The arrival of a baby, in addition to bringing joy and pleasure, greatly alters your habits and lifestyle. However, it is important to discuss your expectations and your desires about resuming your sexual activities after childbirth with your spouse. In addition, you need to think about the contraceptive method that would suit you best. To help you to do this, it is a good idea to talk to your doctor before your newborn arrives.
Fertility can return quickly after childbirth. Ovulation can take place as early as the 25th day after birth. If you are breastfeeding, this period may be longer.
If you are breastfeeding exclusively…
Exclusive breastfeeding as contraception is called the LAM method ( lactational amenorrhea method). Contraceptive efficiency of 98% to 99% can be obtained if all of the following criteria are met :
- Breastfeeding on demand: day and night, maximum interval of four hours during the day and six hours at night;
- Exclusive breastfeeding: baby receives no solid foods or liquids other than milk taken directly from the breast (so the use of a breast pump can reduce efficiency). Some books say that efficiency can be maintained if supplements are only given for a maximum of 1 to 10 feedings;
- Absence of menstruation: no bleeding two days in a row after the 56th day after birth;
- Less than 6 months have elapsed since birth.
We usually recommended an additional contraceptive method after 3 months because of the difficult of assuring every conditions of exclusive breastfeeding. Then the LAM method could be less effective. The contraceptive methods involving estrogens can limit the quantity and quality of maternal milk.
If you are partially breastfeeding…
The use of a contraceptive method 3 weeks after the spouse is highly important, whether or not you breastfeed or not.
The contraceptive efficiency of breastfeeding will be lower. Many women who are breastfeeding but not exclusively or who want to increase the effectiveness of the LAM method will combine it with another compatible contraceptive method. The contraceptive methods involving estrogens can limit the quantity and quality of maternal milk.
Barrier methods
The condom is the barrier method of choice. There are no restrictions and it can be used as soon as sexual activity is resumed. Note that the hormonal changes caused by breastfeeding can also lead to vaginal dryness in some women and so you shouldn’t hesitate to use a water-based lubricant with this method.
The diaphragm, the cervical cap and the contraceptive sponge should not be used before 6 weeks postpartum because there is a risk of developing toxic shock syndrome. Also, you should know that the cap and the sponge are less effective in women who have already given birth. It is important to take (or retake) measurements of the vagina or cervix before prescribing a diaphragm or a cap. This should be done by a doctor who has adequate training (available at the birth control clinic).
Hormonal methods
Progestin-only methods (other than the IUD): Micronor or mini pills, Depo-Provera (contraceptive injections)
Progesterone does not interact with milk production. It isn’t dangerous for the baby. You can start the pills or injections at birth, but often mothers will still wait a few days (72 hours) to allow lactation to start. Optimally, it should be started within 3 weeks after birth to be protected before the first ovulation.
Combined estrogen-progestogen methods: oral contraceptives, Evra patch, Nuvaring Estrogens have a slight risk of slowing milk production. So we wait four to six weeks after childbirth to start it for women who want to use this method of contraception (if they don’t show any contraindications). By this time, breastfeeding is well established. The low dose of estrogens contained in these contraceptives does not present any danger for the baby. For the women you don’t breastfeed, those methods can start after 3 week post-spouse.
IUDs: Copper IUD or Mirena (hormonal IUD)
In general, we wait 4 weeks after childbirth to insert an IUD so that the uterus can have a chance to return to its original shape. The Mirena contains very few hormones and less than 1% are excreted in breast milk. It can therefore be safely used in women who are breastfeeding.
If you are not breastfeeding…
If you are not breastfeeding, or if you stop, the information contained in Section 2 also applies to you, with the exception of the combined hormonal methods containing estrogens, or oral contraceptives, the Evra patch or the Nuvaring, that can be used after the 3rd week after birth in the absence of contraindications.
Finally…
Don’t forget that emergency contraceptive methods remain available and safe for you, such as Plan B (the morning after pill) and the copper morning-after IUD. Don’t hesitate to consult our brochures for each specific method to learn more about them. The section on postpartum contraception from Living Better with Our Child is also very interesting.
Last update : July 2014