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Birth control choices after you have a baby

Posted by on Feb. 9, 2011 at 1:25 PM
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At some point during your pregnancy, you'll want to talk to your practitioner about what kind of contraception will work best for you after you give birth. You may be able to resume using the birth control method you used in the past, or you may decide that something else would work better. In any case, it's a good idea to have a plan in place when you're ready to start having sex again. Here's a summary of your choices.

Barrier methods

Barrier methods physically prevent sperm from reaching the egg. They're immediately reversible, and they don't affect your hormones, interfere with lactation, or have any significant side effects.

Condoms for men: The male condom is a thin tube-like sheath made from latex or polyurethane that fits over the erect penis and traps semen during sex. Condoms don't require a physical exam or fitting, and they offer substantial protection against HIV and many other sexually transmitted infections (STIs).

Unlike many contraceptives, you and your partner can use condoms as soon as you're ready to become sexually active again. So even if you don't intend to rely on condoms for the long term, you can use them while you're waiting to start your preferred birth control method.

Condoms for women: The female condom is a thin polyurethane pouch that's inserted into your vagina before sex to prevent pregnancy and guard against exposure to STIs. Soft rings at either end hold the pouch in place. Female condoms don't require a physical exam or fitting, and you can use them as soon as you're ready to become sexually active again.

Diaphragm: The diaphragm is a shallow dome-shaped device that you partially fill with spermicide and insert into your vagina before sex. It keeps sperm from passing through your cervix.

Your caregiver can try fitting you for a diaphragm at your six-week postpartum visit. Even if you've used a diaphragm before, you'll have to be fitted because you may need a different size after being pregnant and giving birth.

Cervical cap and shield: The cervical cap, FemCap, is a silicone cup shaped like a sailor's hat, and the shield, called Lea's Shield, is a silicone cup with an air valve. You partially fill the cap or shield with spermicide and insert it into your vagina before sex. The device fits over your cervix and blocks sperm from entering the uterus.

You'll need to wait six weeks after childbirth before using Lea's Shield and ten weeks before using FemCap. Both are available by prescription.

Hormonal methods

These birth control methods use synthetic hormones to suppress ovulation, thicken cervical mucus, or both. They're available by prescription only and are highly effective at preventing pregnancy, although they offer no protection against STIs.

You must wait four weeks after delivery to start using methods that use estrogen, such as the combination birth control pill, the ring, and the patch, because estrogen increases your risk for blood clots during the early postpartum weeks. These methods are not recommended for nursing moms because the estrogen may reduce the quantity and quality of breast milk.

The Pill: The combination birth control pill, commonly known as the Pill, is an oral contraceptive that contains estrogen and progesterone. With most brands, you take one pill every day for 21 days and then take nothing (or a "reminder" pill that contains no hormones) for the next seven.

The ring: The birth control ring (NuvaRing) is a flexible, transparent ring you insert into your vagina at the beginning of your cycle. Once inside, the ring releases a continuous low dose of estrogen and progestin. A new ring is inserted every 28 days.

The patch: The birth control patch (Ortho Evra) is a thin, beige square that you apply to your skin like an adhesive bandage. The patch then releases a continuous low dose of estrogen and progestin. You apply a new patch once a week for three consecutive weeks and then go without a patch for a week before starting the cycle again.

The minipill: The minipill is an oral contraceptive that contains a small amount of progestin. The pills come in packs of 28, and you take one pill every day so that you're getting a steady dose of the hormone. The minipill must be taken at the same time each day.

The minipill is a good alternative for women who want to use oral contraceptives but who are breastfeeding or can't take estrogen for some other reason. If you're not exclusively breastfeeding, you can start taking the minipill right after delivery. If your baby is taking nothing but breast milk, it may be best to wait until six weeks after delivery to start. By that time, your milk supply should be well established and your baby will be more mature.

The shot: The birth control shot (Depo-Provera) is an injection of progestin you get every three months. The shot appeals to some women who want a highly effective method of contraception but don't want (or can't use) an IUD, can't take estrogen, or have trouble remembering to take pills. However, it's not a good method for women who plan to start trying to conceive in a year or so.

Many experts recommend that breastfeeding mothers wait six weeks after giving birth to start this method, although some suggest that women who aren't exclusively breastfeeding can start at three weeks postpartum.

The implant: Implanon, the only implantable birth control method available in the United States, is a flexible rod about the size of a matchstick that's inserted under the skin of your upper arm where it continually releases small amounts of progestin.

Once implanted, it is highly effective and can remain in place for up to three years. Your fertility returns soon after the implant is removed. You can have it inserted three weeks after delivery if you're not exclusively breastfeeding and four weeks after if you are.

Intrauterine devices

An IUD is a small T-shaped device made of flexible plastic that's inserted into the uterus by a healthcare provider. Two kinds of IUDs are currently available in the United States: ParaGard, which is wrapped in fine copper wire and lasts for ten years, and Mirena, which contains progestin and lasts five years.

IUDs provide effective, long-term, reversible protection, and they're safe for nursing moms. You can have one inserted about six weeks after delivery, when your uterus has returned to its pre-pregnant state. IUDs are not recommended for women who are at high risk for STIs.

Natural methods

These are behavioral techniques for preventing pregnancy. They work best if you're very organized and disciplined. They cost nothing and cause no side effects but offer no protection against STIs.

Lactational amenorrhea method (LAM): This technique is based on the observation that breastfeeding tends to delay the return of fertility in new moms. LAM is 98 percent effective if you fulfill all of its conditions: You're exclusively breastfeeding your baby, you still haven't gotten your period, and you gave birth less than six months ago.

Fertility awareness methods (FAM): These methods teach you to observe patterns in your monthly cycle so you can predict which days you may be fertile and which days you won't be. Some versions require you to observe physical changes associated with fertility, such as fluctuations in your basal body temperature and changes in the texture of your cervical mucus.

Fertility awareness methods present specific challenges for postpartum mothers. For example, you need to be able to measure your basal body temperature at the same time each morning after at least three hours of uninterrupted sleep.


These procedures are considered permanent methods of birth control. While reversals are sometimes possible, they're expensive, complicated, and only a minority of men and women go on to conceive again. Choose this option only if you're 100 percent sure you don't want to have any more children. These procedures won't affect your hormones, sex drive, or lactation.

Vasectomy: A vasectomy is a safe and highly effective operation designed to make a man sterile. A doctor cuts the two tubes โ€” called the vas deferens โ€” that carry sperm from the testes to the pouch in the scrotum that holds the semen prior to ejaculation. (The sperm is later reabsorbed by the body.)

Men who get vasectomies can still have sex and ejaculate. Their semen won't contain any sperm, however, so it can't fertilize an egg and cause a pregnancy.

Tubal sterilization: This is a surgical procedure in which a doctor cauterizes, stitches, or clips a woman's fallopian tubes so that the egg can't meet the sperm.

You may have this procedure done during delivery if you're having a c-section or within 48 hours of a vaginal delivery. Otherwise, you must wait four to six weeks to have it done. (After six weeks postpartum, there's another option in which implants are inserted into the fallopian tubes by way of your vagina.)

Some states require you to wait a certain amount of time after signing a consent form, so if you want to consider sterilization at the time of your delivery, discuss it with your provider well before your due date.

Emergency contraception

If your regular contraceptive method fails you or you forget to use it or use it incorrectly, using emergency contraception can significantly reduce your chances of getting pregnant. Emergency contraceptive pills โ€” sold under the brand name Plan B โ€” are the most commonly used method. (Alternatively, you may have a copper IUD inserted to prevent pregnancy after unprotected sex.)

Depending on which regular method of birth control you're going to use, you might consider buying a pack of Plan B pills so you'll have them immediately available in case you need them. The sooner you use emergency contraception after unprotected sex, the more likely that it'll be effective. Since Plan B contains only progestin, a single treatment probably won't have any effect on your breast milk.

What method are you planning on using?

by on Feb. 9, 2011 at 1:25 PM
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by Emerald Member on Feb. 9, 2011 at 2:15 PM


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