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?
If a combined oral contraceptive pill was used pre-pregnancy this is not recommended postnatally if breastfeeding as is can result in suppression of milk supply. Rather a progestogen-only pill can be used, 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 you should switch to a combined oral contraceptive pill as this is more effective.
Another hormone option is the Mirena IUCD. This is very effective and has a life of 4 – 5 years after being inserted. 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.
NuvaRing is a newer contraceptive on the market. It is a vaginal ring that estrogen and progestogen hormones, which work together to prevent your ovaries from producing mature eggs. The ring is kept in the vagina for 3 out of 4 weeks with a new ring being used each cycle
There are also the barrier methods of contraception – condoms and the diaphragm. The diaphragm needs to be fitted so you have the correct size.
If your family is complete then permanent contraception should be considered – tubal ligation or vasectomy. 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.
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.