During the last few months of your pregnancy, birth control is probably the last thing on your mind. With the excitement of the new baby’s arrival, you have plenty of other things to think about. But leaving decisions about birth control until after the baby arrives could result in an unexpected or risky new pregnancy. It’s best to develop a plan during the last few weeks or months of your pregnancy to be as prepared as possible.
Things to consider
Fertility can return shortly after chidbirth, but getting pregnant again within a year of having a baby can increase the risk that your baby will be born too early, according to U.S. Department of Health and Human Services. Spacing your pregnancies out further — at least 12 months — ensures that your body has time to recover. Birth control can help you avoid an unplanned pregnancy during the postpartum period.
Your choice of birth control methods will depend on several factors. Before choosing, consider:
- Whether you want more children
- When you want more children
- Whether you will be breastfeeding
Your answers can help you choose the birth control method that is best for you and your growing family. For example, if you want to wait a few years to have more children, you might want to try a long-term birth control method such as an IUD or implant, rather than temporary methods, such as condoms or a diaphragm.
It’s important to remember that what you used for birth control before you were pregnant might not be the best choice after your baby is born. For example, the effectiveness of cervical caps is greatly reduced after pregnancy, diaphragms need to be refitted, and, if you are breastfeeding, you shouldn’t use certain methods for the first few weeks after childbirth.
Breastfeeding as birth control?
When you are breastfeeding, you have limited protection from pregnancy for the first six months, according to the World Alliance for Breastfeeding Action. This is called the lactational amenorrhea method. However, to use this method effectively, you need to breastfeed every four hours during the daytime and every six hours at night. Once you get your period, this protection goes away. Unplanned pregnancies can happen during this time because you may not be aware that the protection is gone until your period starts, which is about two weeks after ovulation.
Hormonal methods of birth control
Many hormonal birth control methods rely on estrogen as the active ingredient. If you are breastfeeding, avoid birth control methods that contain estrogen for the first 4-6 weeks after childbirth because they may affect milk supply, according to the American College of Obstetricians and Gynecologists (ACOG). These methods include birth control pills containing estrogen and progestin, the patch, and the vaginal ring. Even if you are not breastfeeding, your doctor might recommend waiting up to six weeks after delivery to use these methods in order to reduce the risk of blood clots, according to ACOG.
The birth control injection (Depo-Provera), which you receive four times per year, is an effective form of hormonal birth control that does not contain estrogen, but fertility may not return until up to one year after discontinuing the shots, according to the National Institutes of Health. If your plans include another pregnancy within the next year, this method may not be the best choice.
There also are birth control pills that are progestin-only, and you may be able to start these immediately after delivery. This type of pill is sometimes called the “mini-pill.”
Long-acting reversible methods of birth control
An intrauterine device (IUD) is one of the most effective forms of birth control and may be a good option for women who want to wait a few years before having another child or do not want more children. IUDs can sometimes be inserted immediately after birth, but some doctors prefer to wait several weeks until your uterus returns to normal size, according to ACOG. They are effective for three to 10 years, depending on the type you get. There are two main types of IUDs: hormonal (containing a form of progestin) and nonhormonal (copper). Each has its own benefits and side effects.
Another long-acting reversible form of birth control is the implant. It is a form of birth control containing the hormone progestin that goes in the upper arm and can last up to three years.
Nonhormonal methods of birth control
Immediately after birth, you can use condoms for contraception. Some women do experience vaginal dryness or soreness for several weeks or months after delivery and might find condoms uncomfortable or painful. This can usually be alleviated by using a lubricant.
Diaphragms and cervical caps are other nonhormonal options. To use these methods, you will need to be fitted so the device fits securely over your cervix. Even if you used one of these methods prior to pregnancy, you will need to be refitted after childbirth. It may take up to six weeks for the doctor to properly fit you due to changes in your vagina and cervix during pregnancy and childbirth. The cervical cap is not as effective after a vaginal delivery, according to ACOG. If you had a cesarean delivery, you might still need to be refitted, especially if the baby’s head came into the pelvis.
Some people prefer to use the fertility awareness method of birth control. This involves taking your temperature each day, checking your cervical mucus, or tracking your monthly cycle, according to Planned Parenthood. There are several ways to do this, and your doctor or midwife can explain the different methods to find the one that works for you.
One of the potential problems with using this method after childbirth is it isn’t always reliable during the first few months after delivery and aren’t an ideal choice if you have irregular periods. The cervical mucus method, which relies on tracking changes in your cervical mucus, isn’t reliable until after you have had your first period after your delivery. By this time, you have already ovulated and could become pregnant. Using body temperature to track your monthly cycle is only accurate if you have six hours of uninterrupted sleep, which is difficult for a new mother.
Permanent methods of birth control
If you know you don’t want to have anymore biological children, sterilization is also an option. This is the only permanent method of birth control. If done on a man, the procedure is called a vasectomy. If done on a woman, sterilization involves a procedure to close off the fallopian tubes, according to ACOG. Sometimes, these procedures can be done within a few hours of your baby being born.
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Eileen Bailey is a freelance health writer. She is the author of What Went Right: Reframe Your Thinking for a Happier Now, Idiot’s Guide to Adult ADHD, Idiot’s Guide to Cognitive Behavioral Therapy, Essential Guide to Overcoming Obsessive Love, and Essential Guide to Asperger’s Syndrome. She can be found on Twitter @eileenmbailey and on Facebook at eileenmbailey.