Postpartum Contraception: What You Need To Know

It’s time to talk birth control

It’s been six weeks since your little one arrived and changed your life forever – or maybe changed it forever again – and hopefully, you’re starting to get the hang of the fourth trimester. Although, if the days still feel like a blur of feeding and rocking and catching a few naps, that’s also very normal! The six-week mark is when your OB-GYN or midwife will usually want to check on your recovery at a postpartum visit. And, if you have been healing normally, they will let you know it’s safe to start having sex again. You might be thrilled by this news. Or, you might feel like sex is about as likely as mountain climbing at the moment. Also totally normal! Either way, it’s time to have a conversation with your provider about postpartum birth control. 

A healthy pregnancy should last about 40 weeks, but you might not know that there is a healthy period of time between pregnancies as well. Medical research suggests that waiting at least 18 months and up to five years between giving birth and getting pregnant again is safest for both mother and baby. Shorter intervals, particularly less than a year, are associated with a much higher risk of preterm birth, low birth weight, and other health problems. 

Questions to consider

Before your postpartum visit, it’s a good idea to check out all your birth control options. Your doula can help you talk through the pros and cons of different methods and decide what works for you. Here are some questions to think about and discuss with your maternity care provider:

Do you want something permanent or temporary?

  • The only permanent contraception method is sterilization, either for you or your partner. Getting your “tubes tied” is a medical procedure that closes your fallopian tubes so your eggs don’t reach your uterus and can’t be fertilized. Men can have a vasectomy, which seals the tubes that carry sperm. Of course, you need to be sure that you never want another pregnancy if you decide on sterilization, since it usually can’t be reversed. 

Are you breastfeeding?

  • If you are breastfeeding, experts recommend choosing a birth control option that does not involve estrogen. Combined hormonal methods, such as birth control pills, patches, or rings that contain both estrogen and progestin, carry a risk of reducing your milk supply. An alternative is a progestin-only contraceptive. These do not use estrogen and are available as pills, injections, implants, or intrauterine devices (IUDs).
  • Fun fact! Exclusive breastfeeding can actually be used as a form of birth control during the first six months after birth, if you aren’t having periods yet. The Lactational Amenorrhea Method works only if you are nursing frequently and your baby is less than six months old, so it isn’t for everyone, but it can be very effective.

How do you feel about hormones?

  • Whether you are breastfeeding or not, some people prefer not to alter their hormonal balance or have a history of side effects. A non-hormonal IUD is a small device that your provider inserts into your uterus. Instead of delivering hormones, it releases a small amount of copper that prevents pregnancy. Copper IUDs can cause heavier periods and cramping, especially during the first six months, but they are highly effective and can be left in place for up to 10 years. 
  • Barrier methods are also tried and true, including condoms, spermicide, diaphragms or cervical caps, and the sponge. If you used a diaphragm or cervical cap before childbirth, you should be refitted for the correct size.
  • Fertility awareness is another hormone-free form of contraception. It involves tracking physical signs throughout your cycle to determine when you ovulate. Then you can either avoid sex or use another birth control method on the days when you are fertile. Fertility awareness can be very effective, but it isn’t foolproof. Success depends on consistent use and also having a reliable backup method during your fertile window. 

How long do you want it to last?

  • While some people are happy taking a daily pill, others prefer not to think about birth control for longer periods of time. Hormonal IUDs can last up to five years and copper ones as long as ten years. Birth control implants, small rods inserted under the skin, work for up to three years. Progestin injections are good for three months at a time, and birth control rings and patches need to be replaced either monthly or weekly. 
  • Also, consider whether your health care provider is trustworthy and respectful, and how often you can schedule appointments. An IUD must be inserted and removed by a provider, and birth control injections are needed every three months. You are always the decision maker for your birth control method, and a provider should never pressure you to choose a certain option. 

Remember

Even with careful precautions, mistakes can happen. In fact, nearly half of all pregnancies in the U.S. each year are unplanned. But using an effective birth control method is a responsible choice, and it’s essential until your body is healed and replenished and you are also emotionally ready to conceive again.  

Interested in talking through your birth control options? Let a Mae expert help you.