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Contraception options after pregnancy is an important health topic that sometimes we forget about.  This is why I discuss contraception while breastfeeding with all of my postpartum patients.

One misconception is that breastfeeding is an effective form of contraception. It is TRUE that if you are exclusively breastfeeding with no longer than 4-6 hours between feeds and not yet menstruating, you are at a reduced risk of getting pregnant.  This is simply a reduced risk – you can STILL GET PREGNANT!  

Birth control medications containing estrogen are NOT recommended until more than 3 weeks post delivery. This is because women are at an increased risk of developing blood clots in the veins after pregnancy.  Birth controls containing estrogen also increase the risk of developing clots.  These two factors combined make estrogen-containing birth control options a less than ideal choice.  

For women who are breastfeeding, we recommend not using any birth controls that contain estrogen as they may decrease your milk supply. Keep reading for options for birth control while breastfeeding. 

Hormonal or Copper Intrauterine Device (IUD) 

Pros: Contraceptive benefits effective immediately upon insertion and recovery of fertility immediately upon removal.  The IUD can last for up to 10 years depending on the type of IUD, and is equally as effective as tubal ligation or vasectomy.  The benefit of the IUD over tubal ligation or vasectomy is that it is temporary.  If and when you are ready to have another baby, you simply have it removed and start trying to conceive. The hormonal IUD is often the preferred method of contraception by most health care providers.

Cons: Uncomfortable or painful insertion done by health care provider.  There is also a small risk of infection or perforation of the uterus.

Progesterone only pill 

Pros: Progesterone only birth control while breastfeeding may be a better option than an IUD for women who are planning on conceiving within the near future.  You can simply stop taking your contraception pill when you are ready to try to have another baby.  

Cons: The progesterone pill needs to be taken at the same time every day.  If it is not taken at the same time every day, you are at increased risk of getting pregnant.  If you are late by only 3 hours, you will need a backup form of contraception like a condom.  Up to 10% of women using this method will get pregnant unintentionally.  Because it only contains progesterone, some women may experience labile emotions.  You cannot take this medication if you have a known or suspected breast cancer, or undiagnosed abnormal bleeding from the uterus.  

Depo-Provera Injections (Progesterone injection) 

Pros: The benefit of this contraception option is it is ease of use – you receive an intramuscular injection once every 3 months.

Cons: The injection needs to be done by a healthcare provider.  This contraception option is not recommended for women who want to get pregnant within the next year because it can delay a return to fertility.  It takes a while for the medication to “wear out of your system” after you stop the injections.   Long-term use of the progesterone injection can also reduce bone density and put you at risk of nontraumatic fractures.  You cannot take this medication if you have undiagnosed abnormal bleeding from the uterus.  

Permanent sterilization (vasectomy or tubal ligation) 

Pros: The benefit of this method is that it is very effective!  There are no medical conditions that contraindicate vasectomy or tubal ligation.  

Cons: The major drawback to this form of birth control while breastfeeding is its permanency! If you are unsure if you want another baby in the future, this option might not be for you.  

Tubal ligations often are performed via laparoscopic surgery. Every surgery has risks and complications such as reactions to anesthetic and bleeding.  Vasectomies take about 3 months to be effective, so if you and your partner choose this method, use a backup form of contraception in the meantime!  Both procedures involve seeing a physician and with that, the associated wait-time. 

Condoms

Pros: Condoms are easy to use and they are the only contraception options that help to prevent sexually transmitted infections.  If you plan on getting pregnant soon after delivering your baby, this may be a good option for you. They are readily available to purchase.

Cons: Some people don’t like the feel of them and some people will forget to use them.  The effectiveness of the condom depends HIGHLY on the skill level of the users.  2% of women will become pregnant within 1 year of condom use without backup contraception.

The Rhythm Method 

The rhythm method is a form of birth control in which a woman and man try to avoid having intercourse during the time in the woman’s cycle that she is fertile. 

Pros:  There isno need for medications, condoms, surgery, IUDs, or injections.

Cons: This is not an effective form of birth control and you are likely to get pregnant.  The failure rate for this is high.  

I personally advocate for the hormonal IUD or progesterone only pill as they are effective and tend to fit into mom’s busy lifestyles best!  

References:

Warner L, Steiner MJ. Male Condoms. In: Contraceptive Technology, 20th ed, Hatcher RA, Trussell J, Nelson AL, et al (Eds), Ardent Media, New York 2011.

Curtis KM, Tepper NK, Jatlaoui TC, et al. U.S. Medical Eligibility Criteria for Contraceptive Use, 2016. MMWR Recomm Rep 2016; 65:1.

Depo-Provera CI (medroxyprogesterone acetate). US FDA approved product information. National Library of Medicine. www.dailymed.nlm.nih.gov (Accessed on February 11, 2015)

This post was co-authored by Megan Crosby, medical student at the University of Alberta and Stephanie Liu, MD, MSc, CCFP, BHSc.

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