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Birth Control and Breastfeeding: Here's What You Need To Know

You have become a new mother with a little bundle of love and light wrapped in your arms. Already, you may be feeling the effects of sleepless nights, breasts heavy with milk, and going to the grocery store in pajamas for the first time ever. The last thing you want to worry about is getting pregnant again so soon. After all, it is possible to get pregnant almost immediately after giving birth.

A common misconception is that breastfeeding might stop the body from producing an egg, but that’s not true. In fact, breastfeeding only slightly impacts your chances of getting pregnant for the first six months, and that is only if you are feeding your baby every 4-6 hours! A woman’s body can ovulate 3 weeks after birth. So what are you to do?

Luckily, you can use birth control. Let’s learn more about your options to help you find out the best course of action.

Why should I use birth control while breastfeeding?

This is a common concern of new parents. While you have already read that breastfeeding only works as a natural birth control for so long, it bears repeating that it is not a 100-percent method nor does it work for as long as some people think it does. Every mother is unique, and so what has worked for others may not work for you.

Breastfeeding can help to prevent pregnancy, but even if you do breastfeed exclusively it is not guarantee you wont conceive. Since that can be incredibly difficult for mothers of modern times, you cannot rely on this method alone. Breastfeeding will not protect you from pregnancy. That is why you need to consider other ways to protect yourself.

Can I use hormonal birth control when breastfeeding?

While you should never use birth control that contains estrogen within the first 3 weeks post-delivery, you can safely use birth control afterwards. Hormonal methods will not hurt your baby, however it does not mean they may not negatively impact milk supply.

There are several options available, including things like birth control shots, implants, IUDs, natural family planning and mini-pills that can be taken right after birth, as well.

For example, many women are able to get an IUD or an implant (Nexplanon) during their postpartum checkup with the OB/GYN or at the hospital. The reason you cannot get an IUD before that is because you need to heal and stop bleeding. Otherwise, any implanted IUD could get dislodged from the uterine wall and increase your risk of infection.

The best part is that implants and IUDs work extremely well and can give you freedom from an unexpected pregnancy for up to 7 years. For instance, the Nexplanon implant, which contains progestin, is 99 percent effective and goes in the upper arm.

There are two types of IUDs—hormonal and non-hormonal. Hormonal IUDs use progestin, like Nexplanon, to thicken the mucus around the cervix and prevent sperm from entering the uterus. The four hormonal IUDs are Mirena, Kyleena, Liletta, and Skyla.

Once you have received an IUD or implant, you never have to worry about keeping track of them—save the insertion and removal dates.

Depo-Provera shots

Another hormonal form of birth control is the long-lasting Depo-Provera shot. Using the hormone progestin, the shot provides about 3 months of protection against pregnancy. You will need to get it again after those 3 months have passed, or you won’t be protected.

If you continuously get the shot, Depo-Provera is about 97-percent effective. There are some side effects, such as nausea, but your breastmilk will not be effected. However, you should keep in mind that if you plan on having another child, you will need to take about 10 months off of the shot to regain your fertility.

What about combination contraceptives?

Combination contraceptives are widely used and come in a number of forms. There are traditional combination birth control pills that give women periods every moth as well as an extended or continuous dose, which causes a period 4 times throughout the year. Others eliminate periods completely.

However, combination contraceptives work differently for new mothers who are lactating. Estrogen-based birth control, including combination methods, have been linked to reduced milk supply and a shortened duration of breastfeeding, even if your milk supply has been established for months. While the risk of lowered milk supply is not seen in all mothers, you may want to avoid this problem entirely and use another method.

What is the mini-pill?

Since many hormonal birth control pills contain both estrogen and progestin, new mothers often see their milk supply impacted. Estrogen is thought to be the cause of this issue, and so the mini-pill was born.

The mini-pill contains only progestin, making it a safer option for lactation. You often need to request it from your health care provider, but some states also have mini-pills available as an OTC.

You can start taking mini-pills about 6-8 weeks postpartum. This method is about 87-99.7 percent effective.

Can I use non-hormonal methods?

Non-hormonal birth control is one of the best ways to prevent pregnancy after the first 6 months postpartum have passed. However, since you now know that pregnancy can occur rather early post-delivery, you might not want to take any chances. You also might not want to use any hormonal contraceptives.

That brings us to the copper IUD, also known as Paragard, the only non-hormonal IUD available. Paragard utilizes a tiny amount of cooper to disrupt movement of sperm in the uterus, stopping both fertilization and implantation. The copper IUD is super effective, if not the best, at preventing unwanted pregnancy for 10-12 years and can be removed whenever you want. It is an extremely convenient birth control option that doesn’t upset your hormonal balance or breastmilk supply.

The downside of the copper IUD is that women report have longer and heavier flows. Thus, this is not recommended for those who struggle with heavy periods and strong cramping.

Other non-hormonal methods include internal condoms and condoms for your partner, cervical caps, and diaphragms. When used flawlessly, condoms are 98-percent effective at stopping pregnancy, but if condoms are used in a typical sense, such as having genital contact prior to putting on the condom, effectiveness is reduced to 82-percent effective. The one bonus to using a condom is that you are protected against STIs. They can also be paired with other kinds of birth control, like pills, spermicide, and the calendar method (also referred to as natural family planning).

If you relied on a diaphragm or cervical cap previously, you will need to wait until the postpartum checkup to start using it again. You may need a new size after delivering a baby, and since caps are only available by prescription, you will need to wait until your vagina and cervix are less sensitive to get refitted.

That said, cervical caps and diaphragms are not as effective as condoms, implants, IUDs, and pills. Since the window of error is large, you may want to consider other methods of birth control.

Can I use the morning after pill?

You should only use the morning after pill as a last resort, regardless of whether you’re lactating or not. The levels of hormones used in the morning after pill are high, so you need to be careful.

There are two kinds of morning-after pills presently available to consumers:

  • Combination pills containing estrogen and progestin
  • Progestin-only formulas

As mentioned previously, estrogen can effect milk supply. You can anticipate a slight drop in milk production for a few days after using the morning after pill, but you will rebound quickly once the pill is out of your system.

While the morning after pill is considered safe for breastfeeding mothers, you should never rely it or use it routinely.

Are there side effects on lactation?

There have been multiple studies that concluded birth control as safe for breastfeeding mothers and their children. Some studies on hormonal birth control have followed children for nearly 20 years and reported no adverse effects on their health or development.

Some mothers have said that the baby is fussier when they are on birth control. This could be caused by a drop in the nitrogen, protein, or lactose content of their breastmilk. Typically, once the mother stops using birth control, the baby becomes less fussy.

Be sure to talk to your provider before starting any kind of birth control, as your particular medical history may influence you, your baby, and your breastmilk supply differently.

Final thoughts on birth control and breastfeeding

Whether you are breastfeeding exclusively or supplementing, your body is going to be ready for another pregnancy before you know it. That means you need to be intentional about preventing another pregnancy until you are ready. Talk to your midwife about starting birth control or what contraceptives are available to you. Although choosing which option works for you is highly personal, getting as much information as you can is critical to making the right choice.

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