Once you and your new baby are home you will begin to settle into your new life as a family. This period can be full of many emotions, obviously enormous happiness but also, having a new baby –especially a first baby – can be somewhat stressful too.
Being intimate with your partner after pregnancy will probably bring up questions about contraception - you may have decided that you would like to have another baby soon after birth or perhaps you want to wait a while. Knowing what options are available and appropriate for you, can help you to decide on your chosen method of contraception.
We spoke to Consultant Obstetrician and Gynaecologist Dr Shazia Malik about frequently asked questions regarding contraception after birth.
I have just had my baby, when will my periods return?
It is different for each woman, and depends on how you are feeding your baby. If you are fully breastfeeding, you may not get a period until you stop, or may only get light spotting. If you are bottle-feeding, then on average your periods are likely to return five to six weeks after the birth. And if you’re mixed feeding, then it’s somewhere in-between.
Am I fertile right after giving birth?
Ovulation (release of the egg) usually takes place two weeks before a period which means that our bodies can become fertile again as early as 21 days after childbirth. For this reason, unless you are intending to have another child immediately, it is recommended that you discuss your contraception options with your Midwife, Health Visitor or your GP approximately one week after you have delivered your baby.
I have just had my baby, when can I begin contraception again?
Given that you can ovulate as soon as three weeks after the birth of your baby, unless you are exclusively breastfeeding (and breastfeeding at least four hourly during the day, and with a gap no more than six hours overnight), you should use contraception from then.
However, the National Institute for Health and Care Excellence currently recommends that all parents of new-born children discuss their contraception needs and choices with their Midwife, GP or Health Visitor by the time their child is one week old. This is because some methods of contraception may no longer be suitable, and others need to have been in use for three to four weeks to be effective.
Can I get pregnant while breastfeeding?
Breastfeeding can have a remarkable effect on the body and if your baby is younger than six months and you are exclusively breastfeeding your baby, under certain circumstances breastfeeding can act as a ‘natural contraceptive’.
For this to be the case, you must be exclusively breastfeeding your baby at least six times a day with no more than a four hour gap between day feeds and a six hour gap between night feeds. Under these circumstances your risk of pregnancy is very small, unless you are having periods or light spotting. Should the latter be the case you may wish to also consider using condoms or the mini-pill. This contains progesterone only and should not interfere with your milk supply like oestrogen-containing contraceptives can.
Remember, though natural family planning is possible, it is the least effective method and it is best to get advice from your GP or family planning clinic on how to use this method successfully.
Are there any kinds of contraception I should avoid if breastfeeding?
When choosing a method of contraception after childbirth it is important that you remember that any method that you have used successfully in the past may no longer be suitable for you; this is especially relevant for breastfeeding women as some methods of contraception can impact upon breast milk supply. This applies mainly to those methods that contain oestrogen – i.e. the combined oral contraceptive pill, or the vaginal ring or skin patch of combined contraception.
What kinds of contraception can I use while breastfeeding?
It isn’t advisable just to use exclusive breastfeeding as a contraceptive, even if you are not having periods. This is because ovulation takes place two weeks before a period happens, so you will be unaware that there is a risk of pregnancy.
Apart from the methods above containing oestrogen, you can use most other methods of contraception. The most common methods are either condoms or the ‘mini-pill’ which is the progesterone only pill. But this is only effective if taken at the same time every day – so for tired Mummies I advise them to set their phone alarm to the same time every day to remind them!
Pregnancy and childbirth can impact upon the body in many ways and if you have associated risk factors e.g. your blood pressure has changed as a result of your pregnancy, then this will have an impact on the advice that you are given, whatever method of feeding you are using for your baby.
If you choose to have a coil or an implant, it is best to wait until your six week postnatal check, as this is how long it takes your body to change back from the effects of pregnancy and the birth. Especially with an implant, one can get heavy and irregular bleeding if inserted too early. If you are ready to make love before this, then you can use condoms. If you are having a diaphragm fitted, then it is best to wait until the six week check – remember your body is likely to have changed after childbirth and you may need a different size etc.
What common side effects are there when using contraception shortly after having a baby?
Most women do not have any major side effects, especially if you make an informed choice along with your GP or family planning clinic, or indeed your Obstetrician! If you are exclusively breastfeeding, then you may have no periods, especially whilst taking the POP. Otherwise there should be no other major side effects.
Can I use emergency contraception while breastfeeding or shortly after giving birth?
Yes you can – especially if this is the coil – but it must be inserted within five days of unprotected intercourse, and may not be suitable so early if you have had a caesarean section.
As for the emergency contraceptive pill, as it just contains progesterone it can be taken. There are two different pills:
Levonelle can be taken while breastfeeding. Although small amounts of the hormones contained in the pill may pass into your breast milk, it is not thought to be harmful to your baby.
The safety of ellaOne during breastfeeding is not yet known. The manufacturer recommends that you do not breastfeed for one week after taking this pill.
What kind of contraception should I use if I want to have another baby in the next year or so?
It is best to use something that you are comfortable with, and doesn’t affect your cycles too much. So perhaps condoms or a coil might suit you best. But any method only works if used correctly, and suits you, your circumstances and lifestyle.
Where can I get advice about contraception after pregnancy?
The National Institute for Health and Care Excellence currently recommends that all parents of new-born children discuss their contraception needs and choices with their Midwife, GP or Health Visitor by the time their child is one week old. This is because some methods of contraception may no longer be suitable, and others need to have been in use for three to four weeks to be effective.
In my practice, I advise my clients before discharge from The Portland Hospital, and then again at their six week postnatal check.
This is especially the case if you suffered with high blood pressure or certain other medical complications of pregnancy – so the right advice, individualized to you, is crucial.