Contraception is essential for planning the size of your family and spacing children optimally for your family unit. It is useful to talk to your doctor even before giving birth as some contraceptive methods can be initiated very soon after childbirth. There are now long-acting reversible contraceptives available (LARCs) as well as shorter acting options.
Your choice depends on the efficacy of the method, suitability for your personal and medical circumstances, personal preferences, and whether or not you are breastfeeding. Figures quoted below for effectiveness of each contraceptive method are for typical use in real life circumstances (as opposed to perfect use in ideal conditions).
CONTRACEPTIVE OPTIONS IN THE POST-NATAL PERIOD
THE CONTRACEPTIVE IMPLANT
- The contraceptive implant (Implanon) is a small plastic rod which is insertedinto the inner upper arm; it contains a hormone which prevents ovulation.
- The implant is 99.5% effective at preventing pregnancy.
- The implant can be inserted at any time post birth. Although theproduct information advises three weeks, evidence-based guidelines by contraception experts advise that it can be safely inserted earlier.
- The implant can be used by women who are breastfeeding.
THE INTRA-UTERINE DEVICE (IUD)
- The IUD is a small plastic device that is inserted into the uterus. There are two types: the hormonal IUD (Mirena) which lasts five years, and the copper IUD which lasts for 5 or 10 years depending on the model.
- Both types of IUDs are over 99% effective at preventing pregnancy.
- The IUD can be inserted at 4 or more weeks following birth, but itis possible to insert earlier in some situations, and can be removed at any time.
- Both the hormonal IUD and the copper IUD are suitable for women who are breastfeeding.
THE CONTRACEPTIVE INJECTION
- The contraceptive injection (DMPA/Depo) is a hormonal contraceptive containing a progestogen, which is given into the muscle of the buttock or arm every 12 weeks.
- The injection is over 94% effective at preventing pregnancy.
- There can be a delay in return to fertility after ceasing the contraceptive injection, therefore this method may be more suitable for women who do not wish to fall pregnant again within two years.
- The injection can be started any time after delivery.
- The injection be used by breastfeeding women.
THE PROGESTOGEN-ONLY PILL
- The progestogen-only pill (mini pill) is a pill which must be taken at the same time every day and works mainly by changing the mucus in the cervix.
- The minipill is 91% effective at preventing pregnancy.
- The minipill can be started immediately after delivery.
- The minipill is suitable for women who are breastfeeding.
THE COMBINED ORAL CONTRACEPTIVE PILL
- The combined oral contraceptive (‘the pill’) contains two hormones, oestrogen and a progestogen. It works by preventing ovulation.
- •The pill is over 91% effective at preventing pregnancy when taken correctly.
- The pill can be started six weeks after birth.
- The pill can be used by breastfeeding women from 6 weeks post- delivery.
- Condoms are an effective method of contraception when used correctly and can be a good interim choice following childbirth.
- Condoms can be used as soon as you feel ready to resume penetrative sex (water based lubricant optional).
- Condoms are readily available at chemists and supermarkets without a prescription.
- Condoms are about 80% effective at preventing pregnancy.
- Female condoms are available through some chemists or online. Some couples prefer the female condom over the male variety as they provide more protection for women from STIs and retain more sensitivity for the male partner than male condoms.
- Female condoms can be used as soon as you resume penetrative sex.
- Female condoms are between 80% and 95% effective at preventing pregnancy.
- A diaphragm is a barrier contraceptive. It is a silicone dome which is placed into the vagina before intercourse, it covers the cervix and prevents sperm entering the uterus.
- It is preferable for a diaphragm to be individually fitted by a specially trained nurse (e.g., at SHFPACT). The woman can then purchasea diaphragm of the correct size via online suppliers.
- The diaphragm is 88% effective in preventing pregnancy.
- The diaphragm can be used from 6 weeks post childbirth. If you were using a diaphragm before your pregnancy, you would still need a check for the correct fit as sizing can change after the birth of a baby.
EMERGENCY CONTRACEPTION (EC):
- HORMONAL EC:
- This can be used from 21 days post birth when no contraception was used, a condom broke, a diaphragm slipped, or a pill was taken late. Prior to 21 days, no EC is necessary. There are two types ofhormonal emergency contraception:
- Levonorgesterel (LNG) EC works by delaying ovulation (release of an egg) and is 85% effective in preventing pregnancy if taken within four days of unprotected sex. It is safe to use while breastfeeding.No script is required – it is available at SHFPACT, Walk-in Centres inthe ACT and at most chemists.
- Ulipristal (UPA-EC)is a tablet containing a different progestogen. It can be used up to 5 days after unprotected intercourse, and some studies indicate that it may be more effective than the LNG-EC. It is available over the counter from pharmacies but is more costly than the LNG- EC. Hormone contraception cannot be started for five days after taking UPA-EC. Lactating women cannot breastfeed for a week after taking UPA-EC and must discard any breastmilk expressedduring this time.
- IUD EC:
A copper IUD can be inserted by a specially trained doctor within five days of unprotected intercourse as an emergency contraceptive as long as 28 days have passed from childbirth. It is highly effective and can be used as ongoing contraception.
Male sterilisation (vasectomy) and female sterilisation (tubal ligation) are both over 99% effective. As sterilisation is regarded as a permanent method, it is advisable to take the time to thoroughly consider all aspects before making a decision. This includes consideration of whether a sterilisation decision may be regretted if the loss of partner or children through illness or accident were to occur. If you are interested in sterilisation talk to your GP or a doctor at the SHFPACT Clinic, you will need a doctor’s referral for tubal ligation.
IS IT NECESSARY TO USE CONTRACEPTION IF I AM FULLY BREASTFEEDING MY BABY?
If your baby is less than six months old and your periods have not returned, and you are fully breast feeding your baby, you should be 98% protected from pregnancy. Fully breast feeding means no bottle feeds at all and putting the baby to the breast at regular intervals over the 24 hour period (the night feeds are critical). If your baby missesany feeds or begins to sleep long periods at night your risk of pregnancy will increase, and you should use an additional method of contraception if you wish to avoid pregnancy.
Once your periods return, even if you are fully breastfeeding, contraception should be used if you wish to avoid pregnancy. Contraception is also advised once your baby turns six months old.
If there are any difficulties in establishing breastfeeding, if you are using complimentary feeds, or if you decide to bottle feed, you will need to use contraception as soon as you resume sexual intercourse.
WHEN CAN WE RESUME SEXUAL INTERCOURSE?
There is no set time, it is really an individual decision. You may or may not feel like having sex for a while after the birth of your baby.
Be guided by your own emotions and how you feel physically.
You can find other ways to be intimate and be sexually close with your partner until you feel ready to have sexual intercourse again. It’s important to talk to your partner and let them know how you are feeling about it.
WILL SEX BE UNCOMFORTABLE?
Many women worry that sex will be uncomfortable after giving birth. Discomfort may occur because vaginal lubrication is often decreased due to the hormonal changes of birth and breastfeeding. Discomfort may also be related to an episiotomy or tear which is still healing after a vaginal delivery.
Many women find that recovery takes place over a few weeks to months. It is a good idea to use lubricant to make sex more comfortable. This can be applied to the penis or the vaginal entrance before intercourse. Do not continue intercourse if it is painful or uncomfortable, wait a few days before attempting it again.
If penetrative sex continues to be very uncomfortable over a long period, you should see a doctor to discuss it.
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Last updated July 2017