Choosing a contraceptive may not be first and foremost on your mind immediately after having a baby. But you can become fertile again within weeks of your baby's birth, especially if you are not breastfeeding. And having an unintended pregnancy at this time could be very stressful. Therefore, it is a good idea to start thinking about birth control even before you may be ready to resume intercourse.
The decision is multi-faceted. You may be concerned that your previous method is incompatible with breast-feeding, or that you need something more in tune with your busy schedule as a new mom. Discuss the matter with your spouse, your health care provider, and keep the following information in mind.
If your family is complete, you may want to consider getting a tubal ligation. This is not the same as a hysterectomy. It is a minor surgical procedure where the doctor cuts and ties off the fallopian tubes so conception cannot take place. Otherwise, all of the reproductive organs remain intact and you will still menstruate. This procedure can be done immediately postpartum and will not affect breastfeeding.
Alternatively, dad can opt for a vasectomy, which will make him infertile but won't affect his ability to have an erection or ejaculate. It is a much simpler surgical procedure than a tubal ligation, carries less risk and is usually performed under a local anesthetic.
If permanent birth control is not an option at this time and you are not breast-feeding, contraceptive choices are limited only by personal preference and health history. "Regular birth control pills can be started at two weeks postpartum," says Pat Sonnenstuhl, ARNP, CNM, MS, a midwife and women's health care consultant in Olympia, WA. "Low dose progestin can be started sooner. If a woman wants Depo-Provera, the injection can be given while she's still in the hospital".
Norplant, another type of hormonal agent, can also be inserted under the skin of the arm in the immediate postpartum period, says Sonnenstuhl. "But IUDs (intrauterine device) are contraindicated until six to eight weeks postpartum".
The breast-feeding mom has nearly as many options available as the new mother who chooses to bottle-feed her baby. While it is controversial, breast-feeding in and by itself can be an effective method as it does suppress fertility. However, a woman must be completely committed to breast-feeding if she wants to be totally dependent on this method.
"If a mom only breast-feeds, it can be a reliable method of birth control," says Sonnenstuhl. But she emphasizes that not too many women are totally committed to this. "In many cultures it is a good method. But in the U.S. there are so many other factors involved, it seems less reliable".
For breast-feeding to be effective, a baby must be younger than six months and a woman must be without a menstrual period. If she sees any blood past her 56th postpartum day, she must assume that she is getting a period and that fertility may be returning. The baby must be exclusively breast-fed and must nurse often - at least every four hours in the daytime and every six hours at night. Once a baby starts sleeping through the night, the lack of stimulation can cause fertility to return. If a new mom meets all of the above criteria, then breast-feeding may be 98 percent effective in preventing conception, which puts it on par with the birth control pill.
Breast feeding moms can safely use barrier methods such as the diaphragm and condom. Progestin-only hormonal methods, such as Depo-Provera, Norplant and the mini-pill, are also generally considered safe and have not been known to cause any adverse effect on milk supply. But regular combination hormones, such as standard birth control pills, are controversial.
"I don't prescribe regular birth control pills for breast-feeding moms as it can decrease milk supply and also give the baby lots of synthetic estrogen," says Sonnenstuhl. "I prefer the mini-pill as long as the mom can tolerate it. Women like it better because they have less side effects". But, she warns, it is also slightly less effective.
All in all, the best method is one that both a woman and her partner agree on and will adhere to, and which will fit most appropriately into their lifestyle.
