New moms have specific contraceptive needs. They want birth control that is effective, simple to use, can be used over a long period of time, and allows for sexual spontaneity. An important question often asked by new moms is, “How soon after giving birth do I need to start using birth control?” Usually, doctors recommend that birth control be started six weeks after giving birth (if medically it’s okay to have sex) or when menstruation resumes. Breastfeeding does not prevent pregnancy, as many couples accidentally realize, so often couples use condoms until they decide on another form of birth control.

Barrier Methods

Barrier methods of birth control such as diaphragms, cervical caps, or condoms, appeal to women who don't want extra hormones in their systems. None of these impact breastfeeding or future fertility. The diaphragm is a latex cup which is filled with spermicide and inserted into the vagina prior to sexual intercourse. The cervical cap is similar, but smaller. The cervical cap has a high failure rate among women who have had children, so it’s not recommended for new mothers. The diaphragm is 94% effective when used correctly. A newly fitted diaphragm may be inserted six weeks after birth. Condoms are highly effective, (especially when their partners use a spermicide) and are the only non-permanent birth control option for men. Condoms help protect against venereal diseases and HIV, but other barrier methods do not.

Intrauterine Devices

In recent years, a new form of intrauterine contraception (IUC) has been developed. It is a reversible method that is easy to use, provides long-term protection from pregnancy, and does not require monthly trips to the pharmacy. Ninety-six percent of women currently using IUC are satisfied.

Another IUC option, Mirena (R), lasts for five years and is more than 99% effective. Mirena delivers a low dose of the hormone levonorgestrel, which usually results in shorter, lighter periods. Since this hormone is a type of progesterone, there may be negative mood changes in those women vulnerable to depression.

Intrauterine contraception is recommended for women in mutually monogamous relationships who have had at least one child. Women with a history of pelvic inflammatory disease or ectopic pregnancy should not use Mirena. IUCs do not protect against HIV or other venereal diseases.

The Pill, The Shot, and The Implant

New mothers can use Depo-Provera, Norplant, and progestin-only mini-pill six weeks after birth, even if nursing. Depo-Provera is a hormone shot given every 12 weeks. Depo-Provera may delay pregnancy for a year after being discontinued. Norplant, a capsule inserted under the skin, contains hormones which prevent pregnancy for five years. Upon removal, pregnancy can take place immediately. The pills, which are taken daily, contain estrogen and progestin and can be used by new moms six weeks after birth. Progestin-only pills contain no estrogen and are compatible with breastfeeding. Depo-Provera, Norplant, and the pills are all nearly 100% effective. Birth control pills, shots, and implants do not protect against HIV or venereal diseases.

Note: For women who are susceptible to depression, I don’t recommend these methods, especially the first two (Depo-Provera and Norplant), since the hormones delivered may cause depression. Once the shot is given, the woman needs to wait three months before she’ll feel normal again, which is miserable for her. Norplant would need to be removed if the woman experiences mood problems, and that isn’t always simple. Birth control pills can also cause negative mood changes, but can be stopped if this occurs.

Natural Family Planning

Natural Family Planning, or NFP, requires charting your basal body temperature and monitoring cervical fluid to determine when you ovulate. For most women, there are only a couple of days each month when you can get pregnant. Ovulation occurs once a month and the egg lives two days, during which time pregnancy is possible. During ovulation and around that time for a few days, the couple abstains from sexual activity or they use a barrier method.

This method takes time to learn – it takes patience and discipline to chart every day. There is a 25% failure rate, so it’s not very reliable even when done correctly. It also does not prevent HIV or other venereal diseases.

Permanent Birth Control Options

If your family is complete, consider sterilization. Tubal sterilization for women and vasectomy for men permanently prevent pregnancy. A woman's fallopian tubes are cut during tubal sterilization, usually immediately after giving birth. This procedure does not affect breastfeeding, but it can cause mood changes. Vasectomy, the blockage of sperm-carrying tubes, can be performed in a doctor's office under local anesthetic and is a very simple procedure. These methods are considered to be 100% effective, but they don’t prevent venereal diseases.

Shoshana Bennett, Ph.D.
Author, Postpartum Depression For Dummies
http://DrShosh.com

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What a great void you are filling! Thank you for this terrific and comprehensive listing of BC options for new moms. The Association of Reproductive Health Professionals (www.arhp.org) offers tons of free patient education materials and interactive on-line tools on this very topic and more. Check out ARHP's on-line interactive tools: http://www.arhp.org/patienteducation/int... Menstrual Suppression: What it is, and how to do it This user-friendly patient tool allows women to explore and learn about: • What happens to her body during her entire cycle, both on and off hormonal contraception, • Menstrual suppression – what it is and how it works, and • How different hormonal birth control methods suppress menstruation. Birth Control: How Hormones Work to Prevent Pregnancy The tool helps women to better understand the variety of hormonal birth control methods that are available and how these hormones in these methods work in the body to prevent pregnancy. Choosing A Birth Control Method An interactive tool featuring a series of health and lifestyle questions to help guide a patient to choosing a birth control method that best fits their needs. And check out ARHP's terrific patient education materials: http://www.arhp.org/patienteducation/onl... A Woman’s Guide to Understanding IUDs (PDF) This brochure is intended to educate women and their partners on current methods for intrauterine contraception, with focused information to support women in choosing the best method for their individual needs and preferences. A Woman’s Guide to Understanding Today’s Birth Control Choices (PDF) This brochure is intended to educate women and their partners on current methods for birth control, with focused information to support women in choosing the best method for their individual needs and preferences. Also available in Spanish. A Woman’s Guide to Understanding HPV and Cervical Cancer Available in English and Spanish, this brochure explains cervical cancer and its causes, its relationship to human papillomavirus, and guidelines for screening throughout a woman’s lifetime. Building Strong Bones This brochure describes the importance of maintaining healthy bone density and avoiding bone less for both men and women, as well as the role of calcium supplements, prescription drugs, and exercise. Health Benefits of Contraception In addition to preventing pregnancy, birth control pills may offer a variety of health benefits, including reducing acne and menstrual symptoms and many others. Health Matters Health Matters is an ARHP publication for the general public that provides a brief overview of existing facts and data on various topics related to reproductive health. -Dispelling Common Myths About Intrauterine Contraception -Frequently Asked Questions About the Contraceptive Patch -Understanding Menstrual Suppression -Understanding Pap Test Results -Using Birth Control Pills Regularly for Successful Contraception -Your Six-week Post-partum Check-up -Healthy Fish, Healthy Families How a Woman's Reproductive System Works The changes in a woman’s body throughout her monthly cycle, both naturally and while she is taking birth control pills. Human Cloning and Genetic Modification Explore the basic science necessary for understanding human cloning and genetic modification. Perimenopause: Pathways to Change The purpose of this on-line brochure is to help you understand perimenopause, what you can expect, and what this period of transition can mean for you. Questions and Answers about Permanent Birth Control Provides frequently asked questions and answers about transcervical sterilization, a new form of permanent birth control. Your Six-Week Postpartum Check-up: A Health Care Guide for New Mothers A one-pager tear-off sheet that health care providers can offer to their patients during the postpartum check up to facilitate healthy behaviors. Also available in Spanish. Understanding the HPV Vaccine A vaccine is now available for women to prevent the Human PapillomaVirus (HPV)—a common virus that can lead to cervical cancer; this brochure is for anyone who would like to learn more about this vaccine. Which Contraceptive is Right for You? (PDF) A comprehensive chart detailing all the available methods of contraception and important facts to know about each. Finally, check out ARHP's Resource Centers on these topics: http://www.arhp.org/healthcareproviders/... -Abortion -Adolescent Health -Contraception -Emergency Contraception -HIV/AIDS -Male Reproductive Health -Menopause -Menstruation -Politics and Reproductive Health News -Pregnancy -Reproductive Cancers -Reproductive Genetics -Sex and Sexuality -Sexually Transmitted Diseases/Infections -Urologic and Gynecologic Disorders by Posted: Tue., April 22, 2008, 08:55 am

Breastfeeding and Fertility It is not technically true to say that breastfeeding NEVER prevents conception. For the first six months postpartum, if a mother's menses have not returned, a mother who follows the Lactational Amenorrhea Method of natural family planning has less than 2% chance of becoming pregnant. Just "any" breastfeeding will not postpone conception, but frequent and exclusive breastfeeding day and night- no supplements, juice, water, or pacifiers will, and this method has been endorsed by the World Health Organization. More info is here: http://enabling-breastfeeding.blogspot.c..., posted by expert Miriam Labbok, MD, MPH, FACPM, IBCLC, FABM. Additional natural child spacing through breastfeeding is actually the biological norm - though by no means the cultural norm. Research into this phenomenon has been done by Sheila Kippley and a set of evidence-based standards for prolonging natural breastfeeding infertility beyond the first six months' of LAM can be found here: http://www.nfpandmore.org/Chapter4_V2.pd... Ecological, or even just exclusive, breastfeeding requires commitment and support but it is the optimal method of infant care and has significant benefits to the mother, including the many benefits associated with the natural delay in return of her fertility. by Posted: Wed., April 23, 2008, 09:13 am

Effectiveness of Natural Family Planning The article above states that natural family planning has a 25% failure rate. This is inaccurate and may unduly discourage some women from investigating a healthy option for natural child spacing. The Georgetown University Institute for Reproductive Health has a chart stating the "perfect use" effectiveness rates for various methods as well as the "typical use." http://www.irh.org/nfp.htm When discussing natural family planning in comparison to other methods, we need to remember that other methods are not always used perfectly either - women forget to take their Pills, couples skip the condoms or the diaphragm "just this once," condoms break or spill - all of these factor into a method's "typical use" effectiveness rate, but typical use is rarely reported for chemical or mechanical contraceptive methods. NFP effectiveness depends on excellent teaching and understanding and motivation of the couple, but when used accurately and dependably, it has a surprise pregnancy rate of only 1 - 9%. Postpartum women may experience irregular cycles which may make learning a new NFP method more challenging, but all the major providers of NFP instruction offer special instruction and support for breastfeeding women. The information available from the Billings Ovulation Method is representative (and highly accurate and helpful): http://www.woomb.org/bom/breastfeeding.h... In short, women who are examining their contraceptive options postpartum should look carefully at NFP - it is a healthy option, effective and safe for breastfeeding. by Posted: Thu., April 24, 2008, 09:03 am

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