I’ve had a baby – I need a break before the next! Contraception after birth

Reviewed: August 13, 2021
As The Lowdown’s Dr Fran heads off on maternity leave, she spills the T on contraception after birth...

TL;DR; What’s The Lowdown?

  • Pregnancies are higher risk if they happen within 12 months of a previous pregnancy 
  • You are fertile from 21 days after giving birth
  • Most contraceptive options can be started immediately after childbirth
  • The combined pill should be started 6 weeks after delivery but this can be shortened to 3 weeks after delivery in certain conditions
  • Coils can be fitted within 48 hours of delivery but the risk of perforation can be higher if you are breastfeeding, otherwise they can be fitted after 4 weeks
  • Breastfeeding can be used as a form of contraception – with some caveats!
  • Contraception doesn’t affect your breastfeeding journey or milk supply
  • Take care with fertility awareness methods for contraception after giving birth
  • There is little research into how your side effects on a method of contraception can change after having a baby – help us collect reviews here 

 

Picture the scenario – your beautiful bundle of joy has arrived; sleepless nights, leaking breasts and a constant battle with the pile of washing. I’m living through this, and what I would NOT want is to fall pregnant and start with morning sickness again….hence contraception!

The World Health Organization (WHO) currently advises leaving 18-24 months between pregnancies, and a large study from Canada suggests that 12-18 months before your next pregnancy is the ideal gap to reduce risks to the baby, including premature birth and a low birth weight. While you might not be rushing to jump between the sheets within those first few whirlwind weeks, you may be getting the urge of intimacy before these 12 months are up, and contraception is so important to help space out pregnancies.

It’s not uncommon for a woman to find herself pregnant a couple of months after giving birth, sometimes accidentally. This is often because people don’t realise they are fertile BEFORE their periods return. Remember a period is what happens if an egg isn’t fertilised, therefore you must ovulate (which can lead to a pregnancy) before your period comes back. 

So, given this information, it’s a good idea to have a think about contraception before you actually have the baby. Even if you don’t, your healthcare professional should be discussing contraception with you either before you leave hospital or at your 6 week check after birth. UK guidance from the National Institute for Health and Care Excellence (NICE) states this should be done by hospital staff or your GP, but of course the local sexual health service can help too.

 

What contraception is best after giving birth?

The answer to this is both simple and complicated. The best contraception after giving birth is whatever is the best for you based on your needs, preference and medical history. At The Lowdown, we strongly believe contraceptive choice should be individualised, and it’s our mission to give you all the info needed to make the best choice for you.

 

When do I need to start contraception after a baby?

We know you can’t get pregnant for 21 days after delivery. Some women may not ovulate for several months after delivery depending on other factors like breastfeeding. We can’t predict when each woman will start ovulating again so it’s best to think about contraception early.

What can I start straight away?

Even though you don’t need contraception for the first 21 days, some contraception can be started immediately after birth. This is ideal as you don’t have to think about it later when the tiredness really kicks in. These options include:

  • progestogen-only pill (mini pill)
  • injection
  • implant
  • hormonal coil
  • copper coil

The Faculty of Sexual and Reproductive Healthcare (FSRH) suggests that maternity services should always have someone available who can offer you a contraceptive injection, implant or coil immediately after birth. However, unfortunately, in reality this might not always be possible due to staffing and the timing of your delivery. If that’s the case, you should be directed to where you can get your chosen contraceptive and provided with an alternative in the meantime.

 

When can I start the combined pill after a baby?

Combined hormonal contraception (the pill, ring or patch) can be safely started 6 weeks after giving birth for women who are medically eligible whether you are breastfeeding or not. If you AREN’T breastfeeding, you may be able to start combined contraception after 3 weeks as long as you have no other risk factors for blood clots like smoking, a raised BMI or have had a c-section. The reason for the longer delay before you can start combined contraception is all about blood clot risk. We talk a lot about blood clots with combined contraception, you can read more about it here.

We know that during pregnancy and the 6 week period just after giving birth, you have a higher risk of blood clots, which is greater than taking any type or brand of combined contraception. But the chance of you having a blood clot can add up with each separate risk factor, and therefore during this time the risks of taking combined contraception will outweigh the benefits.

Does anything change with barrier methods?

Both male and female condoms can be used straight after delivery, just like they were beforehand. If you use a diaphragm, you will need to wait for 6 weeks after delivery for the uterus to shrink back down and as your size may have changed, have another fitting. It’s advisable to use another method in the meantime.

Can I use fertility awareness methods soon after pregnancy?

Fertility awareness methods are most effective if you’ve been taught by a trained practitioner and are using multiple methods to identify your fertile days (cycle tracking, temperature and cervical mucus). For the first 4 weeks after delivery, these fertility signs aren’t present so the method won’t be reliable. The FSRH advice states that fertility awareness can be used 4 weeks after delivery if you ARE NOT breastfeeding, but that while breastfeeding you may want to consider another option.

If I want, can I be sterilised during a c-section?

Yes, if you discuss this with your obstetrician beforehand, female sterilisation can be offered at the same time as a planned c-section. Guidelines say you should discuss and consent to this at least 2 weeks before your c-section.

Can the coil be put in straight away? Are there any risks?

Both the copper and hormonal coil can be inserted within the first 48 hours after delivery, including straight after the placenta has been delivered, or during a c-section. However, not all maternity services can provide this, so we suggest discussing this option during your antenatal care. If you miss this 48 hour window or develop an infection after delivery, the insertion should be delayed until 4 weeks after and after any infection has been treated. Advantages of an early insertion after a vaginal delivery include significantly less pain on insertion (bonus), however, you have to weigh this up against the disadvantage that the coil has a higher risk of falling out (expulsion). Insertion of coils during a c-section does not increase your risk of expulsion, and you’ll be numb so no pain! Some research shows that the risk of perforation (where the coil can move through the uterus wall) is lower if inserted early after delivery as your muscle wall will still be thick.

Can breastfeeding be used as a contraceptive?

Well yes it can! This is called the Lactational Amenorrhoea Method (LAM). However, this is only considered a reliable form of contraception in certain strict conditions. You can only rely on this method if:

  1. The baby is less than 6 months old
  2. The mother is exclusively (or almost exclusively) breastfeeding day and night, and
  3. Her periods have not returned

If all these conditions are met, the LAM method is considered to be 98% effective, similar to contraceptive methods like the pill. However there are lots of factors that might affect these criteria, such as a reduction in the amount the baby is breastfeeding, if you are expressing milk or introducing other foods. Fertility UK is a useful resource if you want to learn more about this. 

Will my side effects on a certain contraception change after I’ve had a baby?

Unfortunately, as with much of women’s health (don’t get us started), this hasn’t been researched extensively. There has been some patchy research on the bleeding patterns with the implant and injection after pregnancy. This has found no difference in irregular or frequent bleeding compared to what we’d usually expect with these methods. The timing of starting the implant or injection after delivery also makes no difference to change in bleeding pattern. Annoyingly, there is no research on more complex side effects such as mood change. However, at The Lowdown, we have heard stories of women who have been really settled on a method of contraception before they got pregnant. On returning to the same method after pregnancy, they found their side effects were completely different! We believe this is only a small minority of women, but we would LOVE to find out more, so if this relates to you, please leave us a review to help other women.

Don’t forget, if you have any other questions that we haven’t covered, use our Get Advice service or drop us a message!

 

Sources:

  1. Schummers L et al. Association of Short Interpregnancy Interval With Pregnancy Outcomes According to Maternal Age. JAMA Internal Medicine. 2018 Dec 1;178(12):1661-1670. Available at: 10.1001/jamainternmed.2018.4696 
  2. World Health Organization (WHO). Report of a WHO Technical Consultation on Birth Spacing. 2007. Available at: http://www.who.int/reproductivehealth/publications/family_planning/WHO_RHR_07_1/en/ 
  3. The Faculty of Sexual and Reproductive Healthcare. FSRH Guideline. Contraception after Pregnancy. October 2020.
  4. The Faculty of Sexual and Reproductive Healthcare. Clinical Effectiveness Unit. Intrauterine Contraception. September 2019.
  5. The Faculty of Sexual and Reproductive Healthcare. UK Medical Eligibility Criteria for contraceptive use. September 2019.
  6. National Institute for Health and Care Excellence. NICE guidance NG194. Postpartum Care. April 2021.
  7. Tepper NK, Phillips SJ, Kapp N, et al. Combined hormonal contraceptive use among breastfeeding women: an updated systematic review. Contraception;94:262–274.
  8. Heinemann K et al. Risk of uterine perforation with levonorgestrel-releasing and copper intrauterine devices in the European Active Surveillance Study on Intrauterine Devices. Contraception. 2015 Apr;91(4):274-9. Available at: 10.1016/j.contraception.2015.01.007

This guide was brought to you by The Lowdown. We are the world’s first contraception review platform, providing real-life experiences from thousands of reviews collected from our community of men and women.

Why not leave us a review of your contraceptive experience? Whether you’ve got good things to say about the Mirena coil or had trouble with implant removal, we want to hear about it! Tell us about your experience and help people around the world find the right method for them.