Contraception After Having a Baby

When will I be fertile again?

The time for fertility to return is very variable between women. However, it is important not to take any risks if you do not want to become pregnant again. Therefore, you should decide on the type of contraception you are going to use as soon as possible after having a baby. You will need contraception from 21 days after your baby is born.

Your periods usually return four to ten weeks, or perhaps longer, after your baby's birth if you are bottle-feeding or combining breast and bottle. However, if you are breastfeeding then your periods may not start until much later. For some women, this could be even after you have stopped breastfeeding.

How soon can I have sex again?

You can have sex as soon as you and your partner feel ready to. Some people find it takes a while to feel ready, both physically and emotionally. If you have had stitches, then these are usually dissolvable so will not need removing. However, if you are having any discomfort from these then you should see your doctor or midwife. Some women find they need to use some vaginal lubricant if they feel more dry than normal.

Where can I get contraception from?

If you had your baby in hospital, you might have discussed contraception with a healthcare professional before you were discharged home. You will also be asked about contraception at your six (or eight) week postnatal check. However, you can discuss it at any time with your health visitor, midwife, GP or local family planning clinic.

Is breastfeeding an effective contraceptive?

When you breastfeed a hormone called prolactin is produced by your body which stimulates the production of your milk. Prolactin also blocks the release of the hormones involved in ovulation (producing an egg).This means that you are unlikely to become pregnant whilst you are breastfeeding.

Breastfeeding, also known as lactational amenorrhoea method, can be up to 98% effective in preventing pregnancy when the following conditions all apply:

• Your baby is less than six months old, and
• You are fully breastfeeding (your baby is not having any solids or any other liquid), or you are nearly fully breastfeeding (you are mainly breastfeeding and only giving your baby other liquids very infrequently), and
• You have no periods.

However, once you stop fully or nearly fully breastfeeding, you can get pregnant. Many women decide still to use a form of contraception in addition to breastfeeding to reduce their risk of an unplanned pregnancy.

How effective is contraception?

All the methods of contraception listed below are effective. However, no method is 100% reliable. The reliability for each method is given in percentages. For example, the contraceptive injection is more than 99% effective. This means that less than 1 woman in 100 will become pregnant each year using this method. When no contraception is used, more than 80 in 100 sexually active women become pregnant within one year.

The effectiveness of some methods depends on how you use them. You have to use them properly or they may lose their effect. For example, the 'pill' is more than 99% effective if taken correctly. If it is not taken correctly (for example, if you miss a pill or have vomiting) then it becomes less effective. Other 'user-dependent' methods include barrier methods, the progestogen-only pill and natural family planning.

Some methods are not so 'user-dependent' and need to be renewed only infrequently or never. These methods include the contraceptive injection, implant, intrauterine devices (coils) and sterilisation.

What are the different methods of contraception?

Choosing a method of contraception involves a balance between:

• How effective it is.
• Possible risks and side-effects.
• Plans for future pregnancies.
• Personal preference.
• If you have a medical condition that needs to be considered.

The types of contraceptives can be divided into short-acting, long-acting and permanent. If you are planning on having another baby in the next year or so then you should consider a short-acting contraceptive.

(See also separate leaflets on the various methods of contraception for more details.)

Short-acting contraceptives

Combined pill

This is often just called the 'pill'. It is more than 99% effective if used properly.It contains oestrogen and progestogen and works mainly by stopping ovulation. It is very popular. Different brands suit different people.

• Some advantages - very effective. Side-effects uncommon. Helps ease painful and heavy periods. Reduces the chance of some cancers.
• Some disadvantages - small risk of serious problems (for example, thrombosis). Some women get side-effects. Have to remember to take it. Can't be used by women with certain medical conditions.

The combined pill can be started from 21 days after the birth. However, it is not recommended if you are breastfeeding as it can affect your milk supply.

Progestogen-only pill

The progestogen-only pill (POP or 'mini-pill') contains just a progestogen hormone. It is more than 99% effective if used properly. It is commonly taken if the combined pill is not suitable. For example, by breastfeeding women, smokers over the age of 35 and some women with migraine. It works mainly by causing a plug of mucus in the cervix that blocks sperm and also by thinning the lining of the uterus. It may also stop ovulation.

• Some advantages - less risk of serious problems than the combined pill.
• Some disadvantages - periods often become irregular. Some women have side-effects. Not quite as reliable as the combined pill.

The POP can be started from 21 days after the birth. You need to remember to take it at the same time every day because, if you take a pill more than three hours later than usual (12 hours for a POP called Cerazette®), you lose protection.

Contraceptive patch

A combined hormone form of contraception, containing oestrogen and progestogen hormones. It is essentially the same type of contraception as the combined oral contraceptive pill but it is used in a patch form. The contraceptive patch is stuck on to the skin so that the two hormones are continuously delivered to the body. There is one combined contraceptive patch available in the UK, called Evra®.

• Some advantages - it is very effective and easy to use. You do not have to remember to take a pill every day. Periods are often lighter, less painful and more regular. If you have vomiting or diarrhoea, the contraceptive patch is still effective.
• Some disadvantages - some women have skin irritation. Despite its discreet design, some women still feel that the contraceptive patch can be seen.

The contraceptive patch can be started from 21 days after the birth. However, it is not recommended if you are breastfeeding as it can affect your milk supply.

Barrier methods

These include male condoms, the female condom, diaphragms and caps. They prevent sperm entering the uterus. Male condoms are about 98% effective if used properly. Other barrier methods are slightly less effective than this.

You can usually start using a diaphragm or cap around six weeks after giving birth. If you used a diaphragm or cap before becoming pregnant, see your GP or family planning clinic after the birth to ensure that it still fits correctly.

• Some advantages - no serious medical risks or side-effects. Condoms help protect from sexually transmitted infections. Condoms are widely available.
• Some disadvantages - not quite as reliable as other methods. Need to be used properly every time you have sex. Male condoms occasionally split or come off.

You can use male and female condoms as soon as you feel ready to have sex.

Natural methods

This involves fertility awareness. It is effective if done correctly. It requires commitment and regular checking of fertility indicators, such as body temperature and cervical secretions.

• Some advantages - no side-effects or medical risks.
• Some disadvantages - may not be as reliable as other methods. Fertility awareness needs proper instruction and takes 3-6 menstrual cycles to learn properly.

Long-acting contraceptives

These are more suitable for women who do not want to get pregnant again or for a few years.

Contraceptive injection (such as Depo-provera® and Noristerat®)

This contains a progestogen hormone which slowly releases into the body. It is more than 99% effective. It works by preventing ovulation and also has similar actions as the POP. An injection is needed every 8-12 weeks.

• Some advantages - very effective. Do not have to remember to take pills.
• Some disadvantages - periods may become irregular (but often lighter or stop altogether). Some women have side-effects. Normal fertility after stopping may be delayed by several months. Cannot undo the injection, so if side-effects occur they may persist for longer than 8-12 weeks.

It is usually recommended that you wait until six weeks after the birth to start the contraceptive injection because you may get heavy and irregular bleeding. However, it is possible to start it earlier if there are no other alternatives for you.

Contraceptive implant (such as Implanon®)

An implant is a small device placed under the skin. It contains a progestogen hormone which slowly releases into the body. It is more than 99% effective. It works in a similar way to the contraceptive injection. It involves a small minor operation using local anaesthetic. Each one lasts three years.

• Some advantages - very effective. Do not have to remember to take pills.
• Some disadvantages - periods may become irregular (but often lighter or stop all together). Some women develop side-effects but these tend to settle after the first few months.

Intrauterine device

An intrauterine device (IUD) is a plastic and copper device which is put into the uterus. It lasts five or more years. It works mainly by stopping the egg and sperm from meeting. It may also prevent the fertilised egg from attaching to the lining of the uterus. The copper also has a spermicidal effect (kills sperm).

• Some advantages - very effective. Do not have to remember to take pills.
• Some disadvantages - periods may get heavier or more painful. Small risk of serious problems.

An intrauterine device can usually be fitted 6-8 weeks after giving birth.

Intrauterine system

A hormone-releasing intrauterine device called an intrauterine system (IUS) is a plastic device that contains a progestogen hormone. It is put into the uterus in a similar way to an IUD. The progestogen is released at a slow but constant rate. It is more than 99% effective. It works by making the lining of your uterus thinner so it is less likely to accept a fertilised egg. It also thickens the mucus from your cervix. It is also used to treat heavy periods (menorrhagia).

• Some advantages - very effective. Do not have to remember to take pills. Periods become light or stop altogether.
• Some disadvantages - side-effects may occur as with other progestogen methods such as the POP, implant and injection. However, they are much less likely as the hormone is mainly confined to the uterus (little gets into the bloodstream).

An intrauterine system can usually be fitted 6-8 weeks after giving birth.

Sterilisation - a permanent method of contraception

You and your partner may have decided that you have completed your family and decide you would like a more permenant method of contraception. Sterilisation Involves an operation. It is more than 99% effective. Vasectomy (male sterilisation) stops sperm travelling from the testes. Female sterilisation prevents the egg from travelling along the Fallopian tubes to meet a sperm. Vasectomy is easier and more effective than female sterilisation.

• Some advantages - very effective. Do not have to think further about contraception.
• Some disadvantages - very difficult to reverse. Female sterilisation usually needs a general anaesthetic.

Can I still use emergency contraception after having a baby?

Emergency contraception can be used at any time if you had sex without using contraception. Also, if you had sex but there was a mistake with contraception. For example, a split condom or if you missed taking your usual contraceptive pills.

• Emergency contraception pills - are usually effective if started within 72 hours of unprotected sex. They can be bought at pharmacies or prescribed by a doctor. This pill works either by preventing or postponing ovulation or by preventing the fertilised egg from settling in the uterus (womb).
• An IUD - inserted by a doctor or nurse can be used for emergency contraception up to five days after unprotected sex.

You will not need to have emergency contraception though if you have unprotected sex within 21 days of having your baby as you will not get pregnant so soon after childbirth.

Further information

This leaflet is just a brief account of the available methods of contraception after having a baby. Ask your practice nurse, doctor or pharmacist if you want more detailed information about any of these methods.

The fpa (formerly the family planning association) also provide information and advice.
fpa's helpline: 0845 310 1334 or visit their website www.fpa.org.uk