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Usually “Don’t even think about coming near me” is a pretty effective contraceptive option in the early stages after a baby is born. However, if a couple are not planning on having their babies close together, there are other options available to them for more effective and longer term birth control.
What are the options?
Post delivery contraception ideally should be tailored to each couple’s individual wishes and circumstances and discussed before leaving hospital as ovulation can occur as early as 25 days post delivery.
Some of the key aspects to be discussed inlcude
- are you breastfeeding?
- how long do you wish to avoid pregnancy?
- what forms of contraception have worked in the past?
- are there any forms that should be avoided?
General Options
Non-Hormonal
- Barrier methods – condoms (male and female) can be used at any stage during the post-partum period and have the advantage of not having any hormonal effects. Cervical caps and diaphragms require fitting and shouldn’t be used until 6 weeks after delivery.
- Symptomathermal/Rhythm methods are not reliable in the post partum period.
Hormonal
- Progestin-only contraception (mini-pill, depot, implant) can be initiated immediately post partum and have the advantages of not increasing the risk of DVT as well as providing longer acting contraception (depot, implant).
- LNG-IUD (Mirena) can be placed immediately after delivery, but has lower expulsion rates if placed at least 4 weeks post delivery.
- Combined Oral Contraceptives can be commenced 4 weeks after delivery, but a careful evalution for risk factors for DVT should be undertaken as the COCP can increase the risk of developing venous thrombosis.
Breastfeeding Mothers
Breastfeeding alone for contraception
- Breastfeeding generally causes a delay in the resumption of ovulation. In general, breastfeeding alone can be considered a reasonably effective means of contraception if ALL of the following three criteria are met
- less than 6 months after delivery
- exclusively breastfeeding
- no resumption of menstrual bleeding
Barrier methods and intrauterine contraceptive devices have no influence on breastfeeding and are a reasonable choice as they have no systemic effects.
Progestin only hormonal contraceptives (minipill, depot, implant) are the preferred choice of hormonal contraception in breastfeeding mothers as they appear to have no effect on breastfeeding.
Combined estrogen/progestin contraceptives not only increase the risk of DVT, but may also interfere with milk supply.
Permanent Sterilisation
If a couple are certain that they do not wish any more children, then permanent sterilisation (either at the time of caesarean delivery or as an elective procedure after delivery) may be an option they wish to discuss. Either male (vasectomy) or female (tubal interruption) sterilisation may be the preferred option. The couple should be certain they have completed their family, but also be aware of the failure rates of the different procedures.
When it comes to post-partum contraception, ideally each couple should discuss fully their own circumstances and wishes with their obstetrician or GP to decide upon the method that is best suited to them.
The above information doesn’t take the place of a medical consultation so please seek further advice if you have further concerns.
