How to choose a contraception method after childbirth?

Selecting the method of birth control is always an individual matter. On the one hand, one should consider medical aspects – hence, it is necessary for a doctor to exclude any contraindications. On the other hand, it is equally important that the patient herself accepts the method in order to ensure its correct use. In Poland, we have a full selection of hormonal methods: classic pills (progestogen-only or combined), transdermal patches, vaginal rings, IUDs, implants and non-hormonal methods: condoms, cervical caps, spermicides.

A particular situation is selection of contraception after birth, when a young mother has to handle many new responsibilities. In this article, we will look closer at hormonal birth control methods.

How long to wait with sexual activity after birth?

There is no pre-defined time a woman should wait before restarting sexual activity. Authors of scientific publications define this time differently, but it varies from 2 to 6 weeks after birth. Above all, this time depends on the course of labor. It is important if the woman suffered a vaginal damage or a postpartum infection. In practice, however, if there were no complications, women decide to restart sexual activity earlier than the time range defined by the said authors.

Young mothers believe that they cannot get pregnant while breastfeeding. Is it true or is it a myth, and where does this belief come from?

Amenorrhea associated with breastfeeding (lactation) may last even up to two years after birth. However, this does not mean that a woman cannot get pregnant. All depends on how she breastfeeds her baby, whether it is intensive breastfeeding or mixed feeding. Furthermore, fertility is affected by maternal nutrition, and presence of concomitant diseases. Therefore, a belief that you cannot become pregnant during lactation is a myth.

Are there any guidelines on contraception for breastfeeding mothers? Do we have any myths in this case that needs to be debunked?

Definitely yes. Women often think that they shouldn’t use contraception during breastfeeding, which is a total myth. As far as the postpartum contraception is concerned, we follow the so-called “rule of threes”. If a woman is exclusively breastfeeding, we can use contraception as late as 3 months after birth. If she chooses mixed feeding or decides not to breastfeed at all, contraception can be used already from 3 weeks after birth. In practice, a woman may also have concomitant diseases, and if this is the case, we can prescribe contraception already from 3 weeks after birth, regardless of the type of (breast)feeding. Moreover, we can start intrauterine contraception 6 weeks after birth (in the case of delayed uterine involution – after 12 weeks).

What is the best contraception after birth? What should be taken into consideration when selecting this birth control method?

While selecting a contraceptive, we should definitely consider a woman’s desire to breastfeed. Breastfeeding not only helps to build a strong bond between the mother and the baby, but also supports the newborn’s immune system and reduces the risk of ovarian and breast cancer for the mother. Therefore, we should select such a contraception method that will enable a woman to breastfeed. Moreover, we need to take into consideration disease factors, such as thromboembolic risk which is particularly high during pregnancy and the postpartum period. Hence, when a young mother comes to our office, we need to select a “tailored” contraception method.

Can long-term contraception (IUD) be used after birth? If so, when?

An IUD (intrauterine device) is one of the most versatile methods of contraception. First of all, it has no effect on lactation, and secondly, it does not affect the risk of thrombosis. If there are no significant contraindications, this long-term contraception can be used. It is the most popular form of birth control among my patients, and it is most readily chosen in the population of young mothers. For women who prefer oral contraception, it is possible to use progestogen-only tablet, the so-called “mini-pill”, during this period. Classic combined methods in the form of transdermal patches, vaginal rings or pills should not be recommended during breastfeeding as they affect the quantity and quality of breast milk.

Why should we always consult a gynecologist before selecting contraception after birth?

The gynecologist who supervised the pregnancy knows all disease risk factors of the mother. Therefore, they are able to select a “tailored” contraception method. Every woman is different and has different needs. With this in mind, we select a method of birth control by not only considering the patient’s expectations, but also the safety of this method for both the baby’s and the young mother’s health. Knowing the patient – a woman and a mother, and most importantly, knowing her needs, the gynecologist who supervised the pregnancy is best qualified to select her contraception method.

Who cannot use the hormonal contraception?

Obviously, women with suspected pregnancy. But also, we won’t use this method for women with unexplained vaginal bleeding, uterine or breast cancer, pelvic inflammation/infection or liver disease/cancer. The use of IUDs is contraindicated in patients with uterine anatomical anomalies. When considering combined contraception, thrombosis risk should be assessed with particular caution.

What is the risk of using an IUD? 

The risk of an IUD is unequivocally associated with side effects and complications of system insertion. This includes uterine perforation, spontaneous expulsion or low mood caused by hormones. All medicines can cause adverse effects, which is why you should always read the package insert.

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Material prepared in collaboration with Bayer Sp. z o.o.