Birth Control and Breastfeeding: What are Your Options?

By Lynette Wolgemuth

August 14, 2019

Congratulations!  Your beautiful baby is here and you are back home trying to get into the routine of being a mom, caregiver, and, don’t forget, partner!  Unless your family plans include Irish twins (siblings born within a year of each other), discussing birth control options is imperative!

So what birth control options are available for you, the breastfeeding mom?  There are many, allowing you and your partner to choose a method that is right for you before having sex again. The Society of Obstetricians and Gynecologists of Canada provide a comprehensive overview:

 Natural Methods    

 

Lactational Amenorrhea (LAM)  

Elevated prolactin levels during breastfeeding cause ovulatory suppression.  To be effective, women with babes less than six months of age need to be breastfeeding exclusively (at minimum, every 4 hours during the day and 6 hours at night) and have not had a period since delivery (HealthLink BC, 2017).  About 2 out of 100 women become pregnant in the first six months using this method.  

Fertility-Awareness Based Methods

Measuring basal body temperature daily, checking urine for luteinizing hormone, or observing changes in cervical mucus can help calculate when ovulation occurs.  Avoiding sex during this time can be helpful, though 24 out of 100 women become pregnant yearly.

Withdrawal Method 

Demanding impeccable self-control of both partners, about 22 out of 100 women become pregnant yearly using this method.

 

Non-Hormonal Methods

Copper Intrauterine Contraceptive (Cu-IUC)

  IUC is the most effective birth control available, used by 150 million women world-wide. This small T-shaped device can be inserted into the uterus within 10 minutes after birth by your health care provider. It provides immediate contraception, and can be left in place up to 10 years.  Only 8 out of 1000 women become pregnant with this method yearly. 

Barrier Methods

The male or female condom, contraceptive sponge, and cervical cap or diaphragm is used as a physical barrier for sperm in conjunction with spermicide.  Failure rates for these methods vary significantly from 2 out of 100 pregnancies in a year for perfect use of male condoms, to 24 out of 100 pregnancies with typical use of the contraceptive sponge.  

Vaginal Spermicides

Used alone, this form of birth control is among the least effective with failure rates ranging from 18 to 28 per cent.

 

Hormonal Methods

Lovonorgestrel-Releasing Intrauterine System (LNG-IUS)

All hormonal methods prevent the ovary from releasing an egg, thicken cervical mucus to prevent sperm from reaching an egg, and change the lining of the uterus to make implantation difficult.  This progestin-only device, not affecting breast milk production, is the most effective form of birth control available with failure rate only 2 out of 1000 women yearly. The small, T-shaped device can be inserted into the uterus right after birth by a health care provider and can be in place three to five years depending on the product.

Oral Contraceptive Pill (OCP)

Over 100 million women use OCPs for birth control.  There are two types; combined oral contraceptive (COC) with estrogen and progestin, and progestin-only pill (POP). POP does not affect milk production and can be started immediately after birth. COC can be started after breast feeding is established, usually after four weeks. With typical use 90 out of 1000 women will get pregnant within the first year of use, but if used perfectly, pregnancy declines to 3 out of 1000.

Injectable Contraception 

This progestin-only birth control method not affecting breast milk supply can be very effective if injections are administered on schedule, typically four times a year. Failure rate with perfect use is only 2 out of 1000 women though if missing or late for an injection, this increases to 60 out of 1000 women. A common disadvantage of this method is there can be a delay in return of ovulation once stopping the injections of up to six to ten months.

Contraceptive Patch or Vaginal Ring

As combined estrogen-progestin options, these methods can be used once breastfeeding is well established. A patch is applied to the skin or a ring is inserted vaginally and worn/retained for three weeks, slowly releasing hormones.  Their failure rates are the same as OCPs, though the ring is less effective in women weighing more than 90 kg or 198 lbs. 

 

Birth control options for you and your partner are numerous. A great website for more information is PregnancyInfo.ca from the SOGC. Be sure to talk to your health care provider, or one of The Mama Coach Nurse Practitioners to answer your questions in helping with this decision.

 

References:
Fierro, P. (2018).  Irish twins are siblings born less than a year apart.  
HealthLink BC. (2017).  Breastfeeding as birth control.  
Society of Obstetricians and Gynecologists of Canada. (2016).  Contraception. 

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