Deciding on the best birth control option after pregnancy

Learn about your options for contraception post-baby.

By: Jordan Coauette, MD .

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Although in the first few weeks or months after delivery you may feel like you will never be sexual again, be assured this will pass. Try not to worry too much about it.

Depending on your plans for future pregnancy, there are a number of birth control (contraceptive) methods available.

Oral contraceptive pill (OCP)

Oral contraceptives — also known as birth control pills — need to be taken every day to be effective.

The combined pill (which has estrogen plus a progestin) may decrease breast milk production so it should not be started until at least six weeks postpartum.

The progestin-only pill does not affect milk supply and can be used during breastfeeding.

Contraceptive patch or vaginal ring

Like oral contraceptives, contraceptive patches and vaginal rings work on a four-week cycle.

For the patch, you will put a new patch on your skin once a week for three weeks; no patch is worn for the fourth week, when you’ll menstruate.

A vaginal ring is a small plastic ring you insert in your vagina and wear for three weeks. You’ll remove the ring for the fourth week, when you’ll menstruate, and insert a new ring for the next cycle.

You can start using either of these options at three weeks postpartum if you’re not breastfeeding, or after six weeks if you are breastfeeding.

Birth control shot

Commonly called Depo Provera, this contraception option is an injection you’ll receive from your provider once every 12 weeks.

The shot can be given immediately postpartum, whether or not you are breastfeeding. There are no known effects on breast milk or infant ingestion of the hormone.

Intrauterine device (IUD) or intrauterine system (IUS)

Both the IUD and IUS are small T-shaped devices inserted into your uterus by your provider more than six weeks after delivery. IUDs and IUS’s are reliable, long-term birth control options that will last up to five years, but can be removed at any time.

An IUD has a small copper coil that prevents pregnancy. An IUS releases hormones directly into your uterus, and is as effective as tubal ligation.

Barrier methods

These are hormone-free, and only needed when you are actually having sex.

Condoms can be used anytime, and are commonly used temporarily while breastfeeding or to space out babies. You can also use non-spermicidal condoms with lots of extra water-based lubricant to avoid vaginal irritation.

If you choose to use diaphragms or cervical caps, they need to be re-fitted at six weeks postpartum.

Emergency contraception

Emergency contraception (EC) pills, sometimes called morning-after pills, are effective up to five days after unprotected intercourse, but are best if taken within the first 24 to 48 hours. Emergency IUD is available up to seven days after unprotected intercourse.

Sterilization

Female sterilization is called tubal ligation, sometimes referred to as “having your tubes tied,” that closes or blocks your fallopian tubes. This is a permanent option only for women who are absolutely sure they do not want to become pregnant again.

Tubal ligation requires abdominal surgery, which can be performed the day after delivery while still in the hospital, through a small incision at the belly button. Tubal ligation can also be done laparoscopically after six weeks postpartum.

Hysteroscopic tubal ligation does not require a surgical incision; a small implant is placed in the openings of the fallopian tubes through the uterus.

Male sterilization is called a vasectomy. This is also permanent and only for men who are absolutely sure their family is complete. This is an outpatient procedure and is more effective than tubal ligation.

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