Breastfeeding and Birth Control

Birth Control Options for Breastfeeding Moms

Having a baby is a special time in a woman’s life. It is a time of discovery -- from learning all about your new baby’s personality to figuring out what your baby wants and needs. Many new mothers also find themselves navigating the process of breastfeeding. In the middle of all this excitement, birth control may be the farthest thing on your mind. Yet, unless you wish to add an additional brother or sister to the family nine months from now, it is important that you don’t overlook your birth control needs.

When it comes to breastfeeding and birth control, a new mommy has many contraceptive options to choose from. It is also important not to believe the myth that you cannot get pregnant while you are breastfeeding. Though breastfeeding can be considered a birth control method, there are specific conditions that must be met in order for it to be effective. It seems that many women do not think they are fertile again until they receive their first period after giving birth. Keep in mind that you will ovulate before you get your period. If you have unprotected sex around the time of your ovulation, you can become pregnant again. This is why using your period as a fertility indicator is not a good idea. Once you read about all the breastfeeding birth control options available, it is always a good idea to talk to your doctor to decide which one may be best suited for you.

Breastfeeding birth control options fall into four categories: progestin-only hormonal methods, non-hormonal methods, natural methods and permanent methods. All of the following birth control methods are considered safe to use while breastfeeding:

Progestin-Only Methods:

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Progestin-Only Methods. Photo © 2014 Dawn Stacey
Progestin-only contraceptives are hormonal birth control methods that require a prescription from your doctor. Though the progestin may enter your milk supply, it will not cause any harm to your baby or cause a drop in milk production. These methods also tend to be more effective than many non-hormonal alternatives.

Mini-Pill

The Mini-Pill. Photo © 2009 Dawn Stacey

This is a progestin-only birth control pill. Unlike its alternative, combination pills, the mini-pill does not contain any estrogen. These pills come in a 28-day pack, so all the pills in each 4-week pack contain progestin (there are no placebo pills).

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Nexplanon

Nexplanon. Photo Courtesy of Merck

This is also known as the contraceptive implant. Nexplanon is the newer version of Implanon as the manufacturer is slowly phasing out Implanon. This thin, plastic implant is inserted under the skin in the arm. It continually releases a low dose of progestin over 3 years and provides pregnancy protection during this whole time. Implanon or Nexplanon can also be removed any time during this 3-year period.

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Depo Provera

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Depo Provera. Photo © 2014 Dawn Stacey

This birth control method is an injection that slowly releases progestin into your bloodstream over a period of 11 to 14 weeks. So, you are protected from pregnancy during this time. It is important that you receive your next scheduled Depo Provera injection on time so effectiveness will not be compromised.

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Mirena or Skyla

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Skyla and Mirena. Photo © 2014 Dawn Stacey

These are IUDs that also release a small amount of progestin over either a 3 or 5-year timeframe. They must be inserted and removed by your doctor. Both are highly effective and can be taken out at any time.

Non-Hormonal Methods:

With a few exceptions, these breastfeeding birth control options are available over-the-counter. Many are considered "barrier" methods since they basically act like a wall that blocks sperm from being able to reach the egg.

Male Condoms

Condoms. © Damon Hart-Davis

Condoms come in many types, sizes, and materials (such as latex, polyurethane, lambskin or polyisoprene). A man uses a condom to cover his penis before, during and after ejaculation. Even though certain condoms come pre-lubricated, some breastfeeding mothers may have lower estrogen levels, which can cause vaginal dryness. If you find that condom use is irritating your vagina, you may choose to add some additional lubrication (like Astroglide or Wet Naturals).

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Female Condom

Female Condom. Photo © 2009 Dawn Stacey

This birth control method consists of a pouch made from polyurethane with flexible rings at each end. It holds semen and does not allow the sperm to enter your body. It may take a little practice learning how to properly insert a female condom until you feel comfortable using one.

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Spermicide

Spermicides. Photo © 2010 Dawn Stacey

Spermicides come in different forms, but basically work the same way -- spermicides are inserted deep into the vagina right before sex; they will then melt or bubble to form a barrier. They usually contain nonoxynol-9, which is a spermicide that immobilizes and/or destroys sperm.

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Today Sponge

Today Sponge. Photo Courtesy of Mayer Laboratories, Inc.

The sponge is a round, foam device that has an attached nylon loop for removal. It blocks the cervix (the opening to the uterus), so sperm cannot enter. It also releases a spermicide that can stop sperm from swimming. Having a good understanding of your anatomy, along with some practice, can make it easier for you to learn how to insert the sponge.

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Diaphragm

Diaphragm. Photo Courtesy of Michael Matisse/Photodisc/Getty Images

A diaphragm (or its smaller alternative, a cervical cap) is a barrier device. These cannot be used until it has been six weeks since you have given birth. Both the diaphragm and cervical cap must also be fitted by your doctor. They are inserted into the vagina and block the cervix. Both are used with spermicidal cream so that the device blocks the sperm and the cream immobilizes it.

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ParaGard

ParaGard. Photo Courtesy of J. James

This is a hormone-free IUD. It has copper coiled around the device and is inserted by your doctor. ParaGard provides 10 years of pregnancy protection, but can be removed at any point before the 10 years are up.

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Natural Methods:

Also known as behavioral methods, these breastfeeding birth control methods do not rely on any devices or hormones. Natural methods consist of behaviors you can naturally do to help prevent pregnancy.

Continuous Breastfeeding (Lactational Amenorrhea Method)

Breastfeeding. Photo Courtesy of Andersen Ross/Getty Images

If done correctly, LAM can postpone ovulation for up to six months after giving birth -- so if there is no egg being released, there is nothing for a sperm to fertilize. Continuous breastfeeding is effective because the hormone that triggers milk production also prevents the release of the hormone that signals ovulation. Remember, though: you should not rely on this method for more than six months or if you have had a period since giving birth. Also, LAM is only effective if you breastfeed your baby at least 6 times a day with both breasts and do not alternate other foods for breast milk. You must also be breastfeeding your baby every 4 hours during the day and every 6 hours at night.

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Natural Family Planning (NFP)

NFP. Photo © 2014 Dawn Stacey

NFP methods rely on monitoring different body changes to determine when ovulation occurs. They include symptom-based methods (like the Billings method) and calendar-based methods (like the Standard Days method). Although there is no rule that says NFP cannot be considered as a breastfeeding birth control choice, the World Health Organization cautions that using fertility awareness methods may be less effective in breastfeeding women. It is suggested that you wait to rely on NFP options until you have begun to notice fertility signs (such as cervical mucus), you have had at least three post-partum periods, and you have begun to substitute breast milk with other foods.

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Permanent Options:

If you know that this baby is your last, you can always consider permanent options as your breastfeeding birth control choice. Remember, sterilization should be thought of as permanent and non-reversible. If you are still feeling "hormonal" while breastfeeding or are experiencing any post-partum depression, you may wish to postpone the decision to seek permanent birth control until you are in an emotional place where you feel confident in making this choice.

Female Sterilization

Tubal Ligation. Photo © A.D.A.M.

Permanent methods for women include traditional, surgical tubal ligation procedures -- usually referred to as having your tubes tied. Keep in mind that tubal ligation requires anesthesia, which can pass into your breast milk and can affect your baby (usually drowsiness that may result in difficulty with feedings). Another permanent option is called Essure. This is a non-surgical alternative to tubal ligation and doesn’t require anesthesia. Both approaches work by sealing off or blocking the fallopian tubes. This way, eggs cannot travel to the uterus and sperm cannot enter the fallopian tubes to reach an egg.

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Vasectomy

Vasectomy. Photo © Blausen Medical

Male sterilization has no effect on breastfeeding. After a vasectomy, a man’s body still makes semen, but it will not contain any sperm. Men can choose between traditional vasectomies where a small incision is made in the upper part of the man’s scrotum or the no-scalpel vasectomy where the surgeon punctures the skin, so no incisions are made.

Sources:

Centers for Disease Control and Prevention. U.S. Medical Eligibility Criteria for Contraceptive Use, 2010. MMWR Early Release 2010;59 May 28:1-86.

Riordan, J. & Wambach, K. (2009). Breastfeeding and Human Lactation. Sudbury, MA: Jones and Bartlett.

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