Birth Control After Pregnancy
By Katy Brennan
When looking for birth control after pregnancy, there are many options of both hormonal and non-hormonal contraceptives that are safe and effective. Options for contraceptives immediately following birth (which do NOT negatively impact milk production) include the Depo-Provera shot, implant, progestin only birth control pills, and both hormonal and copper IUDs. Peoples’ bodies may respond differently to the birth control that was being used before pregnancy, so it is important to know that there are many choices if what you were using before pregnancy is no longer working for you.
Hormonal Birth Control
Hormonal forms of birth control that contain estrogen are not recommended for the first 6 weeks postpartum because estrogen increases the risk of developing a blood clot (deep vein thrombosis) during the immediate postpartum time period. After 6 weeks, it is considered safe to take birth control with estrogen if the person has no other risk factors -- but there is a chance it may affect milk supply. If someone is already struggling with milk supply and wants to breastfeed, a progestin-only or non-hormonal method might be a better option. The pill remains an effective form of birth control, but the “set-it-and-forget-it” options (discussed below) may be more ideal for a busy parent with a new baby.
Both the implant and IUD are recommended for an easy, forgettable form of birth control that is effective for multiple years. It is extremely rare for IUDs to result in serious injury, but it should be noted that about 5 in 100 IUDs come out unintentionally within the first year of use. Although it is still rare, it is more common for the IUD to become displaced from the uterus if it is inserted immediately after delivery.
The implant is a small, flexible rod that is inserted under the skin in the upper arm and contains progestin. Like most hormonal birth controls, both the implant and the IUD may affect periods. These changes can range from heavier, longer periods (with a copper IUD) to experiencing no bleeding whatsoever (with a hormonal IUD or implant). Just make sure to communicate with a doctor if any of these changes begin to negatively impact your daily life.
Non-Hormonal Birth Control
Non-hormonal birth control comes in many forms as well, such as the copper IUD, condoms, diaphragms or internal condoms, and cervical caps. These forms of birth control will not have any effect on milk supply for breastfeeding parents. Some sources suggest that exclusively breastfeeding for up to 6 months after the baby is born is a form of birth control, but it should be noted that it may not be as effective as other methods of birth control. When looking at other forms of non-hormonal options, the sponge and cervical caps are also possibilities, but have had some evidence suggesting they are less effective in individuals who have given birth.
Permanent Options
The main option for permanent birth control for a person with a uterus is sterilization, sometimes known as “tube-tying” or tubal ligation. This is the closing off or removal of the fallopian tubes in order to prevent future pregnancy – this method is 99% effective. This procedure can be done immediately postpartum, and if you have a cesarean section, it can be done at the time of the surgery, after the baby has been delivered. Laparoscopic sterilization is also an option a few weeks postpartum. It is minimally invasive and leaves a smaller scar. You should be absolutely certain of your decision to be sterilized before the procedure as attempts to reverse it may not be effective. Not all doctors or medical facilities offer these same options for sterilization, so be sure to discuss this with your care providers leading up to birth.
In Conclusion
Options for birth control after pregnancy come in all different forms, and it is okay if it takes some time for your body to adjust or to find the form that works best for you. Access to postnatal visits can be difficult, especially as new parents. If transportation to your doctor and/or available time postpartum become barriers to your postnatal visit, it may be advised to talk to your doctor about a birth control option that you can take with you when you leave the hospital after your pregnancy. See the references list for more information on postpartum birth control options, as well as an informational page on chestfeeding, a term with growing popularity that is more inclusive towards transgender and nonbinary parents whose anatomy or gender identity may not align with the term “breastfeeding.”
References:
Postpartum Birth Control
Postpartum Birth Control, American College of Obstetricians and Gynecologists, November 2021
What are the Best Birth Control Options While Breastfeeding? Planned Parenthood
Chestfeeding
What is chestfeeding and why is it important? Healthline, September 2021