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| |    Postpartum Birth Control Options by Marjorie Greenfield, M.D. reviewed by Laura Jana, M.D., F.A.A.P. While sex may not be on your mind when you leave the hospital with your newborn, chances are it will once again become part of your life in the future. Whether you want more children but would like to space them out, or you have completed your family, here are some practical tips for choosing the right method of birth control for you. Breastfeeding Breastfeeding all on its own acts as a pretty good contraceptive. For a number of months after your baby is born, if you are not having periods and if the baby is feeding exclusively on breast milk, your lactational amenorrhea (the absence of ovulation and menses due to breastfeeding) is 98 percent effective in preventing pregnancy. If a 2 percent chance of getting pregnant is acceptable to you, breastfeeding alone is a reasonable contraceptive for six months. After six months, it's fairly common for ovulation to take place in women who are nursing. Once your periods return, fertility quickly resumes and you will need to use another method of birth control. Even if your periods have not resumed, after six months an additional contraceptive is recommended. Some women do not ovulate until they completely wean the baby, but sometimes the first ovulation takes place before a new mother gets her first period since childbirth. In fact, it's possible to conceive after childbirth without ever having gotten a period. Bottle-feeding mothers can recover their fertility very quickly after childbirth and have been known to be pregnant already by the time of the six-week postpartum checkup. If you are not breastfeeding, effective contraception is needed for every act of intercourse after your baby is born. Relative abstinence Many new parents do not have sex as frequently as they once did before having their baby. New moms are often physically uncomfortable, and many women note a decrease in their sex drive. In addition, both parents may be distracted and exhausted. For many couples, this means that an everyday method of birth control like the Pill or a shot may seem unnecessary. Of course, relative abstinence is not an adequate birth control method in and of itself--remember, you only have to have sex once to get pregnant. Barriers and spermicides Barriers to sperm, such as condoms or the diaphragm, are a good choice for many couples. If sex is infrequent, you only have to use the method when it is actually necessary. Many women who are breastfeeding and who have not had a period since childbirth go with a method that is not usually considered that effective--like spermicides alone--since combining it with lactational amenorrhea provides excellent contraception. But if more than six months have passed since the baby was born, and particularly if your menstrual periods have resumed, a more effective method, such as using condoms plus a spermicide, is needed. The diaphragm is a fairly effective method of birth control, but it must be refitted after childbirth. Often at the time of the six-week checkup, the upper wall of the vagina is still too relaxed to get the diaphragm to fit properly. However, by three months postpartum, the vaginal tone has returned and the diaphragm usually can be fitted appropriately. Birth control pills Standard oral contraceptive pills contain estrogen and a progestin. While the progestin does not interfere with breastfeeding and apparently does not harm the baby, estrogen can diminish the quantity and quality of breast milk and so is generally not recommended for use during the first six months of breastfeeding. The mini-pill The progestin-only birth control pill, or the mini-pill (such as Micronor, Nor QD, or Ovrette) is an oral contraceptive that does not contain estrogen. It is slightly less effective than standard birth control pills, but it works very well when combined with breastfeeding. Keep in mind that the mini-pill and regular oral contraceptives have some important differences. Progestin-only pills do not control common aspects of the menstrual cycle, so if you typically have heavy or irregular periods, they'll likely remain heavy or irregular while you're on progestin-only pills. You will get whatever menstrual periods you were going to get anyway (unlike combination oral contraceptives, which tend to produce lighter, more regular cycles). Your period may not come at all, or it may come at any point in the pack of pills. Every pill in the pack contains medication; there are no sugar pills (placebos) like there are in combined estrogen-progestin pills. And timing for taking the pills is much stricter than with regular pills. You must take every pill in the pack, and take it within six hours of when it is due, in order to be protected. Without the contraceptive protection offered by breastfeeding, it's best for bottle-feeding mothers to use the more effective combination birth control pills. Injectables and implantables You can also get great protection from pregnancy with injectable (depo-Provera) or implantable (Norplant) progestin-only hormonal contraceptives. The first dose of injectable can be taken before you even leave the hospital after giving birth. As for implantable contraceptives, some physicians will insert them right after childbirth as well. Neither method interferes with the quantity or the quality of breast milk. Intrauterine device The intrauterine device, or IUD, is a small plastic, T-shaped implement that is inserted in the uterus by a physician under sterile conditions. It works quite well but is somewhat expensive. While it can be put into place immediately after childbirth, afterbirth contractions cause a high rate of expulsion. Most physicians wait at least six weeks after childbirth before placing an IUD. It's often a good choice for couples who want long-term protection against pregnancy but are not yet ready to choose sterilization. Postpartum tubal ligation Getting your tubes tied can be done within a day or so after your baby is born. The tubes are reached through a surgical incision, usually made just below your navel, and then tied off or cauterized. If you had an epidural for labor, the catheter could have been left in place and a stronger anesthetic dose given when the time came to perform the procedure. If you did not have an epidural, one can be put in for the tubal ligation or you can have a spinal or other anesthetic for the surgery. If a cesarean was performed, the tubes could have easily have been tied before doctors closed up the abdominal incision, adding only a few extra moments in surgery without virtually any increase in risk.
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