Why new moms have to consider contraception differently

Posted on 5 February 2019

You’ve just become a mother and your whole world has begun to revolve around your new bundle of joy. While another baby might be the last thing on your mind (it might be the first) it could be on your radar if you haven’t had a post-partum discussion with your gynaecologist about contraception.

Whether or not you’ve been on any kind of contraception before, having a baby changes the family planning options that are best for you and your baby.

Before falling pregnant your birth control options would have been informed by factors such as your age, health and desire to have children in the future. Now, you also need to consider the impact of breastfeeding on your reproductive system as well as how your contraceptive method will affect your breastfed baby.

Your body on breastfeeding: Health benefits for mom

3 Important considerations for postpartum contraceptive

Dr Malikah Van Der Schyff, a gynaecologist and obstetrician at Mediclinic Constantiaberg, says many new mothers can become overwhelmed by the many contraceptive options on the market. Luckily, this conversation doesn’t have to happen until six weeks postpartum.

Women are advised against sexual intercourse until this point to allow the cervix to recover, to minimise the likelihood of infection or complication and to avoid interfering with breast milk production. If you’re not breastfeeding, this is the period of time it would take for your period (and your fertility) to return.

“If you’re breastfeeding exclusively during this time (and up to six months postpartum) and haven’t resumed menstruating, breastfeeding can act as a natural contraceptive method. However, it’s not 100% effective,” says Dr Van Der Schyff. “We’ve all heard of a breastfeeding mother who’s fallen pregnant unexpectedly before baby number one reaches a year old,” she adds. Research also suggests that the contraceptive effectiveness of breastfeeding varies among women.

Contraception methods then and now

1. Choice

“Not all mothers will want to use contraception outside of a barrier method, like condoms, and that’s perfectly fine,” says Dr Van Der Schyff.

“It really comes down to each woman’s choice and preference. This is determined by a few things such as spacing between births, and whether or not you are choosing to breastfeed or not.”

2. Family planning

If you’re planning to have a second child, the space between births will inform your choice of birth control. “Some mothers who want more than one child may opt to have their children close together – two years apart. For this reason, long-acting contraceptives like the loop or an IUD won’t really be suitable.” She says these women also tend to avoid the injection, which isn’t long-acting per se, but the effects can last up to three months or more between doses.

It’s recommended that new mothers wait between 18 and 24 months before conceiving again to avoid complications.

3. Breastfeeding

Usually, for the first six weeks, abstinence or a progesterone-only method is best to ensure your milk supply isn’t affected. Combined birth control methods (that contain both oestrogen and progesterone) have long been thought to decrease breastmilk supply but recent research suggests this may not be true. “Combined birth control can, however, affect your breastfed baby adversely,” cautions Dr Van Der Schyff,

What are your options?

Your postpartum contraceptive options include:

  • A contraceptive implant (placed in the arm)
  • A copper or hormonal intrauterine device (IUD)
  • Progesterone-only contraceptives, such as the contraceptive injection or the minipill

Dr Van Der Schyff says women who would like to use the rhythm method may only do so safely if they have a regular period. It’s not recommended while breastfeeding if your period hasn’t returned.

Combined birth control methods may also pose an increased risk of blood clots shortly after delivery. Discuss your goals for growing your family with your gynaecologist at your six-week postpartum check-up to customise birth control to your needs.

A detailed guide to contraception

Published in Gynaecology

In the interest of our patients, in accordance with SA law and our commitment to expertise, Mediclinic cannot subscribe to the practice of online diagnosis. Please consult a medical professional for specific medical advice. If you have any major concerns, please see your doctor for an assessment. If you have any cause for concern, your GP will be able to direct you to the appropriate specialists.