Postpartum Contraception

Family Planning

Consider Contraception

Taking charge of your future pregnancies, from a doctor’s point of view

By Lynsey Caldwell Owen, MD, FACOG

When you are still pregnant or the parent of a newborn, it might seem a bit strange to hear your provider asking which method of birth control you would like to use — but it’s actually a very important part of postpartum planning.

The World Health Organization (WHO) advises that the best interpregnancy interval (time from the end of one pregnancy to the beginning of another) is between two and five years. Pregnancies conceived outside of this time frame may have a slightly increased risk of certain complications.

This means that the majority of new moms should be considering a reliable method of contraception early in the postpartum period. There are factors that may change the WHO recommendation. Your provider is the best resource for your specific questions.

Most women are advised to abstain from intercourse for at least six weeks after delivery. As there are increased risks with using certain birth control methods less than a month after your baby’s birth, it may be best to wait until one month postpartum to start many of the available options, which still gives at least two weeks of use to establish efficacy prior to resuming normal sexual activity.

The fact that many breastfeeding moms may not have regular periods does not mean that breastfeeding alone is a reliable method of birth control. Most doctors advise an additional option. Here are the top doctor-recommended, reversible methods of postpartum contraception, ranked in order of effectiveness.

RANK

1: Least likely to result in unintended pregnancy

METHOD

Nexplanon: Small progestin contraceptive rod implanted in superficial skin of the arm

PROS

– Highly effective
– Lasts up to three years with no maintenance
– Quick return to fertility once removed

CONS

– Requires small office procedure for placement
– Long-term irregular bleeding in some women, but bleeding is generally lighter

Mirena IUD: Small, T-shaped device placed inside the uterus; made of plastic and contains progesterone the arm

– Highly effective
– Lasts up to five years with no maintenance except monthly string checks
– Quick return to fertility once removed
– Significant decrease in menstrual blood loss (excellent for women with heavy periods)

– Requires small office procedure for placement with some unique risks
– Irregular bleeding in some women

ParaGard IUD: “Copper T” IUD, hormone-free

– Highly effective
– Lasts up to ten years with no maintenance except monthly string checks
– Quick return to fertility once removed
– No hormonal side effects

– Requires small office procedure for placement with some unique risks
– Slightly heavier periods in some women

2.

Depo Provera: Progestin shot

– Highly effective if used correctly
– Requires action only every three months; therefore, less room for error

– Irregular periods in some women (lighter bleeding may be an advantage)
– Higher dose of hormones may mean more hormonal side effects, such as weight gain
– Longer return to natural fertility

3.
Birth control pills, patches, rings

– No invasive procedures to initiate use
– Generally easy to use

– Effectiveness depends on correct use
– Requires daily, weekly or monthly action

4: Most likely to result in unintended pregnancy
Barrier methods: Condoms, diaphragms

– Only condoms provide protection from sexually transmitted infections
– No delay in return to fertility

– Require use with each sexual encounter

If your family is complete, you may think about permanent sterilization for you or your partner. Highly effective at preventing pregnancy, sterilization should be considered only if you are absolutely certain that you don’t want more children, as it’s not meant to be reversed. In addition, sterilization will not provide any non-contraceptive benefits, such as lightening or regulating periods or decreasing painful menstrual cramps.

The only 100-percent effective method for preventing pregnancy is abstinence. While not having intercourse may be the best option for some moms, most hope to return to some regular sexual activity. It’s important to recognize that sex after having your baby may be very different from sex before parenthood. Sleep deprivation, stress, schedule changes and some physical changes may affect frequency — along with enjoyment. If you have a hard time initially finding the energy for sex, try focusing on other ways to maintain intimacy with your partner, such as cuddling, massage or even just doing nice things for each other. Over time, most couples find a new rhythm that works for them.

Postpartum contraception is an important issue to consider toward the end of pregnancy. Discuss the best methods for you with your provider. Also, tell your provider if you’re worried about postpartum lack of desire or discomfort with intercourse. Often there are interventions that can help improve this aspect of your life as a new parent.

 

Lynsey Caldwell Owen, MD, FACOG, is an OB/GYN at Malcolm Grow Medical Clinic on Andrews Air Force Base and at MedStar Southern Maryland Hospital Center.

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