When do I need contraception after I have had my baby?
Breastfeeding will give some protection, especially while you are fully breastfeeding. Breastfeeding should not be relied on exclusively, as unplanned pregnancies do occur while breastfeeding and even before your first period.
What are the options?
A combined oral contraceptive pill is an option if you are not breastfeeding. If you are breatsfeeding a combined pill is not recommended as is can result in suppression of milk supply. After ceasing a combined comtraceptive pill it can be a quite a while before you resume ovulation.
A progestogen-only pill is recommened if you are breastfeeding as it is less likely to reduce milk supply. Occasionally a progestogen-only pill can cause nuisance bleeding. Also, it must be taken within the same 3 hours time period each day to be effective. When you stop breastfeeding and if you don’t want to have another baby yet, you should switch to alternative contraception such as a combined oral contraceptive pill as this is more effective. Most women still ovulate while taking a progesterone-only pill and so there is usually no extra delay in conceiving when you stop it.
The Mirena IUCD is another progesterone based option, that can be used if breastfeeding. This should not reduce your milk supply and so can be inserted when breast feeding. This is very effective and has a life of 4 – 5 years after being inserted into your uterine cavity. It can be removed at any time and when you decide to have another baby. It can occasionally cause some initial nuisance bleeding especially in the months immediately after insertion, and very occasionally emotional liability and depression. Pelvic infection and unplanned pregnancy would be less often than with other types of IUCD. Menstrual loss is reduced dramatically usually with the Mirena IUCD. Often there are no periods.Most women still ovulate while having a Mirena IUCD in situ and so there is usually no extra delay in conceiving when it is removed.
The Copper IUCD is no longer popular since the Mirena IUCD has been introduced. A copper IUCD can be used if breastfeeding.The Copper IUCD has a higher failure rate (about 3 in 100), can cause pelvic infection and is assocaited with heavier periods. Women still ovulate while having a Copper IUCD in situ and so there is usually no extra delay in conceiving when it is removed.
The Implanon Rod is another progesterone based option, that can be used if breastfeeding. it is inserted unto your arm below the skin. It should be replaced each 3 years. Amenorrhoea (no periods) happens in about 1 of 5 women while another 1 of 5 women report frequent and/or prolonged bleeding. The Implanon Rod stops ovulation and so there can be extra delay in conceiving after it is removed.
Depo-Provera is progesterone intramuscular injection given each 3 months. It can be administered if breast feeding as it should not reduce your milk supply. While being very effective in preventing pregnancy it is assocated with bleeding which can be heavy. It can also result in amenorrhoea. After ceasing the injections it can be a quite a while before you can resume ovulation.
The barrier methods of contraception – condoms and the diaphragm. The diaphragm needs to be fitted by a gynaecologist so you have the correct size. While the diapragm is no longer popular, condoms are currently of increasing popularity .This is because women are now less inclined to use hormonal methods of contraception. Women still ovulate while relying on barrier contraception and so there is no extra delay in conceiving after ceasing barrier contraception.
Natural family planning. That is where you time intercourse so you avoid doing it around ovulation time. It can only be relied on after you start menstruating. You will ovulate two weeks before your first post-pregnany period and you can’t predict when you will have your first period. Natural family planning will not interfere with breastfeeding or delay conceiving.
Tubal ligation or vasectomy. If your family is complete then permanent contraception should be considered. A tubal ligation can be done at the time of a Caesarean section as long as you are certain your family is complete, irrespective of the outcome of this pregnancy. Your husband / partner can have vasectomy even before you deliver, if you are certain there will be no more pregnancies. Then he can use up residual sperm in his system with sexual intercourse before you deliver.
If you had difficulty conceiving this time then for most it does not necessarily mean you will have difficulty next time.
Contraceptive options will be discussed in detail at your postnatal visit. I will then be able to assist you in obtaining contraception support which is in accord with your wishes and which is suitable for you.
If you have contraceptive needs prior to this visit please let me know.
