Contraception should be discussed soon after giving birth. Until your baby is 21 days old you cannot become pregnant. After that you will need contraception. There are many choices available for women. If you feel your family might be complete, long-acting methods or sterilisation should be discussed. If you want to have more children, choose an option that is easily stopped so your body can return to normal.
The time for fertility to return is very variable between women. It is important not to take any risks, if you do not want to become pregnant again. Therefore, you should decide on the type of contraception you are going to use as soon as possible after having a baby. You will need contraception from 21 days after your baby is born.
Your periods usually return about four to ten weeks after your baby's birth if you are bottle-feeding, or combining breast and bottle. If you are breast-feeding then your periods may not start until much later. For some women this might be after you have stopped breast-feeding.
You can have sex as soon as you and your partner feel ready to. Some people find it takes a while to feel ready, both physically and emotionally. If you have had stitches, then these are usually dissolvable so will not need removing. If you are having any discomfort from these then you should see your doctor or midwife. Some women find they need to use some vaginal lubricant if they feel more dry than normal.
If you had your baby in hospital, you might have discussed contraception with your midwife before you were discharged home. You will also be asked about contraception at your six-week (or eight-week) postnatal check. You can discuss it at any time with your health visitor, midwife, GP or local family planning clinic.
When you breast-feed, a hormone called prolactin is produced by your body, which stimulates the production of your milk. Prolactin also blocks the release of the hormones which make you produce an egg. This means that you are less likely to become pregnant whilst you are breast-feeding.
You can use breast-feeding (the lactation amenorrhoea method) for contraception if you are:
You should know that 2 women in every 100 using this will become pregnant within that six months. When you stop fully (or nearly fully) breast-feeding, you can get pregnant. Many women decide to use some contraception in addition to breast-feeding, to reduce their risk of an unplanned pregnancy. There are methods available that will not affect your ability to produce milk.
All the methods of contraception listed below are effective, but none is 100% reliable. The reliability for each method is given in percentages. For example, between 2 and 60 women in 1000 women using the contraceptive injection for a year will become pregnant. When no contraception is used, more than 800 in 1000 sexually active women become pregnant within one year.
The effectiveness of some methods depends on how you use them. You have to use them properly or they are less effective. For example, 3 women in 1000 using the 'pill' perfectly for a year will become pregnant. Nearer to 90 women in 1000 using the pill normally (not perfect usage) will become pregnant. Not perfect use might mean if you miss a pill for example or have vomiting, then it becomes less effective. Other 'user-dependent' methods include barrier methods, the progestogen-only pill (POP) and natural family planning.
Some methods are not so 'user-dependent' and need to be renewed only infrequently or never. These methods include the contraceptive injection, contraceptive implant, intrauterine contraceptive devices (IUCDs) - also known as coils - and sterilisation.
When you choose a method of contraception you need to think about:
The types of contraceptives can be divided into short-acting, long-acting and permanent. If you are planning on having another baby in the next year or so then you should consider a short-acting contraceptive.
There are separate leaflets on each method for more details.
The COCP is often just called 'the pill'. Between 3 and 90 women in 1000 using the pill will become pregnant each year. It contains oestrogen and progestogen and works mainly by stopping egg production (ovulation). It is very popular. Different brands suit different people.
The COCP can be started from 21 days after the birth. However, it is not recommended if you are breast-feeding, as it can affect your milk supply.
The POP used to be called the 'mini-pill'. It contains just a progestogen hormone. It is commonly taken if the COCP is not suitable, such as in breast-feeding women, smokers over the age of 35 and some women with migraine. Between 3 and 90 women in 1000 using the pill will become pregnant each year. It works mainly by causing a plug of mucus in the neck of the womb (cervix) that blocks sperm. It also thins the lining of the womb, making it less likely the egg will implant. One type (Cerazette®) stops ovulation.
The POP can be started from 21 days after the birth. You need to remember to take it at the same time every day because, if you take a pill more than three hours later than usual (12 hours for a POP called Cerazette®), you lose protection.
This contains the same hormones as the COCP, but in patch form. It is as effective as the COCP at preventing pregnancy. The contraceptive patch is stuck on to the skin so that the two hormones are continuously delivered to the body. There is one combined contraceptive patch available in the UK, called Evra®.
The contraceptive patch can be started from 21 days after the birth. However, it is not recommended if you are breast-feeding, as it can affect your milk supply.
These include male condoms, the female condom, diaphragms and caps. They prevent sperm entering the uterus. If used perfectly about 5 women in 100 will become pregnant. With normal (not perfect) usage closer to 20 women in 100 will become pregnant each year. Other barrier methods are slightly less effective than this.
You can use male and female condoms as soon as you feel ready to have sex.
Less likely to develop swelling of your feet, ankles or hands.
Less likely to develop back pain.
Less likely to have problems with high blood pressure during your pregnancy.
Sleep better and feel less tired.
If you already have diabetes, regular physical activity may help to improve the control.
Have a reduced chance of becoming anxious or depressed.
Have a reduced chance of developing varicose veins.
More likely to have a shorter labour and be less likely to have problems or complications during the delivery of your baby.
More likely to keep a healthy weight during and after your pregnancy.
Now you have read 9 benefits of physical activity during pregnancy, why not look at some of our other slideshows.
Less likely to develop swelling of your feet, ankles or hands.
This involves fertility awareness. Between 1 and 9 women per 100 will become pregnant using this method. It requires commitment and regular checking of fertility indicators such as body temperature and cervical secretions.
The lactation amenorrhoea method (as above) is suitable for the first six months after having a baby, if you are only breast-feeding and do not have a period. 2 women in 100 will conceive during that six months using this method.
These are more suitable for women who do not want to get pregnant again or for a few years.
This contains a progestogen hormone which slowly releases into the body. It is very effective. Between 2 and 60 women in 1000 using it will become pregnant after a year. It works by preventing ovulation and also has similar actions as the POP. An injection is needed every 8-12 weeks.
It is usually recommended that you wait until six weeks after the birth to start the contraceptive injection because you may get heavy and irregular bleeding. However, it is possible to start it earlier if there are no other alternatives for you.
An implant is a small device placed under the skin. It contains a progestogen hormone which slowly releases into the body. Around 1 woman in 2,000 using the implant will become pregnant each year. It works in a similar way to the contraceptive injection. It involves a small minor operation using local anaesthetic. Each one lasts three years.
A plastic and copper device is put into the womb. It lasts five or more years. Between 6-8 women in 1000 using an IUD for a year will become pregnant. It works mainly by stopping the egg and sperm from meeting. It may also prevent the fertilised egg from attaching to the lining of the uterus. The copper also has a spermicidal effect (kills sperm).
An IUCD can usually be fitted 6-8 weeks after giving birth.
A plastic device that contains a progestogen hormone is put into the uterus. The progestogen is released at a slow but constant rate. Around 2 women in 1000 will become pregnant using this method for a year. It works by making the lining of your womb thinner so it is less likely to accept a fertilised egg. It also thickens the mucus from the neck of your womb. It is also used to treat heavy periods (menorrhagia).
An IUS can usually be fitted 6-8 weeks after giving birth.
This involves an operation. It is very effective but this can vary from surgeon to surgeon. Vasectomy (male sterilisation) stops sperm travelling from the testes. Female sterilisation prevents the egg from travelling along the Fallopian tubes to meet a sperm. Vasectomy is easier as it can be done under local anaesthetic. These methods are often used when your family is complete. You should be sure of your decision as they are difficult to reverse.
If you have Caesarean section, the surgeon may sterilise you at the same time, if you are very sure of your decision. Or you can return later when you and your partner have decided.
Emergency contraception can be used at any time if you had sex without using contraception. Also, if you had sex but there was a mistake with contraception. For example, a split condom or if you missed taking your usual contraceptive pills.
You will not need emergency contraception if you have unprotected sex within 21 days of having your baby. You cannot get pregnant so soon after childbirth.
This leaflet is just a brief account of the available methods of contraception after having a baby. Ask your practice nurse, doctor or pharmacist if you want more detailed information about any of these methods.
The fpa (formerly the Family Planning Association) also provides information and advice.
fpa's helpline: 0845 310 1334 or visit their website www.fpa.org.uk