Contraception After Giving Birth

If you’ve just given birth and are going through sleepless nights, feeding and nappy changes, another baby could be the last thing you’re thinking about. You can become fertile again quickly after having a baby though, so if you’re not planning on getting pregnant again soon, thinking about contraception is vital.

If you are feeding your baby formula milk exclusively, or combining breastfeeding with formula feeding, then your periods will probably start again from six weeks to three months after giving birth. You could be fertile two weeks before starting your periods again though, so if you’re not planning on getting pregnant again you need to consider using some type of contraception again pretty soon after having your baby.

Even if your periods haven’t come back yet, you could still be fertile without knowing it. Using contraception again after giving birth can help give you the peace of mind that you won’t get pregnant again (even if sex is the last thing on your mind!).

If you are breastfeeding your baby then some forms of combined hormonal contraceptives (containing oestrogen and progestogen) may not be recommended as they may reduce your milk supply.

However, there are many other forms of contraceptives that are safe to use when breastfeeding. If you have any questions about which methods of contraception to use after having a baby, you can discuss it with your doctor at your six-week postnatal check. Your health visitor or midwife can also help and give you advice at any time.

You will generally be less fertile while you’re breastfeeding, because it curbs the hormones that cause ovulation. Whether you’re exclusively breastfeeding or combining giving your baby formula milk with breastfeeding, you may not start your periods again for months or over a year. However, you’re not infertile and you can’t rely on breastfeeding to act as an effective contraceptive.

Even if you haven’t had a period yet, your body could release its first egg after birth before you start to menstruate again. So you could ovulate - and be fertile - without knowing it.

If you know that you don’t want to get pregnant again, the safest option is to start using contraception as soon as you start having sex again.

There are a number of contraceptive options available to you that can safely be used while you’re breastfeeding.

Your doctor may recommend using a barrier method of contraception if you’re still breastfeeding, as some contraceptives containing combined hormones, such as the combined pill, the patch and the contraceptive ring, can decrease your milk supply.

The following methods of contraception can be used while breastfeeding:

• Condoms (male and female)
• Contraceptive Diaphragm or cap
• The mini-pill (which contains progestogen only)
• Contraceptive injection - but the injection will usually not be given less than six weeks after birth if you are breastfeeding
• Contraceptive implant
• Intrauterine device (IUD, also known as the coil)
• Intrauterine system (IUS, also known as the hormonal coil)

Some of these contraceptive methods, including the mini-pill, the injection and the IUS, contain a synthetic progestogen. A small amount of this hormone may be passed to your baby through your milk, but this is thought to be harmless.

If you have had a miscarriage then you may not want to think about getting pregnant again yet. Your doctor may advise you against having sex until the bleeding has stopped, to avoid the possibility of infection.

You can ovulate 14 days after a miscarriage so if you don’t want to get pregnant again, the best way to give yourself peace of mind is to start using contraception as soon as you start having sex again.

The first menstrual cycle after miscarriage can also be unpredictable and longer or shorter than usual so you could conceive and it would be difficult to work out when it happened.

You can have the contraceptive injection or the implant immediately after a miscarriage. It will give you immediate protection against pregnancy. Barrier methods such as condoms, diaphragms and caps can also be used when you have sex to protect you against pregnancy.

As long as there is no infection present, the IUD is also safe to be used. The combined contraceptive pill and mini-pill are both safe to take after a miscarriage.

When taken correctly the combined contraceptive pill is more than 99% effective and the mini-pill is 99% effective, but very rarely women can get pregnant while on the pill. If this happens, you may worry that the baby will be harmed by the unintentional use of contraception while pregnant.

Some of the symptoms of pregnancy - feeling sick, tender breasts and some irregular bleeding - can also be side effects of taking the pill. If you are in any doubt, do a pregnancy test for your own peace of mind. There is a slightly increased chance of an ectopic pregnancy (where the foetus implants outside the womb) if you get pregnant while taking the pill.

There is so far no evidence to suggest that taking the combined contraceptive pill or the mini-pill during early pregnancy increases the risk of birth defects. Though to be on the safe side you should stop taking the pill as soon as you think you are pregnant and consult your doctor. It may also be advisable to use an alternative form of contraception such as condoms until you are sure.

If you think you may be pregnant while on the pill but are not sure, condoms can protect you against pregnancy until you can take a test and/or see your doctor. Condoms can also be used while you are pregnant to protect you from sexually transmitted infections.