is a minimally invasive outpatient procedure. I do want you to make sure you are completely done having children before selecting this option as although vasectomies are sometimes reversible, I have seen too often reversals being unsuccessful or requiring additional fertility treatments including IVF, if couples decided they wanted children later. But again, if you are sure, than this is a great option that involves no hormones and can allow your body to cycle naturally, which is a huge win.
Intrauterine Devices (IUD)
Intrauterine devices (IUDs) can come both as hormone or non-hormonal options and can be inserted shortly after birth. copper IUDs (which are non-hormonal) have not been found to affect milk supply or breastfeeding. Although the Society of Family Planning notes IUDs are safe to be used even within 10 minutes of delivery of the placenta, most doctor suggest you wait at least 6 weeks to reduce the risk of displacement of the IUD since the uterus typically takes about 6 weeks to contract back to its original “pre-pregnancy” size. Although an IUD’s expulsion rate (i.e IUD can fall out) is about 3-10% in non-postpartum women, it is estimated that between 10-40% of IUD placed postpartum can fall out. Again, if you wait 6-8 weeks postpartum, this reduces your risk of expulsion.
Can I Get Pregnant If I Am Breastfeeding?
Lactational amenorrhea method (LAM)
The lactational amenorrhea method is the idea of using breastfeeding as a form of contraceptive. In the LAM method, women must be amenorrheic (haven’t gotten their period postpartum) and can not use supplementary feeding or breast pumps for up to six months after delivery. LAM was originally thought to be a useful method as it is thought that an infant’s suckling results in a reduction of pulsatile secretion of gonadotropin-releasing hormone (GnHR) and luteinizing hormone (LH) which in turn would suppress ovulation. Although this method can be helpful, 20-56% of fully nursing women are not amenorrheic (which means they have gotten their period back) by six months postpartum. It is also true that many women will stop exclusively breastfeeding prior to six months, so again the LAM method may not be useful in your particular case. Please remember that in order for LAM to work, you can not have had the return of your period (not even once) postpartum and you must be breastfeeding exclusively, which may not be your postpartum experience.
Barrier Methods
In general, barrier methods are by far the most popular form of birth control postpartum, especially for those wanting to have more children in the future who are not looking for a permanent solution like a vasectomy and who are not interested in hormonal birth control options. Male condoms are generally the preferred method, since diaphragms and cervical caps are generally not as effective especially early in postpartum as the uterus continues to return to it’s “pre-pregnancy” size in the first six weeks. Condoms, specifically male condoms are said to be 98% effective at preventing pregnancy when used correctly. However, according to Planned Parenthood, people aren’t perfect, so in reality condoms are most likely about 85% effective. Its also important to note that not all condoms are created equal. In fact, making sure to use fair-trade non-toxic condoms like Sustain Natural can help reduce the risk of irritation, yeast infections and were developed without interfering with the normal vaginal pH. You can also use condoms in conjunction with some of the other forms of contraception for additional efficacy and support.
About the Author: Meet Dr. Zen
Alissia Zenhausern- Pfeiffer, NMD, FABNE, (commonly known by her patients as Dr. Zen), is a licensed naturopathic doctor board certified in naturopathic endocrinology and the founder of NMD Wellness of Scottsdale, a premier naturopathic medical practice that focuses on helping women to take a proactive approach to their hormone and fertility health. Dr. Zen has been featured as a lead expert in Forbes, Shape Magazine, and Instyle and is deeply passionate about bridging the gap between traditional and natural medicine in the world of fertility. She works with a variety of hormone related issues including PCOS, endometriosis and unexplained infertility. Her goal is to help more women get back into the driver’s seat of their own health to make lasting transformational changes to their health to bring more cute and adorable babies into this world. Read More About Dr. Zen...
