Using Birth Control After Having a Baby
You can get pregnant very shortly after you give birth, even if you're breastfeeding and your periods haven't started again, so before you have sex again, decide what form of contraception you'd like to use. You can talk to your doctor or midwife about what form of birth control to use at your 6 week check up, or if you'd like to discuss it before then, book an appointment to see your doctor or visit your local family planning clinic. You can use the same method of birth control you used before you got pregnant, or you might decide a different method would now suit you better.
Male and female condoms can be used as soon as you're ready to have sex again. They help protect against pregnancy and are the only form of contraception which protects against HIV and STD's. Condoms don't affect your hormones, or breastfeeding, and there are no side effects (as long as you aren't allergic to latex or lubricant). You can either use condoms long term or short term. If you choose to use a hormonal form of contraception, you can use condoms until your chosen method has become effective. The male condom is between 84-89% effective against pregnancy, and the female condom is 80% effective.
This fits into your vagina before you have sex and works by stopping sperm from entering your cervix. You will need to fill it with spermicide before insertion. A diaphragm can be used 6 weeks after giving birth. You will need to be fitted by a nurse for one of these. If you have previously used a diaphragm, you'll need to be refitted after giving birth as your size may have changed. Weight gain/loss also affects the size of diaphragm you'll need. This type of contraception does not contain hormones and doesn't affect breastfeeding. The diaprhagm can however, slip out of the vagina, and is only 80% effective at preventing pregnancy.
The Cervical Cap
The cervical cap is a thimble shaped cap made of silicone or rubber which you partially fill with spermicide, and then insert it into the vagina before you have sex. It fits over your cervix and stops sperm from entering your uterus. It is smaller and less noticeable to either partner than the diaphragm, and is less likely to slip out during sex. After sex, you have to leave the cap in for at least 6 hours, after which you can remove and wash it. You can use the cap ten weeks after giving birth. You will need to be fitted by a nurse to ensure you're using the correct size. The cap doesn't interfere with breastfeeding and doesn't have any common side effects. The cap is 82-93% effective in preventing pregnancy, depending on whether it is properly used and on the manufacturer.
A coil, also known as an IUD or IUS, can be fitted 6-8 weeks after giving birth and is effective immediately. It is a t-shaped device which is inserted into the entrance of the womb via the cervix by a nurse or doctor. The t-shaped arms fold down during insertion. It is highly effective against pregnancy, but offers no protection against STD's. It works by stopping sperm entering your uterus and by making the womb inhospitable for fertilisation. The coil is suitable for women who want long term protection, as it can last for up to 8 years, although it is common to have it changed every 5 years. If you want to have another baby sooner than this, you can have it removed at any time and normal fertility will return immediately. The coil is suitable for breastfeeding mothers as it doesn't interfere with nursing. The coil is over 99% effective at preventing pregnancy.
The Mirena coil is a particular type of coil which releases hormones into the bloodstream. This helps to lighten periods and lessen menstrual cramps. Women have reported less side effects with the Mirena coil than the traditional copper coil.
Some women experience bleeding and abdominal pain after having the coil fitted. These side effects should only last a few weeks however. It can be uncomfortable while the coil is fitted, but shouldn't be painful. Doctors have reported that it is easier to fit a coil on a patient who has had a baby as the cervix is not as tightly shut as in women who haven't had a baby.
The coil isn't suitable for women who have had an ectopic pregnancy, or are exposed to the risk of STD's, as not only does it offer no protection against STD's, but it can cause existing infections to inflame, which can result in infertility. Some clinics insist on performing an STD screening before inserting a coil. There is also a small chance that the womb can be perforated by the coil when it is inserted, but this is rare.
Hormonal methods are very effective against pregnancy, but offer no protection against HIV and other STD's. They are only available on prescription.
The Combined Pill
There are two types of pill; the combined pill and the progestogen only pill. Both types of pill are 95% effective at preventing pregnancy. The combined pill contains progestogen and estrogen. It isn't suitable for breastfeeding mothers, as it reduces the quality and quantity of breastmilk. You need to take a pill every day for 21 days, and then have a 7 day break, where you will experience withdrawal bleeding (similar to a period but normally lighter and less painful). You have to wait 4 weeks after giving birth to take the combined pill as it contains estrogen, which increases the risk of blood clots in postpartum women. Its effects are reversible and fertility returns as quickly as your next period when you stop taking it.
The Mini Pill
This contains progestin, and must be taken every day. It is suitable for breastfeeding mothers, but you should wait until 6 weeks after labour to start taking it if you are exclusively breastfeeding. If you aren't breastfeeding, you can start taking it immediately. When you stop taking the mini pill, your fertility will return immediately.
Implant and Injections
These types of hormonal contraception are convenient for women who want a highly effective and long lasting method of contraception but don't want an IUD and don't like taking pills every day, or find it hard remembering to take them. They usually cause changes to periods, and many women experience nuisance irregular bleeding for quite some time after starting either method. Periods may remain irregular while on these methods of contraception. Both methods are over 99% effective at preventing pregnancy. As with other non-barrier methods of contraception, they don't protect against STD's.
The implant is inserted into the inner side of your upper arm during a small operation under local anesthetic. It lasts for 3 years, and is the size of a hairgrip. It slowly releases the progestogen hormone into your bloodstream, which stops ovulation, and also stops sperm getting through to the womb. It also makes the lining of the womb thinner so an egg can't attach itself to the uterus. The implant is over 99% effective at preventing pregnancy.
The contraceptive implant can be fitted 3 weeks after giving birth. If it is fitted on or before the 21st day you gave birth, you will be protected against pregnancy immediately. If it is fitted after 21 days since you gave birth, you'll need to use another form of contraception, such as condoms, for an additional 7 days. As soon as the implant is taken out, your fertility will return to normal.
The contraceptive injection lasts either 8 or 12 weeks, depending on which injection you are given. It works by stopping ovulation, and also thickens the mucus made by the cervix, forming a mucus plug which stops sperms getting through to the womb. The injection is given into a muscle, usually the buttock. You can have the injection any time after you give birth, if you aren't breastfeeding. If you are breastfeeding, you can have it done 6 weeks after you gave birth. The injection is safe to use while breastfeeding. You can have the injection given to you on any day of your cycle, but if you have it on or before the 21st day since giving birth you will be protected against pregnancy immediately. If you have it after the 21st day, you'll need to use additional contraception, such as condoms for 7 days.
Women often experience heavy and irregular bleeding if they have the injection within a few weeks of giving birth. Side effects of the injection last 2-3 months, and it can take 6-8 months for your periods to return to normal after stopping injections. Occasionally it can take up to 1-2 years for a woman's periods to return, so factor this in if you plan to have another baby in the future.
If you are unsure which form of contraception would be best for you, talk to your doctor about the pros and cons of each one and any specific health concerns have, or pre-existing health issues.