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Birth control after baby: What’s best for you?

Reversible postpartum contraceptive options


Barrier + withdrawal methods

This includes male condoms, female condoms, cervical cap/diaphragm, the vaginal sponge, spermicide and the withdrawal method. These contraceptive forms decrease the amount of or prevent sperm from entering a woman’s body or reaching the cervix.

Breastfeeding mamas, take note...

The most commonly used contraceptive options that may be used within three weeks of birth in breastfeeding women are the progestin-only injection and the progestin-only pill, since they do not diminish milk supply.

It is also possible to place the progestin-only implant (IUD) during this early postpartum period, but many patients wait until later. Combined hormonal contraceptive methods are delayed until six weeks postpartum if breastfeeding to allow an adequate milk supply to develop, or they may be delayed and another form of contraception used until she is no longer breastfeeding.

If a woman does not plan to breastfeed, any of the combined hormonal contraceptive options can be initiated three weeks after delivery.

Progestin-only injection

This is a progestin-only method that is given as a shot every three months. This is a valid option for many women who cannot use combined hormonal contraceptive methods. It may cause weight gain and irregular cycles in some women. In other women it may cause monthly menstrual cycles to cease.

Oral contraceptive pills

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Combined OCPs contain the hormones estrogen and progestin and are considered a combined hormonal contraceptive method. They are taken orally daily. If a woman decides to start combined OCPs, it is important to discuss the options with an OB-GYN. Combined OCPs are avoided for a period of time if a woman plans to breastfeed. They are also contraindicated in women with certain medical conditions, due to the estrogen component. As a result, it is essential to discuss all medical illnesses with an OB-GYN prior to starting combined OCPs. The “mini pill” is a progestin-only OCP that is often prescribed to women who cannot take combined OCPs due to the estrogen component or because they want to breastfeed.

Copper IUD

The copper IUD does not contain any hormones. It is also inserted in the office into the intrauterine cavity by an OB-GYN and can be left in place for up to 10 years. The copper IUD works by creating an unfavorable intrauterine environment so the sperm is unable to reach and fertilize the egg. It may also inhibit attachment of the egg to the uterine wall. It is a good option for women who cannot or don’t want to use combined hormonal forms of contraception.

The patch

The patch is worn on the skin and contains both estrogen and progestin (combined hormonal contraceptive method). A new patch is placed weekly for three weeks, and during the fourth week a patch is not worn to allow for a period.

Postpartum tubal ligation

There is an option for permanent postpartum sterilization immediately after delivery via postpartum tubal ligation. This can be performed after a vaginal delivery or during a cesarean section. If done after a vaginal delivery, a small incision is made under the belly button. If done during a cesarean section, the same incision that is made for the cesarean will allow access to the fallopian tubes for permanent sterilization.

Hysteroscopic bilateral tubal occlusion

The hysteroscopic bilateral tubal occlusion is a procedure that is performed vaginally and does not require an abdominal incision. This can be done after six weeks postpartum or anytime thereafter. With this procedure, coils are placed into the fallopian tubes via the uterus and cause scarring, thereby blocking the fallopian tubes. The laparoscopic tubal ligation is another procedure performed after the six-week postpartum period. It requires several small incisions on the abdomen. The fallopian tubes are then interrupted by burning, placing clips or placing rings over each tube.

Well, you just had a baby (congratulations!), so you’re probably not thinking of immediately getting pregnant again. In fact, a 1999 study by the Centers for Disease Control and Prevention suggests waiting 18 to 23 months after birth to get pregnant again to allow your body time to recover from childbirth and give your future children the best chance of a healthy pregnancy.

So... birth control.

We asked Dr. Shannon M. Clark, a double board certified obstetrician and gynecologist and maternal-fetal medicine specialist, about all birth control options to consider postpartum. Here’s what we learned.

Permanent postpartum sterilization

Natural family planning

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This method of contraception requires a woman to track her menstrual cycle and avoid sexual intercourse or use a barrier method during her fertility period when ovulation occurs. This method is not very reliable, with a failure rate of up to 25%.

Vaginal ring

This is a vaginal insert that contains both estrogen and progestin, thus it is considered a combined hormonal contraceptive method. It a flexible plastic (latex-free) ring that is placed high in the vaginal canal using a two-finger insertion method. It is left in place for three weeks and removed for one week to allow for a menstrual cycle, then another ring is placed.

Vasectomy

A vasectomy is a procedure performed on the male partner where the tube that transports sperm from the testes to the penis is cut.

Progestin-only intrauterine device (IUDs)

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This IUD contains progestin. The IUD is inserted in the gynecologist’s office into the intrauterine cavity. The IUD can be left in place for three or five years, depending on which progestin-only IUD is chosen. As with the progestin-only implant, the progestin-only IUD is a valid option for patients who want a long-term contraceptive method or who should not have estrogen-containing forms of contraception.

Think twice about making things permanent: Prior to having any permanent sterilization procedure, a woman should be very certain that she does not want to have any more children. If she changes her mind at a later date, tubal reanastomosis (“tubal reversal”) can be attempted, but it is a technically difficult procedure that does not have guaranteed success.

Shannon M. Clark, MD, is a double board certified OB-GYN and maternal-fetal medicine specialist focusing on the care of women with either maternal or fetal complications of pregnancy. Dr. Clark is also an associate professor at UTMB-Galveston and the founder of Babies After 35.

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Progestin-only implant

This is small rod containing only progestin that is placed under the skin of your non-dominant upper arm. It is the most effective form of contraception available. It may be left in place for three years or removed earlier if a woman decides to become pregnant. It is an excellent choice for a woman who wants a longer-term contraceptive option or has a health condition where estrogen-containing forms of contraception are contraindicated.

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