How soon to use contraception after giving birth?

Most women are fertile two weeks before their period. Your periods will come back around six weeks to three months after giving birth, depending on whether you're exclusively breastfeeding, formula feeding, or a combination of the two.

Your periods might not return until you stop or decrease breastfeeding. Yet you can still get fertile without realising it.

If you are going to initiate using contraception after childbirth, you should initiate it from approximately 3 weeks post-birth.

Does breastfeeding as a method of contraception work?

Breastfeeding can function as a method of birth control by postponing the resumption of your menstrual periods. But it only functions if your breastfeeding is constant and frequent. Specifically, breastfeeding as a contraceptive method only functions if:

Your baby is under 6 months old
Your periods have not yet started again
You are exclusively breastfeeding your baby on demand, day and night (at least 6 extended breastfeeds every 24 hours without a gap greater than 4 hours between feeds).

After your baby stops exclusive breastfeeding, this method of contraception is no longer effective and you should use another method.

Safe contraception if breastfeeding

If you are breastfeeding, you can safely use:

Mini pill
Condoms
Diaphragms
A contraceptive injection (Depo-Provera® or Depo-Ralovera®)
An Implanon NXT™ implant
Intrauterine devices (iuds)
Permanent sterilisation (tubal ligation).

If you should need to use emergency contraception, the following are safe to use:

Levonorgestrel emergency contraceptive pill (LNG-ECP) – this is one of the two emergency contraceptive pills (sometimes referred to as the 'morning after pill'). The other, the ulipristal acetate (UPA) pill, is not advised.
Copper IUD – this is highly effective if inserted up to five days after unprotected sex, and can also give good continuing protection.

Non-recommended contraception if breastfeeding

The following contraceptives are not advised if you are lactating:

The combined oestrogen/progestogen contraceptive pill should not be used until after six weeks because it will lower the milk supply.
The vaginal ring (nuvaring) should not be used for the same reasons as the combined pill.
The ulipristal acetate (UPA) emergency contraceptive pill should not be recommended, since it is secreted into breastmilk and the infant's effect is not known. If used, women are cautioned not to breastfeed for seven days after they have used it.

Selecting contraception after delivery

To help you decide what form of contraception is best for you after delivery, ask your doctor or nurse:

What options are available
How they function, and how effectively they function when used 'perfectly' or when used 'typically' (i.e. Not used precisely as advised)
What methods are best for your body and lifestyle
How quickly you can start using the contraception
How you and your partner can divide responsibility for contraception
Potential side-effects.

Specifically, find out about the effectiveness of each method. No method works 100 per cent of the time, but some are more effective than others.

Various forms of contraception – summary

These forms of contraception will need a clinical or medical consultation to determine if they are safe and appropriate for each woman:

Implants and devices
Permanent sterilisation
Methods of contraception with medication.

In some others, like the barrier methods, you might benefit from certain education and training to optimise their use.

Mini pill

This progestogen-only pill thickens the fluid at the entrance to the uterus, preventing the sperm from passing through. It doesn't prevent ovulation. If you take it perfectly – at the same time every day – then the mini pill is 99.7 per cent effective. With typical (imperfect) use, it is less so.

Female condom

The female condom is a flexible, rubbery bag with a ring at one end. You put it inside your vagina to prevent sperm from reaching your uterus.

With ideal use (if you use it correctly each time you have sex), the female condom is 95 per cent effective. But, the condom has to be in the right place, and you need to remind yourself to put it in each time before sex. With average use, the female condom is less effective.

Each female condom is only to be used once, and not simultaneously when your partner uses a male condom.

Male condom

The male condom is a thin rubber or plastic sheath worn by your partner on his erect penis. It keeps sperm from reaching your vagina and uterus.

Condoms are 98 per cent effective when used ideally. With average or typical use, male condoms are less effective.

Condoms are the benefit of preventing sexually transmissible infections (stis).

Diaphragm

A diaphragm is a silicone cap that you insert inside your vagina and that sits over your cervix (the entrance to your uterus). It prevents sperm from passing into your uterus.

You can use a diaphragm at any point, including during your menstruation. You put the diaphragm in beforehand (up to 24 hours before) and take it out afterwards. It is reusable so that you can wash it after use.

With typical use, diaphragms are 84 per cent effective.

Contraceptive injection

Depo-Provera® (or Depo-Ralovera®) is an injection of a hormone which is administered every 12 weeks.

You will have side effects from the injection, including mood change, stomach upset and headaches. The effects will last for as long as 12 weeks.

Depo-Provera® is 99.8 per cent effective when used to perfection.

Contraceptive skin implant (Implanon implant)

A plastic rod is implanted beneath your skin on the inside of your upper arm. It releases progestogen slowly to prevent your ovaries from releasing an egg every month.

Your bleeding pattern is likely to alter and perhaps even cease. Side effects of the contraceptive skin implant can involve skin alterations, mood swings or slight weight gain.

The implant has a life span of three years. It is 99.95 per cent effective.

Intrauterine device (IUD)

A small contraceptive device is inserted into your uterus and stops you from getting pregnant (conceiving).

Copper iuds have a lifespan of up to 10 years, and are 99.4 per cent effective.

Progestogen iuds have a lifespan of five years and are 99.8 per cent effective.

Natural methods of contraception

Natural or fertility awareness methods of contraception are rhythm, symptothermal, cervical mucus observation and basal temperature methods.

The woman has to monitor her body signs every day (or, in the case of the method, more than once a day) to establish when she can be fertile in the menstrual cycle.

Practising natural birth control methods forces women to abstain from sex or practice contraception when they are fertile. Based on a woman's menstrual cycle, she will have to abstain from sex for a period of up to 16 days.

Natural birth control methods depend on abstinence and recognition of signs and symptoms of fertility. For this reason, its practice could be especially challenging post-childbirth and lactation.

High failure rates are associated with typical use.

Sterilisation

Men and women can both have an operation to render them sterile. (infertile)

Female sterilisation is known as tubal ligation. It is done by blocking the fallopian tubes.

Male sterilisation is known as vasectomy. It is done by cutting the tubes that carry sperm from the testes to the penis.

These procedures are over 99 per cent effective. They are permanent, so they are appropriate for individuals who are sure that they do not wish to have any further children.

If you are thinking about sterilisation, make a medical appointment with your doctor. They will give you all the relevant information and allow you to consent to this operation in an informed way.

Emergency contraceptive pill

The emergency contraceptive pill must be taken as soon as possible after having unprotected sex for it to be most effective. Though it has the nickname 'morning after pill', the emergency contraceptive pill does not have to be taken in the morning.

It is not 100 per cent effective in stopping pregnancy, but it is more effective the earlier it is taken.

There are 2 forms of emergency contraceptive pills, both of which you can get over the counter from pharmacies:

Ulipristal (UPA-EC) should be taken within 5 days (120 hours) of having unprotected sex (though not advised if you're breastfeeding)
Levonorgestrel (LNG-EC) should be taken within 3 days (72 hours) of having unprotected sex.

Ulipristal has been clinically proven to be more effective than levonorgestrel in preventing pregnancy when taken within 5 days (120 hours) of unprotected sex. It should not be used while breastfeeding since it passes into breastmilk and its safety for the infant is not known.

Vaginal ring (not advisable if breastfeeding)

The vaginal ring does precisely the same as the combined pill. It has hormones that stop your ovaries from releasing an egg every month. It is not suitable if you are breastfeeding a child under 6 weeks since it decreases the amount of milk that a mother can produce.

The ring remains high in your vagina for 3 weeks, after which you take it out for one week so you can experience a regular monthly period.

The vaginal ring is 99.7 per cent effective with perfect use.

Combined pill ('the pill') (not advised if breastfeeding)

The pill contains two hormones that prevent your ovaries from releasing an egg every month. In addition to avoiding pregnancy, the pill might also cut down on your monthly bleeding, acne, and premenstrual symptoms.

You can experience side effects like bloating, nausea and a slight weight gain.

The combined pill is 99.7 per cent effective if used ideally. It is less effective with typical use.

It is not advised if you are breastfeeding an infant under six weeks as it lowers the breastmilk supply.