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If you're pregnant or just had a baby, preventing or delaying another pregnancy may not be the most pressing issue on your mind. But it would be wise to make some decisions now about what method of contraception (pregnancy prevention) to use after you deliver. It's healthier to wait awhile before having your next child.
If you're breast-feeding or planning to breast-feed, you've made an excellent decision: Breast-feeding has many health benefits for both mothers and babies. However, nursing may affect your choice of contraceptive. You want a method that is safe and effective, easy to use, won't interfere with your ability to produce breast milk, and won't harm your baby's growth and development. Your own health history and any medical conditions will also affect the methods you can safely use. All types of contraception are now covered by most insurance plans without cost to you.
The ideal time to talk with your clinician (doctor or nurse midwife) about contraception is before you have your baby. The convenient “get it and forget it” methods (the implant and intrauterine device [IUD]) are very effective and can be started before you take your baby home from the hospital. If you've already delivered, it's not too late to discuss contraception. Here is some information to guide that discussion.
“Lactation” means “producing milk,” and “amenorrhea” means “having no periods.” When you are breast-feeding your baby exclusively (offering no other food or formula), you get a special contraceptive benefit: For the first 6 months after delivery, women who are producing all the milk their baby is eating (giving no formula) and do not have periods do not release eggs from their ovaries and cannot get pregnant. As soon as you have a period or add any milk other than your own to your baby's diet, you will need a new contraceptive method. Some women choose an additional method of contraception even while breast-feeding exclusively to make sure they are protected from pregnancy.
There are several types of IUDs (some contain copper, and others, a hormone known as a progestin); all are safe and very effective. All can be removed as soon as you are ready for another pregnancy and can be used for many years if desired. An IUD can be placed in your uterus immediately after your baby is born, but this increases the chance it will fall out of your uterus, so some women prefer to wait until their first follow-up visit or at a later time. Copper IUDs will not affect your baby's health or your ability to produce milk.
The contraceptive implant (placed under the skin of your upper arm), birth control “shot,” and one type of birth control pill (the progestin-only pill) contain forms of the hormone progesterone. Experts consider these three methods safe for breast-feeding women, and you may start one immediately after delivery or later. The implant is the most effective birth control available; it is more effective than surgical sterilization, offers years of convenient contraception, and you can get pregnant right away after having it removed. For most women, the implant is less painful than the shot. The shot is also effective as long as you are able to get it every 3 months. The progestin-only pill is typically less effective than the implant. You must take one pill every day at about the same time — which can be difficult when you have a baby to care for.
Contraceptive methods containing the hormone estrogen (the contraceptive patch, ring, and the more common type of birth control pills that contain two hormones, estrogen and progesterone) should not be used within the first 3 to 12 weeks after your baby's birth. During this time, you are slightly more likely to develop blood clots in your legs or lungs, and estrogen increases this risk further (as does smoking). If you prefer estrogen-containing methods, you may be able to use them after this time.
Most types of birth control will not make it harder to lose weight after your baby is born, although some women find that the shot makes them gain weight.
If you have sex without using contraception, or if your regular method fails (forgotten pill, broken condom), you can lower your risk for pregnancy by taking action as soon as possible. If you are 17 or older, you can get EC pills at the pharmacy without a prescription. Take them within 3 days of unprotected sex — the sooner the better. (If you are under 17, contact your clinician for a prescription). This is safe if you are breast-feeding.
A prescription-only EC pill, ulipristal acetate, can be used up to 5 days after unprotected sex. Ulipristal is more effective than nonprescription EC. Very small amounts of ulipristal have been found to enter mothers' breast milk, so pumping and discarding breast milk is recommended for 24 hours after taking ulipristal EC.
The most effective EC is having a copper IUD placed within 5 days of unprotected sex. This also provides you with a continuing method of contraception. If you call your clinician for an EC IUD, tell whoever answers the phone that you need it for this purpose so you can be seen promptly.
One of the many decisions before having your baby is how to prevent or delay another pregnancy after delivery. Take time to discuss your preferences with your clinician so you will be ready when the time comes. For more specific information about each of these methods, see the resources below.