Birth Control in the Postpartum Period


Written by : Dr.M.D.Mazumdar, MD

"Which is the best birth control method which can be used after childbirth, in the postpartum period ?" - This is a common question asked by many new mothers.

Before answering this question, here are some common facts about postpartum birth control:

  • Pregnancy can occur at any time after a childbirth. Since ovulation occurs two weeks before menstruation, a pregnancy can occur even before the first period. So the earlier a birth control method is started, the better.

  • Breastfeeding is not a reliable way of preventing a pregnancy. A woman who is exclusively breastfeeding usually does not ovulate in the first 6 months. Exclusive breastfeeding means feeding the baby by breast every four hours during the day and six hours at night with no supplemental feedings, not even water. If the baby is less than 6 months of age and the mother has not yet got her periods, then the chances of pregnancy are low but cannot be ruled out.

  • Non-breastfeeding mothers, including mothers who are breastfeeding with supplemental feeds will ovulate 1-3 months after childbirth, usually at around the 45th day.

  • Breastfeeding Women should not use birth control methods like the pill or patch containing estrogen since estrogen can reduce the production of breastmilk. Estrogen also increases the risks for formation of blood clots during the early postpartum weeks. If a hormonal method of birth control is needed, then progesterone only pills are better.

  • Hormonal contraceptives like the birth control pill, a patch, the IUD, and Depo-Provera injections are more effective than non-hormonal ones like the condom and spermicides.

  • Tubal Ligation can be done within 1 day of giving birth.

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What Birth Control Method to Use after Childbirth

A woman who has recently given birth will get a period usually about four to ten weeks after the baby's birth if she is bottle-feeding, or combining breast and bottle. If she is exclusively breast-feeding then periods may not start until much later. For some women this might be after she has stopped breast-feeding.

Non-Hormonal Contraceptives

Condoms

Condoms are the best methods of birth control after delivery. Sex is not advisable for at least 6 weeks after delivery, i.e. in the postpartum period, as the tissues are fragile at this time and need time to recover. But, if necessary, barrier contraceptives like condoms should be used.

Condoms have the advantage of being readily available, of not containing any hormones and being cheap. They have no effect on breastfeeding and have no risks to the mother or child. The disadvantage is that they can irritate the already fragile vaginal tissues and additional lubrication may be necessary.

Other Barrier Methods

Other barrier methods of birth control like diaphragms and female condoms can also be used. But they are better used with a spermicide. Since the size of the cervix may change during pregnancy and childbirth, Diaphragms needs to be resized after birth and after the uterus has returned to its pre-pregnancy size after about 6 weeks.

Spermicides can be used alone, but is more effective when used with other contraceptives like the female diaphragm.

Copper-T Intrauterine Device

The Copper T IUD380A, also known as Paragard is a small T-shaped plastic device with its arms wrapped in fine copper wire. It is effective for 10 years after inserition. It can be inserted immediately after childbirth but there is a risk of expulsion of the Cu-T since the uterus is still enlarged at this time. There is also a risk of perforation of the uterus.

Postpartum insertion of a Cu-T can take place within 10 minutes of the placental delivery (immediate postplacental) or upto 72 hours after delivery. Or it can be done at about six weeks after birth. Postpartum insertion should not be done between 72 hours and about six weeks postpartum because of an increased risk of expulsion and perforation. Special training is required for immediate postplacental insertions and for insertion within the first 2 hours.

Rhythm Method of Contraception

The rhythm method, also known as the family planning method, is based on calculating a woman's fertile period during her menstrual cycle and avoiding sexual intercourse at that time. Since the periods can be irregular after childbirth, this method is not a suitable and reliable way of preventing pregnancy at this time.

Hormonal Contraceptives

Mini Pills

If a woman wishes to use a birth control pill after childbirth, it is better to use a progesterone only pill like the minipill. These do not contain estrogen and will minimally affect the amount of breastmilk. But it is recommended that the use of progestin-only hormones be delayed for at least six weeks post-partum since the hormones may interfere with the early establishment of breastfeeding.

Norplant, Depo-Provera

The Norplant is a thin plastic rod which contains progesterone. It is inserted into the fat of the underarm and releases progesterone into the body. It can be inserted soon after childbirth, although it is recommended that it should be inserted after breastfeeding has been comfortably established.

Mirena

The Mirena is an intrauterine device containing progesterone. It is inserted into the uterus and releases progesterone directly into the uterine cavity. It cannot be inserted during involution of the uterus and needs to be inserted after 4-6 weeks after childbirth.

Birth control methods containing Estrogen

Contraceptions containing estrogen such as the combination birth control pills, the Nuvaring and the patch should ideally not be used while breastfeeding as the estrogen can affect the quality and quantity of the milk. There is also a risk of blood clots in the early postpartum period. Some amount of estrogen can also pass to the baby via the breastmilk although negative effects have been noted in the baby.

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