Photo by Karin Pedersen Photography

Contraception options after pregnancy is an important health topic that sometimes we forget about when we are busy with the new baby.  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 immediately postpartum.

For women who are breastfeeding, birth control medications that contain estrogen can be stated once breastfeeding is well established.

Hormonal or Copper Intrauterine Device (IUD) 

Pros: The IUD is one of the most effective forms of contraception (it is as effective as tubal ligation)! Contraceptive benefits are effective immediately upon insertion and recovery of fertility is 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. Patient’s report having lighter or even no menstral period when the hormonal IUD is in place which can improve quality of life.

Cons: Some women find the insertion to be uncomfortable while others find the discomfort minimal. Health care professionals will sometimes recommend you take a medication to help with discomfort before and after insertion. IUD’s also come with a small risk of infection or perforation of the uterus.

Progesterone only pill 

Pros: Progesterone only pill 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: For the progesterone only pill to be effective, it must be taken at the same time everyday. If it is not taken at the same time every day, you are at increased risk of getting pregnant.  Being late only 3 hours can result in a unplanned pregnancy. If you are late taking your pill, use a back up form of contraception such as a condom. There are some women who should not take oral birth control such as those with a known or suspected breast cancer, heart disease our uncontrolled high blood pressure.

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 “leave 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. 

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.  With perfect use, 2% of women will become pregnant within 1 year of condom use.

The Rhythm Method 

The rhythm method is a form of birth control where couples 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.  

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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