by Dr. Wendy (OB/Gyn)

Question

What birth control options can I use after I deliver? What about if I'm breastfeeding?

Answer

CONDOM
The condom can be used if you are or aren't breastfeeding. If you are not in a monogamous relationship and there is a chance that your partner has other partners, you MUST use a condom to protect yourself against sexually transmitted disease. The condom is also used to protect against pregnancy. If it slips off or breaks you can still take the morning after pill (Plan B one step) even if you are breastfeeding.

DIAPHRAGM OR CERVICAL CAP
Both of these methods are effective against pregnancy but both need to be fit for size and therefore cannot be fit until 6 weeks postpartum. Both are fine if you are or aren't breastfeeding.

PROGESTERONE ONLY METHODS
The progestin only mini pill, Depo provera and Etonorgestrel implants can be used as contraceptive methods right after delivery in women who are not breastfeeding. There is some controversy about using these methods immediately after delivery in breastfeeding women, but in general their use is approved right after delivery in breastfeeding women.

COPPER IUD
The copper IUD (Paragard IUD) can be placed within 10 minutes after delivery of your placenta if you have a vaginal delivery or a cesarean section, and it is totally safe to use if you are breastfeeding or if you aren't. There is however, a higher risk of expulsion and uterine perforation if you place the IUD immediately postpartum as opposed to waiting until 6 weeks postpartum, where these risks are much lower.

PROGESTERONE RELEASING IUD
Progesterone releasing IUDs can also be placed immediately postpartum, (Mirena or Skyla) but there are some theoretic concerns that the IUD mechanism can be damaged by postpartum insertion by hand as opposed to the way it is inserted at the 6 week postpartum check up ensheathed in its typical inserter.

COMBINED ESTROGEN AND PROGESTERONE ORAL CONTRACEPTIVE PILLS (OCPs)
OCPs should not be initiated in any postpartum woman, whether breastfeeding or not, prior to 21 days after delivery due to the increased risk of blood clots in women who are postpartum. These blood clots can occur in the leg or lung or other vital organs and can be life threatening, and we will not initiate the combined pill prior to 4 weeks postpartum, and then only in women who do not have extra risk factors (extra risk factors include BMI greater than 30, history of post partum hemorrhage, history of cesarean section, age greater than 35 or a history of preeclampsia). In women with the above risk factors who have no actual contra indications to the pill, you should wait until 6 weeks postpartum to start the pill.

If you are breastfeeding, it is better to use the progesterone only mini pill as opposed to the combined pill because of the theoretic risk that the combined pill can decrease your milk supply. Once you have established a good milk supply (after 3-6 months) you can consider switching to the combined pill. It is in no way harmful to the baby.

STERILIZATION
Postpartum tubal ligation done within 24 hours of delivery, or tubal ligation done at the time of cesarean section are highly effective.

Related Q&A:

After delivery, can I get pregnant before my period returns?

Wendy Fried, M.D., FACOG, FACS, is an OB/Gyn with Northern Obstetrics and Gynecology, PC in North Hills, New York

Disclaimer: The information provided in this document is for educational purposes only. It is not medical advice and is not intended as a substitute for medical advice. Only your own physician knows all the important details of your specific medical and personal history and should be the only one to give you advice regarding your own medical care. You should never disregard medical advice or delay seeking medical advice or treatment because of something you have read herein. If you have any questions whatsoever about your medical health or believe you have a medical problem or disease, you should contact your medical doctor or healthcare provider.