Post Natal Contraception
When can we resume sexual intercourse?
There is no set time; it is really an individual decision. You 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.
Many women worry that the first intercourse after giving birth will be painful, and sometimes it is. This is because vaginal lubrication is slower and not as profuse for eight to ten weeks after birth. It may also be related to an episiotomy or tear which has not fully healed. However, usually by the twelfth week you will find it is the same as before you were pregnant. If intercourse is painful or uncomfortable, either wait a few more days before attempting it again, or use a lubricant (available from chemists, supermarkets and SHFPACT. This can be applied to the penis or put at the entrance to the vagina before intercourse. If intercourse is still painful or not possible, you should see your doctor.
Will it be necessary to use birth control if I am breast feeding my baby?
If you are fully breast feeding your baby (not bottle feeding) and putting the baby to the breast at regular intervals over the 24 hour period (the night feeds are critical) you should be 98% protected from pregnancy, as long as your periods have not returned, in the first 6 months. If your baby misses feeds or begins to sleep long periods at night this will increase your risk of pregnancy.
Once your periods return, even if fully breast feeding, contraception should be used if you wish to avoid pregnancy. Contraception is also advised after your baby turns 6 months old. However, if there are any difficulties in establishing full breast feeding (or if you decide to bottle feed), it is important to use contraception as soon as you resume sexual intercourse.
Which method of birth control would be suitable to use if I am breast feeding or bottle feeding?
The method of birth control you choose is up to you and your partner. The following list of contraceptives may assist you in your decision-making.
The mini (progestogen-only) pill
- The mini pill may be used by women who choose to breast feed their baby. The mini pill does not affect the quality or quantity of breast milk you produce (according to research).
- It is usually recommended that it be started 2 to 6 weeks after delivery. It needs to be taken for seven days before you have contraceptive cover, and must be taken at approximately the same time every day.
- Consider switching to the combined pill when weaning your baby. The mini-pill is a little different from the common contraceptive pill, and you may wish to get further information from your doctor, midwife or the SHFPACT Clinic.
The combined oral contraceptive pill
- The Pill may be used by women who choose to bottle feed their baby, or at the time of weaning. IT is not suitable for women who are breastfeeding.
- The Pill should not be started until at least three weeks after you have had your baby because of the risk of thrombosis (blood clots).
- It is not suitable for all women, and depends upon your medical history etc. discuss the pill thoroughly with your doctor or SHFPACT clinic.
- Depo Provera is an injection of progestogen which is given every 12 weeks. It may be used by women who are breast feeding. Studies suggest no change in the quality or quantity of breast milk produced.
- If you are breast feeding you should have your first injection 2 to 6 weeks postnatally.
- If you decide not to breast feed the injection can be given within 48 hours of having your baby. However it may be best to wait for the first injection until five or six weeks, as earlier use may increase post-natal bleeding.
The Intra-uterine device (IUD)
- If you have had a vaginal or forceps delivery an IUD may be inserted 8 to 10 weeks after you have had your baby.
- If you have had a caesarian section you may need to wait 12 weeks.
- The Mirena IUD is an IUD containing progestrogen. Research has shown that it is safe to use during breastfeeding.
- IUDs are effective for between 5 to 10 years depending on the type of device used. Check with your doctor or the SHFPACT Clinic for more detailed information.
- Implanon is a progestogen implant inserted into the inner upper arm (under local anaesthetic). It is a very reliable contraceptive lasting for 3 years, when it should be removed. It can be removed earlier if desired.
- It may be inserted 4 weeks after you had your baby.
- It may be used by women who are breast feeding from 6 weeks.
- Obtainable from your doctor or the SHFPACT Clinic.
- A diaphragm needs to be fitted by a nurse approximately six weeks after you have had your baby. If you were using a diaphragm before your pregnancy, it may not fit. Again, check this with the nurse approximately six weeks after the birth of your baby.
- If used correctly, condoms are an effective method of contraception, particularly as an interim measure following childbirth and can be used as soon as you feel ready to resume intercourse.
- Condoms are available at chemists, supermarkets and the SHFPACT Clinic without prescription.
- Female condoms are also available through the SHFPACT Clinic and some chemists. Some people prefer these because they provide more protection for women from STIs and more sensitivity for men than male condoms.
- Contraceptive jelly, cream and foam are all spermicides. They are usually used in combination with a diaphragm to make it more effective.
Periodic Abstinence (Billings, Temperature and Rhythm Methods)
- Periodic abstinence may be more difficult to use following childbirth, particularly if you have had no previous experience. Consult your doctor or the SHFPACT Clinic for more information.
Emergency Contraception (E.C)
- Can be used if no contraception was used or if a condom broke, diaphragm slipped.
- Progesterone E.C – can be used by lactating women within 72 hours of unprotected intercourse.
- IUD can be inserted within 5 days of unprotected intercourse.
- No script required - available at SHFPACT and most chemists
- It is often not the best time to decide on sterilisation immediately after having your baby. It is usually a good idea to wait for about 12 months, making sure that your baby is healthy, and that you would not want another child under any circumstances.
- Although sterilization can sometimes be reversed, there is no guarantee that pregnancy will happen after reversal.
- If you are interested in this option talk to your doctor or a doctor at the SHFPACT Clinic.