Life of dr mom blog explores Birth control while breastfeeding and contraception options
Life of dr mom blog explores Birth control while breastfeeding and contraception options

After having a baby, women experience incredible hormonal and physical changes in their bodies.  With the additional stress of caring for a little one, they are often not thinking about having sex.  But it is only a matter of time before sexual intercourse will resume.  I always will recall a friend of mine who got pregnant 3 months after delivering her first son.  Needless to say we were all SHOCKED!  Contraception options after pregnancy is an important health topic that sometimes we forget about.  This is why I discuss contraception and birth control while breastfeeding at all of my postpartum visits.

One misconception that I have heard is that breastfeeding is an effective form of contraception. It is TRUE that if you are breastfeeding exclusively 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 increased risks of developing blood clots in the veins after pregnancy.  Birth controls containing estrogen increase the risk of developing clots, and 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. Options for birth control while breastfeeding include the following:

The Hormonal Intrauterine Device (IUD) as birth control while breastfeeding

Pros: Contraceptive benefits effective immediately upon insertion and recovery of fertility immediately upon removal.  The IUD can last for up to 7 years depending on the brand, 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.

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 options like a condom.  Up to 10% of women using this method will get pregnant unintentionally. 

Because it only contains progesterone, some women may experience worsening emotions that can be hard to deal with.  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) contraception options:

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

Cons: The injection needs to be done by a healthcare provider.  It can also take a while to “wear out of your system” so to speak, so if you want to get pregnant quickly this may reduce your fertility.  This contraception option is contraindicated in women who want to get pregnant within the next year because it can delay a return to fertility.  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) as an option for contraception:

Pros: The major pro 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 a 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. 

The Rhythm Method as a contraception option:

The rhythm method is a form of birth control while breastfeeding in which a woman and man try to time intercourse based on where the woman is at her menstrual cycle.  The woman determines the length of her last 6 cycles, and subtracts 18 from the number of days in her longest cycle.  This estimates when you are ovulating and then you avoid sexual intercourse during this time. 

Pros:  There is no need for medications, condoms, surgery, IUDs, or injections.

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

Condoms as contraception while breastfeeding:

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 at many stores or gas stations.

Cons: Some people don’t like the feel of them and some people will forget to use them and then you are at risk of going without contraception.  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.

Abstinence as birth control while breastfeeding

Pros: 100% effective

Cons: No fun

I personally advocate for the hormonal IUD or progesterone only pill as they are the 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)

Co-written by Dr. Stephanie Liu and Megan Crosby, 3rd year medical student at the University of Alberta

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