Contraception after baby
So, you’ve just had a baby! Or, my preference would be – you are about to have a baby! Congratulations! But why do I want you to think about contraception? Well, unless you are wanting to welcome another baby 40-odd weeks after this one, this is something you need to plan – during pregnancy if possible. Why? Because when you’ve just had that baby, and your midwife or OB is doing a 5 minute chat on your options, chances are you are not going to make an informed decision that is best suited to your circumstances. Doing your research in pregnancy means you have plenty of time to read, understand, plan, ask questions and consider.
Ovulation (the time where your body releases an egg for possible fertilisation) can and does occur within 2 weeks of birth. It’s certainly not common, but it happens enough for most midwives to see it in practice – this midwife included! I remember many years ago admitting a mum who was in labour but had not had any pregnancy care. When we looked her up on our database, our records showed she had birthed a baby (her first) at our hospital 44 weeks prior to this labour. Panic ensued – we assumed this bub was premature so we hustled the paediatricians and NICU teams. Not long after, out popped a healthy, fat little baby screaming his lungs out. He was certainly not premature! This mum must have ovulated very soon after having her first baby!
Therefore – if you’re not planning a baby immediately after birth, you need to take steps to prevent conception. And you need to consider your options for the immediate postnatal period…
If you only take one thing away from this article, it is this:
OVULATION OCCURS BEFORE YOU HAVE A PERIOD!
This is why you mightn’t have a period after baby, but still find yourself pregnant!
Unfortunately in my experience, women are given very little contraceptive advice (if at all), and it’s often rushed or inaccurate. Consequently, a lot of us think the main option is the Pill, but there are a few reasons why this is one of my least favourite options for you. Here I’m going to summarise what’s available to you so you can start thinking about your choice, NOW!
Here we go!
1. Do nothing
Whether this means take no action to prevent pregnancy, or don’t have sex, is up to you! Doing nothing means you should be open to the possibility of pregnancy. Abstaining from sex means 100% likelihood of avoiding pregnancy!
2. Lactational method
This refers to the natural inhibition of ovulation that is seen in breastfeeding women. Put simply, you don’t ovulate in pregnancy because the hormones of pregnancy stop it from happening. Breastfeeding is the same…except hormone levels will fluctuate, decrease and change throughout the breastfeeding journey, and are not consistent from woman to woman. Therefore, we can’t predict when each mum will return to fertility. Some breastfeeding mums have a period within weeks of giving birth, for others it might be years. On average it’s around 14 months post birth, but this just means 50% of women will have their period return by this time, and 50% not. It doesn’t mean 14 months is the most common time to get it back. For this reason, breastfeeding is a fairly unreliable form of contraception, so consider whether this is the right choice for your circumstances before counting on this alone.
Condoms are a common and cheap form of contraception. Widely available, they may be beneficial if you want to avoid hormonal based contraceptives. Used perfectly, there is a very, very low failure rate (meaning they prevent pregnancy very well), however we know that in the average population, perfect use is not the norm. You need to ensure they are properly *ahem* applied, and used with no substances etc that may affect their function. You also need to be prepared (have them stocked!) and not forget them in the heat of the moment
4. Fertility tracking
Some of you may have done this when trying to conceive. Well here you are again, trying to avoid pregnancy. Why am I talking about tracking your fertility? Well, all these methods are used to pinpoint ovulation. If you know when ovulation is happening, you can abstain from sex or use extra protection in order to avoid pregnancy. Taking your basal body temperature (your temperature at the same time each day just as you wake), tracking your cervical mucous, ovulation tests and other fertile signs may help you to do this. The downside is again your body may work against you: the many hormones and fluctuations of the postpartum time means it can be hard to read your body’s signs, which could potentially mean miscalculations of ovulation. Plus, I might add, ain’t nobody got time for all this when you have a baby!
5. The (Combined Oral Contraceptive) Pill
Ah, our old friend the pill. Many of us have tried one or more forms of this contraception method at some point. It’s a combination of two hormones, and it’s very reliable (99% success rate) at preventing pregnancy. Unfortunately, one of these hormones will affect your milk supply, so it’s not an option if you are planning to breastfeed. However...keep reading below for your breastfeeding-friendly Pill option...
A standard contraceptive pill packet
6. The Mini-pill
The mini-pill consists of just one of the hormones that is in the COC pill, so therefore it shouldn’t affect your milk supply. It’s not recommended to start this until 6 weeks postpartum, so that needs to work for you. Also, it is highly effective with perfect use – this means you must take the tablet within the same 2hr window each day, and if you don’t, you may be fertile for the week to come! Thus why I consider the mini-pill to be the biggest bummer of all these options – who can remember to take a tablet at the same time each day when you have an unpredictable newborn? Unless you’re highly organised, you’re likely to forget or not remember if you took it at all…
This brings me to the hormonal methods that are longer acting (meaning you don’t have to take them ‘regularly’)…
This is a small rod inserted into the upper inner arm, and it releases a hormone very slowly and hence it can last 3-5 years. Once inserted, it does its thing without you having to remember to take a pill or anything. Bonus: you can have it inserted immediately post-birth, if you wish and it is over 99% effective.
The Implanon rod (only about 4cm long) and the device used to insert it. Local anaesthetic is used, and it only takes about a minute to pop in.
8. Intra-uterine device (IUD)
This is a small T-shaped rod inserted into the uterus. There are 2 types: one type is made of copper (not hormonal) and works by preventing a potential pregnancy implanting in the uterus. The other type is hormonal-based, and adds another mechanism to the prevention of fertility, making it extremely effective at preventing pregnancy. This also can be inserted following birth, but it can be best to wait 6 weeks for your uterus and cervix to return back to their pre-pregnant size.
The IUD rod. Measures around 3cm long and 3cm across the bar. Inserted in a Pap-smear like procedure, with local anaesthetic if you wish. It's extremely easy to insert if your cervix has dilated before, but is still a simple procedure otherwise
9. Depo injection
This is an injection of a synthetic version of progesterone, to inhibit ovulation. Each injection lasts 12 weeks. If you don’t have a subsequent injection then your fertility will return over several months (but it is unpredictable when) so you need to be vigilant in having a subsequent injection if you wish to avoid pregnancy.
10. Vaginal ring
This is a small ring placed high inside the vagina. It releases the same hormones as the Pill, and therefore it can affect milk supply so won’t be an option if you are planning on breastfeeding. It is inserted for a 3 week period before removal for a monthly bleed, then a new one is placed.
11. Other non-hormonal options
There are several lesser known/utilised non-hormonal options. They are not super popular and this may be because of their failure rates or ease of use, but I am going to cover them briefly anyway. One is a female condom, which is exactly as it sounds – like a reverse condom that fits inside the vagina. If used properly they are 95% effective at preventing pregnancy, but again like male condoms, because most of the time, they are not used properly, there is around a 20% failure rate. Another option is a diaphragm, which is a cap that fits over the cervix to prevent sperm entering the uterus. They have similar efficacy and failure rates to the female condom, again because they need to be fitted properly and inserted properly.
These methods involve reducing the likelihood of sperm entering the uterus in order to prevent pregnancy. Spermicides are a substance that will destroy sperm, but they need to be applied vaginally before sex. This method alone has around a 30% failure rate (meaning around 30 women in a 100 will still fall pregnant using this method). The withdrawal method requires the male partner to withdraw from the vagina before ejaculation. This method is also unreliable because sperm can still be present in fluid that is released during arousal. It goes without saying too that you’re also relying on your partner not getting carried away in the heat of the moment!
13. Emergency Contraception
Of course, most of us know about the “morning-after pill” – an option for preventing pregnancy after unprotected sex (or perhaps contraception failure e.g. a condom has broken, missed a pill tablet). Emergency contraception should not be your ‘go-to’ option – you should not be planning to take it. Rather, you should be aware of your options should your chosen contraceptive fail and you are concerned about the risk of pregnancy. You can obtain the morning-after pill from your pharmacist, and it is 85% effective at preventing a pregnancy when taken within 24 hours of having sex (ideal), but it can be effective up to 4 days after sex (not recommended waiting this long!).
This is the final option because for most people, it is permanent. Sterilisation for men means a vasectomy (where the tube that transports sperm from the testicles to the penis is surgically sealed to prevent the release of sperm). Sterilisation for women means a tubal ligation (where the fallopian tubes are surgically sealed to prevent an egg being able to be fertilised then implant into the uterus. These procedures are usually very simple and low in complications, and can even be done whilst the patient is awake. Because they are permanent, there is an extremely low chance of pregnancy. In very rare cases, the tubes can re-attach and result in pregnancy. And whilst some people can be certain of their need for permanent contraception, sometimes our life circumstances change and we find ourselves desiring another baby. Both these methods can be reversed, but there is no guarantee of success, so you need to be absolutely certain before proceeding with this method.
If thinking about a hormonal method – consider that there may be side effects or reactions to these. Everybody reacts differently to hormones, and these are artificial versions of natural hormones. What works for someone might not work well for someone else. For this reason you should chat more with a GP, midwife or obstetrician about any hormonal contraception that is of interest to you.
Not many of these options prevent STIs (sexually transmitted infections – e.g. chlamydia, gonorrhoea) either. This may be a consideration for you if you or your partner has a transmittable infection or if there is a change in sexual partner.
Think about the ease of use of each option, and how this will fit into your new lifestyle with a baby. Are you going to remember to take it at the same time every day? Are you able to remember the option in the heat of the moment?! Are you aware of how to use it properly for maximum protection?
What is the cost of each option? How does that fit with your circumstances? Will you be able to afford it long-term? And finally – if you are wanting a pregnancy in the future – how long after ceasing the contraception will you be able to fall pregnant? It's worth noting also that many public hospitals have family planning (or similarly named) clinics aimed at educating, supporting and prescribing contraceptive options to women and their families. It's highly worth investigating your closest option and seeking a referral, as you will get expert advice and input (free because of public health care!) and either free or potentially subsidised contraception. Also worth noting is that if you are choosing an option requiring a procedure (e.g. Implanon, IUD, sterilisation), these clinics do them multiple times a day meaning the staff there are super skilled at each procedure (meaning less discomfort, quicker, easier for you!).
Bottom line: there is no one size fits all approach to contraception. What works for your best friend, sister or work colleague won't necessarily fit with your lifestyle, plans and your body. Being as informed as possible is going to help your make the best decision for your and your family.
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