May 14, 2019

Reviewed by Kimberly Langdon, M.D., OB/GYN

Still feeling like you just had the baby? If you’re not quite ready for another yet (here’s an overview of the medical recommendation of how long to wait between pregnancies), you have some options to consider for how to prevent that from happening.

First, we have to dispel the myth that you don’t need to use birth control until after your period starts again. That is not true, and I have friends with babies close in age that can prove it. If you breastfeed, your period may not return until after you wean, but it is absolutely possible to get pregnant before then. Sidenote: there is a temporary birth-control method called the lactational amenorrhea method, which requires exclusive, frequent breastfeeding. But you have to be really intentional about it for it to be effective.

Another myth: there are limited or no options for birth control if you want to breastfeed. Wrong again! Most of the options are completely fine for breastfeeding moms. And even the ones that are not recommended while breastfeeding, it’s not because they’re not safe, it’s because they might decrease your milk supply. These are the “combined hormonal” methods, which include the pill, the ring, and the patch, but there are a bunch of other options that don’t have any effect on your milk supply.

So, as soon as you’re ready to have sex again, you need to have a plan for birth control. You may already have a good idea if you want another baby in the future, or if you’re done. And if you haven’t decided yet, that’s totally okay, you can always choose a non-permanent method for the time being.

Here are your main options (and the pros/cons of each):

Temporary Options (If you’re pretty sure you want to get pregnant again, or just want to keep the option open)

Condoms - The most popular of the barrier methods (also including the diaphragm, the cervical cap, and the sponge), condoms work by preventing the man’s sperm from reaching the woman’s egg.

• 85-98% effective, depending if correctly used
• No effect on breastfeeding
• Effective right away
• Over the counter

Long-Acting Reversible Contraception (LARC) - LARCs include IUDs (copper and hormonal) and implants. The intrauterine device (IUD) is a small device shaped like a T that is inserted into your uterus by a health professional (usually an OB/GYN). The hormonal IUD releases progestin into the uterus, which prevents the sperm and egg from joining (aka fertilization). The copper IUD works the same way, except it releases copper instead of the progestin hormone. The implant is a tiny rod that is inserted under the skin in your upper arm. It also releases progestin into the body, which prevents fertilization.

• 99%+ effective
• Breastfeeding-friendly
• Can be conveniently placed immediately after delivery, but otherwise you need to see a healthcare professional for placement
• Long-lasting (copper IUD lasts 10 years, hormonal IUD lasts 3-5 years, implant lasts 3 years)

Combined hormonal methods - These include the pill, the ring, and the patch that contain estrogen and progestin. They work by preventing ovulation, which is when an egg is released from an ovary. When an egg is not released, it can’t be fertilized.

• 93% effective
• Not recommended for breastfeeding
• You have to remember to take a pill every day
• Can’t be used until 3 weeks after delivery, sometimes 6 weeks, depending on your risk factors

Progestin-only pill - This pill is similar to the combined pill, but instead of preventing ovulation, it prevents the egg from being fertilized. Because it only has progestin, there is no effect on breast milk.

• 93% effective
• Breastfeeding-friendly
• Must be taken at the same time each day, within a 3 hour window
• You have to remember to take a pill every day

Injections - You basically get a shot of hormones in your arm or butt every 3 months. The shot contains a type of progestin called depot medroxyprogesterone acetate (DMPA). It works by preventing ovulation.

• 96% effective or higher
• Breastfeeding-friendly
• You can get a shot right after delivery
• You have to get a shot every 3 months

Lactational amenorrhea method (LAM) - This method may be impractical for many women. Effectiveness requires frequent & exclusive breastfeeding (no pumping or bottles; time between feeding during day <4 hours & <6 hours at night)

• 92-98% effective
• Doesn’t cost anything
• Can only be used for the first 6 months postpartum, or until your period returns

Permanent Options (Stick a fork in me, I’m done!)

Postpartum tubal sterilization (female sterilization) - This is a procedure that closes or blocks a woman’s fallopian tubes to prevent pregnancy. It’s considered one of the safest and most effective forms of contraception.

• 99%+ effective
• Generally covered by insurance, but depending on your insurance, there may be some cumbersome consent requirements
• Usually done immediately after a vaginal delivery or at the time of a cesarean delivery, and doesn’t lengthen hospital stay
• Breastfeeding-friendly

Vasectomy (male sterilization) - This procedure removes a portion of the vas deferens, which prevents the release of sperm into the semen. With no sperm in the semen, the egg cannot be fertilized.

• 99%+ effective
• considered to be even safer than female sterilization and requires only local anesthesia
• Technically it may be reversible in some cases, but it’s best to consider it permanent
• Safe for breastfeeding (might go without saying)
• Takes 2-4 months for it to be effective, so another form of birth control should be used until a sperm count shows that no sperm are present.

Which medical provider should I talk to about this?

Since the only over-the-counter method is condoms, for pretty much everything else you’ll need to see a doctor to either write a prescription or perform the procedure.

During the postpartum period, there’s the fun question of “which doctor do I see for this” and for so many things it’s a gray area. Technically either your OB/GYN or Primary Care Physician (PCP) should be able to diagnose/treat most things, or refer you to the right specialist, sometimes it makes more sense to see one more than the other.

In this case, your OB/GYN would probably have a lot more experience and knowledge about the side effects and risks of the various birth control methods. They should be able to answer any questions and help you decide what is best for you.

If you are using a method that you LOVE, describe your experience in the comments and help other mamas decide!

Sources:

https://www.cdc.gov/reproductivehealth/contraception/index.htm
https://www.acog.org/Patients/FAQs/Postpartum-Birth-Control
https://pcainitiative.acog.org/postpartum-contraception/options-for-postpartum-contraception/
https://www.acog.org/Patients/FAQs/Sterilization-for-Women-and-Men
https://www.acog.org/Patients/FAQs/Long-Acting-Reversible-Contraception-Intrauterine-Device-and-Implant
https://pcainitiative.acog.org/clinical-considerations/breastfeeding/

Kimberly Langdon M.D. is a retired University-trained obstetrician/gynecologist with 19-years of clinical experience. She graduated from The Ohio State University College of Medicine and then completed her OB/GYN residency program at The Ohio State University Medical Center. Recently, she founded a medical device start-up company that focuses on non-drug treatment for common maladies.