Contraception after childbirth

I believe as Mothers this topic is something we will come by at some point or another. Shazia gained her Medical degree with Honours and the Gold Medal in Obstetrics and Gynaecology in 1991. She has trained in Obstetrics in some of the largest tertiary level units in the country – her specialist training was undertaken in Cambridge, where she was also a research fellow funded by the MRC with a world-famous team looking at abnormal vessel function in women with excessively heavy periods or endometriosis. She went on to successfully complete Subspecialty accreditation in Reproductive Medicine and Surgery at UCLH (London), where she remains an Honorary Consultant. She has worked as a Consultant Obstetrician and Gynaecologist as part of the Recurrent Miscarriage team at St Mary’s Hospital, Paddington and as a Consultant in IVF at CRGH – one of the country’s leading IVF units. She works both in a busy high risk NHS maternity unit as well as her private Obstetrics and Gynaecology practice at the renowned Portland Hospital in London.

Although sex may be the last thing on your mind immediately after giving birth, unless you are intending to have another child immediately, or you have infertility that can only be treated with IVF, you need to think about contraception.  In fact NICE recommend that you should have had this discussion with either your midwife, health visitor or doctor within 1 week of giving birth.  Also your body could be fertile from about 21 days after the birth, so it’s worth thinking about your options early.  You do not need to have had a period to be fertile – remember that ovulation (release of the egg) occurs about 2 weeks before a period.  Even if you have used a method successfully in the past, it may no longer be suitable for you for a variety of reasons – so do take advice on what might be best for you (and your baby and partner).

The method that you choose will depend on your medical history (and associated risk factors), future fertility plans and whether or not you are breastfeeding.  If you are, then it depends on whether you are fully breastfeeding or doing combination feeding with breast and bottle.  If the latter is true, then you need to use contraception from 3 weeks onwards.  Otherwise if you are exclusively breastfeeding (i.e. no other solids or fluids), as long as you have no periods (even light spotting counts as a period), are feeding your baby at least 6 times a day with no more than a 4 hour gap between starts of feeds during the day, and 6 hours at night AND your baby is less than 6 months old, then your chance of pregnancy is very small.

Otherwise breastfeeding women usually prefer to use either condoms or the mini-pill (progesterone only pill or POP).  The POP should not reduce your milk supply (whereas the combined oral contraceptive pill contains oestrogen which can have this effect), but must be taken at the same time every day to be effective.

If you are bottle feeding then as long as there are no medical contraindications, you can use any method that works for you.  If you want the Progesterone-only injection (each lasts 12 weeks) or the contraceptive implant (lasts upto 3 years), you should wait until 6 weeks after birth – to avoid heavy and irregular bleeding.  This means that you need to use condoms or the POP from 3 weeks until the injection/implant  is given.  If you feel that you need this method from 3 weeks, then be prepared for some irregular and heavy bleeds until your body adjusts.

 

Although a coil (either the Copper Coil or the hormone coil or IUS) can be inserted in the 48 hours after delivery, this is unusual. If this is what you would like to use, then I would recommend waiting at least 4 weeks, but preferably 6 (after a vaginal or caesarean birth) to have it fitted.  The copper coil lasts for 5-10 years depending on type, and the IUS (Mirena coil) for upto 5 years.  If you prefer a diaphragm or cap along with spermicide , then remember that your body changes after giving birth, and you will need to have a new fitting.  It takes the body about 6 weeks to fully recover and this would be the best time at your 6 week postnatal check to have this done.

 

The combined oral contraceptive pill or the contraceptive patch or vaginal ring all contain oestrogen.  So they need to be avoided until 6 months after birth if you are breastfeeding – otherwise you can use them from 3 weeks after having your baby.  If you are over 35, a smoker, very overweight or have some other medical conditions, these may not be suitable for you – it is best to take expert advice either from your GP or your local Family Planning Clinic.

It is always possible to use what is known as ‘natural family planning’ but this is the least effective method, and it is best to get advice on how to use this successfully. There are now apps that purport to help with natural (cycle based) family planning around the ‘fertile window’ of your cycle, using body temperature and mucus monitoring but in my experience these are certainly not failsafe – so use with caution and only if an unplanned pregnancy wouldn’t be a disaster!

 

If you know that you are planning another pregnancy in the next year or so, it would be best to avoid the contraceptive implant or injection.  Although you could have a coil inserted, if it’s only for a matter of months then you might prefer to use a contraceptive pill (either POP or combined pill), patch, vaginal ring or barrier methods (condom or diaphragm).

It is safe to use emergency contraception if you have unprotected sex from 3 weeks after delivery, even if you are breastfeeding. This can be either tablets (from 3 weeks) or a copper coilfrom 4 weeks).

If sex is painful or difficult, then do seek help and advice.  It is best to sort these problems early so that they don’t affect you in the long-term – either physically or within your relationship.