How to Decide What Method of Postpartum Contraception is Best

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So, you have had a baby (or babies), now what?

What are you thinking about for family planning? Or is your mind the normal mush mind of a new mom?

When you are ready to think about your sexual health and postpartum contraception, we want to help you decide what is right for you and your family.

Bottle or breastfeeding?

If you are breastfeeding, you will constantly find yourself asking the question, “Is it safe with breastfeeding?” Regarding contraceptive options, they are all ‘safe’ with breastfeeding, meaning that there are no ill effects on breastmilk no matter what contraceptive method you choose, however there are some that may interfere with your breastmilk supply.

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Contraceptive methods containing estrogen have been linked to a decreased milk supply, which is why most providers will recommend either a method that does not contain estrogen or waiting until your milk supply is well established before initiating an estrogen containing method of contraception.

Another consideration if you are breastfeeding is lactational amenorrhea which is an effective method of contraception so long as you are exclusively breastfeeding (no supplements, pumping or nursing every 2-3 hours during the day and no longer than 5 hours between feeds at night). Once this changes or your menstrual cycle starts again, consider tracking your cycles to determine when you are ovulating.

If you are bottle feeding, all choices are available to you. Pick the one that has either worked the best for you in the past or is the best method for your short- and long-term family planning goals.

Options that do not contain any hormone:

  • Paragard IUD (known world wide as the copper IUD): This can be inserted as soon as immediately following the delivery of the placenta (offered in some settings-talk to your provider) or you can wait until your postpartum visit. You will have a menstrual cycle with Paragard (unless you are nursing, then you may or may not).
  • Natural Family Planning: Tracking your cycles using an app or calendar and your basal body temperature and cervical mucus changes to determine when you are ovulating to either avoid or initiate intercourse depending on what your plans are (more babies right away or spacing pregnancies out)
  • Condoms
  • Diaphragm

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Options that contain progesterone only (will not affect milk supply):

  • Mirena/Liletta/Skyla/Kyleena IUD (progestin-only IUD): Just like the copper IUD, this can be inserted immediately postpartum or at your postpartum visit. Typically, you will have lighter or no menses at all with this method, though some people do have menses with this method.
  • Progestin only pills: These are also known as the “mini pill” because instead of both estrogen and progestin being used to regulate your ovulation, this pill only uses progestin. It is slightly less effective (91% with typical use) and it is important to make sure you take it each day to maintain it’s effectiveness.
  • Depo-provera injection: Depo Provera is the name brand of medroxyprogesterone acetate. You receive this injection approximately every 3 months. It is 99% effective. This method of contraception does have more side effects and some studies have shown that Depo Provera can either a) increase milk supply b) decrease milk supply or c) have no effect on milk supply. Menstrual bleeding patterns vary greatly with this method.
  • Nexplanon: progestin only contraceptive implant that is inserted just under your skin in your upper arm. It is effective for up to three years. On some units, it can be inserted before you even go home with baby. At other locations, you can have it inserted postpartum. It is a very easy in office procedure. Some women experience irregular menses with this method and others have light spotting and some have no menses at all. 

Options that contain both estrogen and progesterone:

  • The Patch: You apply one patch per week for three weeks and then have one week off and have a menstrual cycle.
  • The Pill: Daily combined contraceptive pill. These can be taken for three weeks, then one week off for withdrawal bleed or taken continuously. There are also formularies that you take a pill each day for 11 weeks and have a cycle every 12 weeks.
  • The Ring: This is flexible ring inserted into your vagina for three weeks, then removed for one week for a withdrawal bleed.

Whatever you are thinking, your provider will have a more detailed discussion with you. Not all methods are right for all people given your medical history (hypertension, smoking, history of breast cancer, or migraine headaches are some of the conditions to be considered).  We love the site bedsider.org for detailed information on all the various methods!

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