Mama’s Must Knows for Postpartum Contraception

Mama’s Must Knows for Postpartum Contraception
Photo by Sai De Silva / Unsplash

Hello there, new mums and mums-to-be! 

As a GP, I understand the whirlwind of information and decisions that come with the territory of pregnancy and childbirth. 

But there are some important things you absolutely should know after delivery.

Did you know that pregnancies within 12 months of a previous one tend to be higher risk? 

Some health authorities even advise waiting 18-24 months before trying for conception! 

Why? 

Because it's important to give your body time to recover fully before considering another pregnancy, as pregnancies within twelve months of a live birth are associated with higher risks such as preterm birth and babies with low birth weight. 

And contrary to popular belief, you can become fertile as early as 21 days after giving birth. 

Were you aware that you can ovulate even without periods? This means that your cycles aren't always a reliable indicator of your fertility. 

The good news is that most contraceptive options can be started immediately after childbirth, giving you peace of mind right from the start. So let’s get to the reason you’re here; below are my  ‘Mama’s Must Knows’: 

Be Wary Of FAMs - Fertility Awareness Methods

FAMs are ‘natural’ methods of contraception. They require careful tracking of your cycles and can include additional measurements like your body temperature and the stretchiness of your cervical mucus. 

Whilst being fairly effective with perfect use,  it's essential to approach FAMs with caution after giving birth—your body's rhythms and signs may still be adjusting, so it may not be a reliable method to use initially.

Breastfeeding Can Be Contraception 

Breastfeeding can serve as a unique form of natural contraception in the postpartum period, but there are some important tick-boxes:

  • you must be exclusively breastfeeding at least every 4 hours during the day and every 6 hours at night 
  • you must be less than six months postpartum 
  • and you must not be having any periods

If any of these three requirements aren’t met, you leave yourself exposed (meaning it won’t serve as effective contraception!) Always discuss this with your Doctor to ensure it's the right option for you.

If you opt for alternative contraception while breastfeeding for peace of mind or because you can't meet all criteria, be assured that current evidence suggests most contraception methods are safe for your baby and should not significantly affect your milk supply. While there's no absolute guarantee that milk supply won't be affected - due to ongoing gaps in data - the majority of mothers are unlikely to notice any difference.

Coils (IUDs) Are Quick To Fit At Delivery

IUDs are one of the most effective contraceptives at preventing pregnancy (over 99%!) If you opt for an IUD, whether hormonal or non-hormonal, it can be fitted within 48 hours of delivery - so do let your Obstetrician know beforehand! If you’ve signed up for a midwife-led birth, let your team know your intentions in your antenatal appointments and when you arrive for delivery to allow for planning.

If the 48-hour window is missed, current guidelines dictate that you must wait at least 4 weeks before it’s safe to insert again.

It’s worth noting that if you're breastfeeding, there is a slightly higher risk of perforation with an IUD (meaning the IUD migrates outside the womb into the pelvis, requiring surgery to remove it). This is a rare event and should always be weighed up against the huge benefits of breastfeeding and effective contraception with your Doctor.

Combined Pill vs Mini Pill:
The Combined Pill Has Caveats
.

A recent change in guidelines now allows you to begin the combined pill six weeks after childbirth if you're breastfeeding (as opposed to six months previously), but this does depend on your medical background. However, in specific circumstances, this timeframe can be shortened to three weeks if you are not breastfeeding, but this should definitely be discussed with your GP.

On the other hand, the mini pill has far fewer restrictions. Your GP, Obstetrician, or Sexual Health Doctor can advise you on the most suitable option for your situation.

Condoms Can Still Be Part Of Your Postpartum Playbook

If all this talk about hormones makes you nervous (despite their numerous benefits, I might add!), remember the condom - which can still serve as useful contraception during the postpartum period for several reasons. Firstly, they offer immediate protection without interfering with postpartum hormonal changes or breastfeeding since they are hormone-free. Additionally, condoms provide barrier protection against Sexually Transmitted Infections (STIs). 

But do keep in mind that condoms have one of the highest failure rates in the contraception spectrum, and opting for a longer-acting contraception method can offer greater reliability and convenience, especially whilst you’re busy navigating the early days of motherhood! 

Remember that contraception postpartum is not just about preventing another surprise bundle of joy; it's about protecting your and your family's well-being and giving yourself the time you need to recover fully. 

If you’re overwhelmed, I also recommend taking full advantage of your Postnatal check at 6-8 weeks with your GP to pick their brains on which is right for you—that is, if you haven’t already discussed this with your Obstetrician pre- or post-delivery!

You can also read my previous blog, “Choosing the Right Contraception for You”, to browse the Contraception spectrum.

So, whether you're considering immediate options or planning for the future, your GP or Sexual Health Doctor is there to guide you every step of the way. Here's to informed choices, peace of mind, and a bright, healthy future ahead with your new little bundle!

References

Faculty of Sexual and Reproductive Healthcare (FSRH) Clinical Guideline:Contraception after pregnancy (January 2017, amended October 2020) Faculty of Sexual and Reproductive Healthcare (FSRH) Clinical Guideline. Available at: https://www.fsrh.org/documents/contraception-after-pregnancy-guideline-january-2017/ (Accessed: 22 March 2024).