Breastfeeding and birth control

It is difficult to predict when your fertility will return. Pregnancy can occur as early as 4 to 6 weeks after giving birth. Ovulation can occur before your menstrual period returns. The timing of when birth control can be started depends on which birth control method is chosen and whether you have made an informed decision to breastfeed or not. Planning for contraception should be done while you are still pregnant. You can discuss your birth control options with your healthcare provider. You may be able to start your chosen method before your 6-week postpartum check-up.

Birth control MOST COMPATIBLE with breastfeeding

The following birth control choices have no effect on breastfeeding your baby and generally can be started soon after childbirth or at the postpartum check-up:

LAM (Lactational Amenorrhea Method)

Breastfeeding itself can be an effective method of birth control. LAM can reduce the chances of pregnancy by approximately 98% if you answer YES to ALL the following statements:

1. My monthly period has not returned.
2. My baby is less than 6 months old.
3. I breastfeed on demand day and night (intervals between feedings are no more than 4 hours during the day and 6 hours during the night).
4. My baby is fully or nearly fully breastfed*.

If you answered NO to any of these statements, and are not planning to become pregnant, begin another method of contraception. Continue breastfeeding for both your health and the health of your baby.

* Fully breastfed: Your baby gets all their food from suckling at the breast
Nearly fully breastfed: In addition to breastfeeding, vitamins, minerals, juice, water or any other foods are given infrequently (no more than one to two mouthfuls a day).

Condoms (female and male)

The female condom is a polyurethane pouch that is inserted in the vagina before intercourse. It covers the inside of the vagina and prevents sperm from entering. When used correctly, this method is 95% effective.

The male condom is a latex or plastic covering worn on the penis during intercourse. It prevents sperm from entering the vagina. When used correctly, this method is 98% effective.

Diaphragm (must be refitted after childbirth)

The diaphragm is a shallow, dome-shaped silicone cup that is inserted into the vagina prior to intercourse. This method is more effective when used in combination with a spermicide. When used correctly, this method is 95% effective.

Spermicides (Foam, Gel, Sponge)

All spermicides contain chemicals that kill sperm. Spermicides are inserted into the vagina before intercourse. When used correctly, this method is 80% effective.

Intrauterine Device (IUD)

An IUD is a “T-shaped” device inserted into the uterus by a healthcare provider and can be left in place for up to 5 years. It is usually inserted at least 4 to 6 weeks after delivery. When used correctly, this method is 99% effective.

Progestin-Only Pill (Mini Pill)

This pill is progestin-only and can be started anytime after giving birth. When used correctly, this method is 92% effective. The progestin-only pill does not appear to interfere with lactation and can be started right after birth.

Sterilization (female and male)

Tubal Ligation (female sterilization) is performed in a hospital, whereby the tubes that carry eggs to the uterus are cut or blocked. This method is meant to be permanent and is 99.5% effective.

Vasectomy (male sterilization) is performed by a doctor, whereby the tubes that carry the sperms from the testicles are cut. This method is meant to be permanent and is 99.9% effective.

Birth control LESS COMPATIBLE with breastfeeding

Hormone-based birth control, such as progestin-only types (IUD, Mini Pill) are compatible with breastfeeding, but should only be used after your baby is 6 weeks old and breastfeeding is well established. Combined estrogen-progestin birth control should be considered only after other methods have been ruled out as these may decrease your milk supply.

These options include:

Combined Birth Control

Combined Birth Control contains both estrogen and progestin. Mothers using this method should continue to breastfeed. When using Combined Birth Control, mothers should monitor their baby to ensure they are drinking enough milk. Combined Birth Control can be taken orally (“the Pill”), worn on the skin (“the Patch”), inserted under the skin (contraceptive implant) or inserted into the vagina (“the Ring”). When used correctly, these methods are 99.7% effective.

Injectables (Depo-Provera)

Depo-Provera is a hormone injection given by a healthcare provider every 12 to 14 weeks (approximately 3 months). When used correctly, this method is 99.7% effective.

There are no negative side effects on breast milk supply if breast milk supply is already well established.

Emergency Contraceptive Pills—Plan B

Emergency contraceptive, also known as the “Morning After Pill” is NOT a regular method of birth control. It is used on the rare occasion that another form of birth control has failed or has been forgotten. The progestin-only pills should be taken as soon as possible after unprotected sex has occurred. When used correctly, this method is 80 to 90% effective. Breast milk supply may be temporarily reduced.

There are many types of birth control options available. To help you in your decision, access It’s a Plan to see which one is for you.

Source: The Society of Obstetricians and Gynaecologists of Canada