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Contraception after having a baby

I thought I couldn’t get pregnant when I was breastfeeding?

This is a question that I have been asked many times in my career as a private consultant obstetrician and private gynaecologist. For some another pregnancy so soon after giving birth is a manageable surprise but for others it can be a disaster, putting strain on the family. An unwanted pregnancy soon after childbirth can put you into a very difficult situation when hormone levels may already be affecting mood and a pregnancy so soon after a recent one may not be easy emotionally, physically or financially. If the gap between your pregnancies is less than a year then you also have an increased risk of having your baby early and possibly of having a low birthweight baby.

Contraception is probably one of the last things on your mind when you are pregnant or have just given birth, but it is important to do some forward thinking about it to avoid being in the situation where you are faced with an unplanned pregnancy whilst caring for a young baby. We know from national statistics that one in three pregnancies are unplanned, and that 50% of women have had intercourse before the six week check. Until recently this check was when contraception would be discussed, but at the Birth Team, we discuss contraception before discharge from hospital, reducing the risk of unplanned pregnancies.

How does breastfeeding affect fertility?

Breastfeeding is accompanied by an increase in the hormone prolactin which is made in the brain, stimulating breast tissue to make milk. At the same time oestrogen levels usually fall, reducing the function of the ovaries where eggs are stored, made and then released. This doesn’t mean that NO eggs will be released though, and even if you are exclusively breastfeeding i.e. not supplementing any feeds with formula milk or solid food, there is still a chance that ovulation can happen.

This fall in oestrogen levels may reduce a woman’s libido (sex drive) as well as making the vagina drier and the vaginal tissue thinner and feel uncomfortable, obviously increasing any residual pain from any healed stitches the mother may have had.

This temporary physical discomfort and dryness in association with postnatal tiredness, a changing body and meeting the demands of a newborn often quite understandably removes the desire for intercourse for a while, but not all women feel that way – some new mothers are ready to resume having sex and in this case contraception becomes very important unless they are planning on having their babies very close together. Although womens’ bodies in the main cope well with this there are disadvantages and ideally pregnancy is best planned after optimising health and losing any extra remaining post baby weight.

What contraception can be used when breastfeeding?

Some types of contraception are not suitable for breastfeeding mothers because they may reduce milk quality and quantity and can pass through to the baby. This mainly refers to the combined oral contraceptive pill.

An alternative when breastfeeding is the mini pill which is made of a type of progesterone hormone. It is important that it is taken daily without a break. Forgetting mini pills is much riskier than forgetting the normal pill and you should try and take it at the same time every day. It can usually be started almost immediately after normal birth.

It can be as long as 10 weeks post birth before your period starts, and if breastfeeding you may not have a period at all until you stop. Some women have periods taking the mini pill and some don’t. Long acting progesterone contraception, including the Mirena coil, implant into the arm and Depo injection can be started almost immediately after birth.

Condoms can be used as per normal but remember they should be put on before any penetration.

It is important to remember that vaginal birth may change the size and shape of your vagina and if you use a diaphragm (cap) then the fit needs to be checked before relying on it.

What if you are not breastfeeding?

Artificial feeding means there are no restrictions on types of contraception; the combined oral contraceptive pill generally can be started 6 weeks after normal birth or with the first period which can be 10 weeks post birth if there are no contraindications to taking it.

Progesterone coils are often inserted at the 6 week check although if birth was by caesarean then insertion of any coil is generally delayed until 12 weeks have passed, similarly a standard coil can be inserted at 6 weeks after normal delivery or 12 weeks after Caesarean. In the next few years, having a coil inserted may be possible at caesarean section or following delivery of the placenta after a normal birth, which is already happening in the USA, but not here yet.

The non-hormonal coil is not as effective as the hormone containing coil, periods are generally heavier and the risk of infection is greater than with the IUS.

Withdrawal prior to ejaculation and using the perceived timing of a menstrual cycle have a much higher failure rate and are not to be relied on.

Remember failure of contraception is often a failure to use it!!

If your family is finished then an option to consider may be a permanent solution such as sterilisation. Female sterilisation is effective after one menstrual cycle but vasectomy may not be effective for 3 months and generally a sperm analysis is needed before the all clear is given.

Finally for those couples who needed IVF or other methods of assisted conception then unless they were told that fertility was not possible because of NO sperm or completely blocked or absent tubes, they may find that a pregnancy has normalised their fertility and conception can happen – a natural conception very soon after the birth of an IVF conceived baby is quite a common occurrence so beware unless that is your plan!

Prior to leaving hospital, it may sound odd but good medical and midwifery practice means that contraception should be discussed.

At The Birth Team we are here to discuss contraception and pregnancy planning in the private gynaecology clinic as well as care for you during private pregnancy and delivery.