New moms have specific contraceptive needs. They want birth control that is effective, simple to use, can be used over a long period of time, and allows for sexual spontaneity. An important question often asked by new moms is, “How soon after giving birth do I need to start using birth control?” Usually, doctors recommend that birth control be started six weeks after giving birth (if medically it’s okay to have sex) or when menstruation resumes. Breastfeeding does not prevent pregnancy, as many couples accidentally realize, so often couples use condoms until they decide on another form of birth control.
Barrier Methods
Barrier methods of birth control such as diaphragms, cervical caps, or condoms, appeal to women who don't want extra hormones in their systems. None of these impact breastfeeding or future fertility. The diaphragm is a latex cup which is filled with spermicide and inserted into the vagina prior to sexual intercourse. The cervical cap is similar, but smaller. The cervical cap has a high failure rate among women who have had children, so it’s not recommended for new mothers. The diaphragm is 94% effective when used correctly. A newly fitted diaphragm may be inserted six weeks after birth. Condoms are highly effective, (especially when their partners use a spermicide) and are the only non-permanent birth control option for men. Condoms help protect against venereal diseases and HIV, but other barrier methods do not.
Intrauterine Devices
In recent years, a new form of intrauterine contraception (IUC) has been developed. It is a reversible method that is easy to use, provides long-term protection from pregnancy, and does not require monthly trips to the pharmacy. Ninety-six percent of women currently using IUC are satisfied.
Another IUC option, Mirena (R), lasts for five years and is more than 99% effective. Mirena delivers a low dose of the hormone levonorgestrel, which usually results in shorter, lighter periods. Since this hormone is a type of progesterone, there may be negative mood changes in those women vulnerable to depression.
Intrauterine contraception is recommended for women in mutually monogamous relationships who have had at least one child. Women with a history of pelvic inflammatory disease or ectopic pregnancy should not use Mirena. IUCs do not protect against HIV or other venereal diseases.
The Pill, The Shot, and The Implant
New mothers can use Depo-Provera, Norplant, and progestin-only mini-pill six weeks after birth, even if nursing. Depo-Provera is a hormone shot given every 12 weeks. Depo-Provera may delay pregnancy for a year after being discontinued. Norplant, a capsule inserted under the skin, contains hormones which prevent pregnancy for five years. Upon removal, pregnancy can take place immediately. The pills, which are taken daily, contain estrogen and progestin and can be used by new moms six weeks after birth. Progestin-only pills contain no estrogen and are compatible with breastfeeding. Depo-Provera, Norplant, and the pills are all nearly 100% effective. Birth control pills, shots, and implants do not protect against HIV or venereal diseases.
Note: For women who are susceptible to depression, I don’t recommend these methods, especially the first two (Depo-Provera and Norplant), since the hormones delivered may cause depression. Once the shot is given, the woman needs to wait three months before she’ll feel normal again, which is miserable for her. Norplant would need to be removed if the woman experiences mood problems, and that isn’t always simple. Birth control pills can also cause negative mood changes, but can be stopped if this occurs.
Natural Family Planning
Natural Family Planning, or NFP, requires charting your basal body temperature and monitoring cervical fluid to determine when you ovulate. For most women, there are only a couple of days each month when you can get pregnant. Ovulation occurs once a month and the egg lives two days, during which time pregnancy is possible. During ovulation and around that time for a few days, the couple abstains from sexual activity or they use a barrier method.
This method takes time to learn – it takes patience and discipline to chart every day. However, when accurately used, research has shown that NFP has a high degree (95-99%) of effectiveness. NFP does not prevent HIV or other venereal diseases.
Permanent Birth Control Options
If your family is complete, consider sterilization. Tubal sterilization for women and vasectomy for men permanently prevent pregnancy. A woman's fallopian tubes are cut during tubal sterilization, usually immediately after giving birth. This procedure does not affect breastfeeding, but it can cause mood changes. Vasectomy, the blockage of sperm-carrying tubes, can be performed in a doctor's office under local anesthetic and is a very simple procedure. These methods are considered to be 100% effective, but they don’t prevent venereal diseases.
Dr. Shoshana is a psychologist who treats women with prenatal and postpartum depression. She is the author of a number of books on postpartum depression including, Postpartum Depression for Dummies. Her most recent book, Pregnant on Prozac, is available on Amazon.com. Dr. Shoshana can be contacted through her website, DrShosh.com.