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Choosing contraception after giving birth

After you’ve had a baby, you may be considering contraception. This article offers information about options for contraception after birth.

Although the last thing on your mind may be sex after giving birth, your body could be fertile within 21 days. Many couples take some time before they are ready to have sex, although some women feel more sexual after the birth.

Even if you don’t plan on having sex for a while after having a baby, knowing about your options, thinking about what you want and discussing it with your partner puts you in a good place when the time comes.

How soon can you get pregnant after giving birth?

In the first 21 days after giving birth, you are extremely unlikely to get pregnant, so you don’t need contraception. After this, you can become pregnant, even before you have your first period. This is because ovulation (when the ovary releases an egg) occurs before you get your period.

Your body will change after giving birth and, if you were using contraception before you became pregnant, it may no longer be right for you. Also, there are other considerations you may need to take into account, particularly if you are breastfeeding, which are outlined below.

According to the National Institute for Health and Clinical Excellence (NICE), contraception should be discussed within one week of giving birth, with either your healthcare practitioner or midwife as some methods of contraception need to have been in use for three to four weeks to be effective. All the reliable birth control methods are for women except for condoms and male sterilisation.

Contraceptive choices after pregnancy

Barrier methods

  • Male and female condoms - you can use condoms any time after giving birth.
  • Diaphragm or cap - if you have been using a cap or diaphragm, you will need to wait until your vaginal area and cervix has fully recovered after you have had your baby. This is normally by about 6 weeks. As vaginal birth can alter your size you will need to be refitted to check what size or type of diaphragm or cap is right for you. A spermicide is recommended with the diaphragm or cap for it to be effective.
  • Intrauterine device (IUD) – this can be fitted within 48 hours of the birth. If it is not fitted at this time, it will need to be fitted from four weeks after you had your baby, whether you had a vaginal birth  or acaesarean section.

Exclusively breastfeeding

Breastfeeding can be a very effective method of contraception, sometimes called the Lactational Amenorrhoea Method (LAM). It works because the hormone required to stimulate milk production prevents the release of the hormone that triggers ovulation. It is more than 98% effective in preventing pregnancy so long as:

  • You are breastfeeding exclusively and haven’t introduced formula milk, drinks or solids, with no long gaps between feeds.
  • Your period hasn’t returned, even light spotting counts.
  • Your baby is less than six months old.

You need to be aware: ‘exclusively breastfeeding’ in this case  means a minimum of six long breastfeeds per 24 hours. And if you wish to relyon LAM as a method of contraception then you need to ensure that there are no gaps of longer than fourhours from the start of one feed to the next during the day and no longer than  sixhours at night.

  • Once you are giving your baby solid foods or formula milk and no longer exclusively breastfeeding then LAM will become less effective and other means of contraception will need to be considered if you want to avoid pregnancy.

Hormonal methods Progestogen-only

Although the World Health Organisation (WHO) recommends that progestogen-only methods should not be used in the first six weeks after having a baby, it is common practice in the UK to do so as no evidence has been found which suggests that it affects your milk supply or baby during this period. These methods, listed below, include:

  • Progestogen-only pill (mini-pill).
  • Progestogen-only injection - if you want to use the contraceptive injection, GPs recommend that you wait until six weeks after birth  because then you are less likely to have heavy and irregular bleeding if you are breastfeeding. If you have decided to formula feed your baby you can have the injection as soon as you wish, but you may get heavy and irregular bleeding as a result.
  • Progestogen-only implant – You can have an implant put in three weeks (21 days) after you have a baby. In this case it is an effective contraceptive straightaway. If the implant is put in more than 3 weeks after your baby is born, it will not be effective as a contraceptive for the first seven days.
  • Hormonal intrauterine system (IUS). Usually fitted anytime from four weeks after a vaginal or caesarean birth.
  • You can also use emergency contraception if you are breastfeeding.

Breastfeeding women are recommended to avoid any contraceptive method which contains oestrogen, as this has been shown to reduce the milk supply. Contraceptive methods that use oestrogen include:

  • Combined oral contraceptive pill.
  • Contraceptive patch.
  • Vaginal contraceptive ring.

Making a decision

You can choose whatever method you feel is best suited to you. But don’t forget, your body has changed and what suited you before may no longer be right for you now. If you are bottle or mixed feeding, then your periods will return around four to six weeks after the  birth or later.

The combined pill is can be prescribed  from six months after birth for women who are breastfeeding. It does not appear to affect either the quantity or the quality of breastmilk after this time, although some women prefer not to go down this route.

What about natural family planning?

Natural family planning is possible though it can be more difficult to learn and use just after you have had a baby. If you used this method before your pregnancy, ask your natural family planning teacher for advice.

Further information

NCT's helpline offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700.
You might find attending one of NCT's Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

NHS choices has a comprehensive list of contraception available in the UK.

The Family Planning Association has an interactive tool you can use to help you decide what the most appropriate method of contraception for yourself would be.