Postpartum Birth Control: What Option Is Best for You?

The last thing on my mind right after giving birth to my first child was birth control. Once I recovered, however, I had to think about it since I didn’t want to have another baby right away. (The Lactational Amenorrhea Method, or breastfeeding as birth control, isn’t reliable; although ovulation will be delayed during breastfeeding, it’s hard to say for how long.) While talking to my midwife I learned that my postpartum birth control options were different than the birth control options I had before getting pregnant. Because I was breastfeeding, I couldn’t take the same estrogen-heavy option I’d once used. “Estrogen containing contraception can decrease a mom’s milk supply,” explains Tara Abella, MD, an ob-gyn in private practice in Livingston, New Jersey. The good news was that there were still a lot of options for me to choose from; I just needed to pick one. 
So, if you’ve recently had a baby, you definitely have plenty of options to prevent pregnancy (because you will want to have sex again at some point, trust us). You’ll need to take into account whether you’re breastfeeding, as well as what method of birth control best suits your lifestyle and health history. Consider: Will you remember to take a pill every day? Do you have a history of blood clots in your family? Are you planning on getting pregnant within the next year or two? And so on. Here, we break down your different birth control options postpartum, with pros and cons for each one. 

1. Oral Contraceptive Pill 

What it is: The Pill comes in two basic forms, one combining the hormones estrogen and progestin (a synthetic form of progesterone), and a progestin-only pill, called the “Mini Pill”. 
Pros: It can be extremely effective, may reduce the duration of your period, and could reduce cramps. The Mini Pill does not affect breastmilk supply, so it’s a good option for breastfeeding moms.

Cons: You must remember to take it every day for it to be effective. There’s a possibility of blood clots, breast tenderness, and weight gain. “Additionally, its effectiveness can be lessened by certain medications, such as antibiotics,” adds Oren Keiser, MD, an ob-gyn in private practice in Livingston, New Jersey.

2. Nuva Ring

What it is: This small plastic ring contains estrogen and progestin. You insert it into your vagina for three weeks, then remove it for one week, during which time you get your period; you’ll repeat this cycle every month. “It works the same way as a birth control pill,” says Dr. Keiser. “It’s just that the hormone is introduced into your blood stream by being absorbed through the skin instead of the GI tract.” 

Pros: It can be very effective, and you only need to change it once a month.

Cons: There’s a possibility of developing blood clots and gaining weight. If you’re breastfeeding, it may decrease your breastmilk supply.

3. IUD 

What it is: This T-shaped piece of plastic is inserted into your uterus by your doctor; it blocks sperm from fertilizing the egg. There is a hormone-free version, ParaGard, as well as three progestin-only options: Mirena, Skyla, and Liletta (all safe for breastfeeding moms). “A patient with a history of blood clots would only be eligible for a non-hormonal method which is the ParaGard IUD,” says Dr. Abella. IUDs last from 3 to 10 years, depending on the brand, but can be taken out at any time. 
Pros: It’s long lasting, low maintenance, and highly effective, as well as a good choice for nursing moms.

Cons: There is a possibility of irregular bleeding in the beginning (which usually resolves and results in shorter, lighter periods), and a small risk of perforation. According to Dr. Abella, women with a history of very heavy or painful periods might not want the non-hormonal IUD (ParaGard), because it has been associated with some reports of heavier periods and increased cramping.

4. Depo Provera

What it is: Known as The Birth Control Shot, this progestin-only injection is administered by a doctor every three months.

Pros: It can be very effective, and involves only four shots per year. You also may have lighter periods while taking it. Since it doesn’t contain estrogen, it’s a good choice for nursing moms.

Cons: “Using this method of birth control beyond two years may reduce bone density,” says Dr. Keiser. In addition, there is possible weight gain, irregular bleeding, and it might take you longer to get pregnant again. 

5. Birth Control Patch

What it is: Think of it as a big band-aid that sticks to your skin and delivers both estrogen and progestin through your bloodstream to prevent ovulation. You change it every week for three weeks (don’t worry, it won’t fall off), followed by one week, patch-free, during which time you get your period. The birth control patch contains both estrogen and progestin.

Pros: It can be very effective, easy to use, and you may have shorter, lighter periods while using it. 

Cons: It may cause blood clots, breast tenderness, spotting, and a rash. It’s not recommended for nursing moms. 

6. Birth Control Implant

What it is: This is a progestin-only, matchstick-size implantable device that is inserted by your doctor under the skin of the upper arm (an IUD, on the other hand, is inserted into the uterus). Brand names include Implanon and Nexplanon.  

Pros: It’s effective for up to three years, a good choice for nursing moms, and might reduce the length of (or even eliminate) your period.

Cons: Similar to OCPs, the implant can be less effective in combination with other medications. Additionally, it may cause irregular bleeding for up to a year after the implant.

7. The Barrier Method

What it is: You know, condoms and diaphragms. Keep in mind that diaphragms may need to be refitted after you give birth, as the size and shape of your vagina may have changed.
Pros: Both are easy to use, effective when used correctly, and have no side effects. They’re also a good choice for nursing moms.

Cons: They’re not very effective when used incorrectly, and they can break. You must remember to put it on (or in, in the case of an IUD) every single time. 

And before you ask, no, doctors don’t recommend the “pull-out method.” It might have worked for you in the past, but there is never a guarantee with this method. “The only thing that is 100 percent effective against pregnancy is abstinence,” says Dr. Abella. She adds that women who’ve experienced infertility and used IVF to become pregnant are not off the hook, either. “They could still possibly get pregnant spontaneously in the future.” Discuss your options with your healthcare provider, and choose the best one for you. Hey, it’s great to have options, right?

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Photo: Getty