Choosing the right birth control is hard enough. But what about after having a baby and using birth control while breastfeeding? Your post-birth body, your breastmilk, and your baby all need to be considered. It’s not always as easy as just re-starting whatever worked for you previously. This guide will take you through birth control options that may be suitable in the weeks and months after having a baby.
We look at the postpartum (which means “after pregnancy”) considerations of common birth control methods, how they impact breastfeeding, and what effect they may have on you.
Why Is Postpartum Birth Control Recommended?
After having your baby, you may have said, “OMG! I’m never doing that again!” or “That was amazing! Let’s do it again!”.
Regardless of your reaction to childbirth and how eager you are (or are not) to do it all again, it is recommended you wait at least 12 months between pregnancies.
Having babies too close together may increase your risk of pregnancy-related complications or complications with your next baby.
Non-breastfeeding women may start ovulating as early as 21 days after birth, so timely birth control is an important consideration to avoid unintentional pregnancies in the 12 months after birth.
Because ovulation comes before menstruation, it isn’t always feasible to predict when you may be fertile again and may make the Fertility Awareness Method more difficult.
While still possible, it is recommended you meet with a FAM provider and use barrier methods during this phase of life.
Which Birth Control Is Best After Pregnancy?
The best birth control after pregnancy is the one that is best for you. It needs to have minimal side effects, be something that fits your lifestyle, and be one you’re comfortable using.
The right contraception is highly individualized.
After having a baby, it will depend on many factors, including:
- Birth method
- Your baby’s feeding method
- Health history
- Personal choice
Below, we’ll take a look at options that may be suitable after birth and some factors you need to consider.
This list covers the information you need to consider concerning breastfeeding and the postpartum period.
For a deeper dive into all the pros and cons of each method, check out my article, The Contraception Guide.
Combined Hormonal Contraceptives
Combined hormonal contraceptives contain both estrogen and progestin.
- Birth control pill
- Birth control patch
- Birth control vaginal ring
According to ACOG, you’ll need to wait about six weeks after birth before starting any of these or until breastfeeding is established. Estrogen-containing medicines may increase your risk of venous thromboembolism (VTE), which is the medical term for blood clots, in the weeks after birth.
Anything containing estrogen is not recommended for breastfeeding moms in early postpartum. There is a small risk estrogen may inhibit prolactin, a hormone that is vital for breast milk production.
The WHO recommends delayed introduction of the combined estrogen and progestin pill until 6 months postpartum.
Progestin Only Contraceptives
As the name suggests, progestin-only contraceptives contain only progestin.
- Progestin-only pill
- Progestin injection
- Progestin-only implant
- Progestin-releasing intrauterine device (IUD)
Progestin-only pill can generally be started immediately after birth and doesn't appear to impact breastfeeding.
The WHO recommends delaying the progestin only injection until 6 weeks postpartum.
Although it may be offered to you straight after birth, a progestin-releasing intrauterine device (IUD) isn’t suitable for everyone at this time. Let me explain…
Intrauterine Device (IUD)
IUDs are small devices that sit inside the uterus. You can choose a progestin releasing option or a copper IUD that has no hormonal component.
The presence of an IUD makes it difficult for the sperm to swim through the uterus. They also can prevent implantation and, subsequently, pregnancy.
Although some health professionals will insert an IUD immediately after birth for convenience, this may increase the risk of the IUD falling out or becoming displaced.
The uterus typically takes about six weeks after birth to contract (involute) back to its pre-pregnant size. If you’ve had a vaginal birth, the cervix also remains partially open for up to two weeks.
This altered anatomy may explain why IUDs are more likely to fall out or become displaced when inserted 0-8 weeks after birth.
If you are considering an IUD, you may have fewer complications if you wait 6-8 weeks after birth before having it inserted.
Male and female condoms are safe and effective forms of birth control at any time after birth.
You’ll have to wait approximately six weeks before you use diaphragms or cervical caps. (Most providers will have you wait six weeks or longer to resume intercourse anyway.) The cervix and uterus need to return to their pre-pregnant size and position before you use these forms of birth control.
Spermicide and vaginal sponges both contain acidic substances and are used in the vagina at the time of intercourse. Sperm can’t survive in this acidic environment.
Both methods are safe from birth. However, if you have any tears or damage to the lining of your vagina, these substances may cause irritation and discomfort.
Sterilization (Tubal Ligation)
If you have a cesarean birth, you may choose to have a tubal ligation at the same time. This procedure permanently blocks the fallopian tube so eggs can no longer travel to the uterus.
You’ll need to discuss this with your obstetrician before your cesarean. You’ll also need to be sure that you don’t want any more children.
If you have a vaginal birth, this surgical procedure can be performed days to weeks after birth.
Fertility Awareness Method (FAM)
In my article Does Fertility Awareness Method Work, I detail this natural method of birth control.
However, because it involves tracking your cycles, you’ll need to wait until you may need to wait until your period returns. Exactly when a period returns varies widely among women after having a baby, and your body may resume ovulation at any point — breastfeeding or not. (More on that, coming up.)
So, looking for an alternative birth control method in the meantime is a good idea.
How Soon Can You Get On Birth Control After Having A Baby?
This depends on what form of birth control you choose.
Okay to use immediately:
- Condoms (both male and female)
- Progestin-only pill
- IUD (but the risk of complication is higher)
- Spermicides (caution if you’ve experienced vaginal tearing)
You should wait six weeks:
- Combined hormonal contraceptives
- Vaginal caps or diaphragms
- IUD (for reduced risk of complication)
Which Birth Control Is Best For Breastfeeding Moms?
Breastfeeding moms should aim to avoid estrogen-containing contraceptives for approximately six months post-birth because they may affect your supply of breastmilk.
Birth control hormones may also transfer to your baby through the breastmilk.
Other methods of birth control appear to be suitable for breastfeeding moms.
So, the best option is the option that suits you and your lifestyle best.
For a realistic and detailed view of lifestyle considerations for the contraceptive methods listed above, check out my article, The Contraceptive Guide.
Can I Get Pregnant If I Am Breastfeeding?
Using breastfeeding as contraception is called the Lactational Amenorrhea Method (LAM). The concept is that breastfeeding may prevent you from ovulating and from getting pregnant.
And yes, breastfeeding may inhibit ovulation, but there are a few things you need to consider before choosing this method.
For this method to be considered effective, you must:
- Exclusively breastfeed (no other solids or liquids are given to your baby)
- Avoid offering pacifiers (as it may reduce suckling time at the breast)
- Avoid going more than 4 hours between breastfeeds during the day or 6 hours at night.
- Not have your period back yet
- Be less than six months postpartum
Additionally, if suckling time decreases, you or your baby are ill, or if you introduce supplemental feeds (bottles), it may decrease the effectiveness of this method.
Currently, we don’t know how pumping affects LAM.
Also, remember that our bodies are all different. For some women, even if you follow all the ‘rules’, there is a chance that your ovaries will kick into gear earlier than you expect.
And your postpartum experience may be different every time. With my first I didn’t get my period back until after a year postpartum, but with my second it came before 6 months. I’ve had many patients report similar experiences.
Overall, breastfeeding may help reduce pregnancy temporarily if strict criteria are followed.
But, you might like to consider alternative birth control methods as a backup.
Can I Get Pregnant Two Weeks After Giving Birth?
It’s unlikely. At two weeks after birth, your body is recovering and settling from birth. Most of your pregnancy hormones have typically settled by this point, but your uterus is still shrinking back to its pre-pregnant size.
There is a wide variation in when women start to ovulate again after birth. Some reports indicate women may start ovulating as early as 21 days after birth.
Breastfeeding moms will typically ovulate later than non-breastfeeding moms.
Can Birth Control Affect Milk Supply?
There is a small risk that estrogen-containing birth control could reduce your milk supply. This is one reason why it is not recommended that you begin a combination hormonal birth control until 4-6 weeks postpartum to give you time to establish breastfeeding.
This includes combined hormonal contraceptives such as:
- Birth control pill
- Birth control patch
- Birth control vaginal ring
All other forms of birth control don’t appear to impact milk supply.
Other than birth control, nutrition and stress can both impact milk supply. I understand (honestly, I do!) that being a new mom can be stressful, so nutrition can often slip to the wayside. In your sleep-deprived state, ensuring that every meal contains all your essential nutrients is a little unrealistic.
This is where a quality prenatal and breastfeeding supplement can help boost your nutrient intake and support you. It can help you maintain levels of essential nutrients that you and your baby need. Not to mention that many of your nutrient needs are higher breastfeeding than they were during pregnancy.
Can Birth Control Affect A Breastfed Baby?
Non-hormonal birth control has no known impact on the baby’s health.
Progestin-only birth control appears not to affect infants growth and wellbeing when compared to non-hormonal methods of contraception.
In some instances, estrogen-containing birth control was suspected of causing reversible breast growth in infants while exposed to the medication via breastmilk.
Does Hormonal Birth Control Enter The Breast Milk?
A small amount of hormonal birth control does enter the breastmilk.
However, only estrogen-containing birth control appears to impact the baby.
Does Birth Control Affect Postpartum Mood?
Pregnancy and early motherhood may put women at an increased risk of mood disturbance, even if they are not on birth control.
Birth control may affect moods in women even when they are not postpartum.
So, asking if birth control affects postpartum mood is an excellent question.
Let’s look at these factors separately first.
Postpartum Effect On Mood
In the US, 70-80% of women will experience at least the ‘Baby Blues’. Baby Blues is a temporary disruption to mood that starts approximately 2-3 days after birth.
The Baby Blues may make you feel teary, anxious, overwhelmed, or leave you prone to rapid mood swings. They can last up to two weeks but tend to settle on their own if you rest and seek help from family and friends.
If your disrupted mood lasts longer than two weeks, it’s important you seek out professional help because you may be experiencing postpartum depression.
10-20% of women will experience clinical postpartum depression.
Now let’s look at the effect of hormonal birth control on mood in women who have not just had a baby.
Birth Control Effect On Mood
Some studies indicate that depression and the risk of suicide are increased in women on hormonal birth control versus those not on hormonal birth control.
Although hormonal birth control hasn’t been proven as a cause of depression or mood disturbance, there may be a link.
How To Decide If Hormonal Contraception Will Affect Me
Before deciding if hormonal birth control is for you, you’ll need to weigh up the risks versus benefits in your personal situation.
If you have a personal or family history of depression or anxiety, have a limited support network, or have lots of other stressors in your life, you are already at an increased risk for postpartum depression.
Adding hormonal birth control may remove one of those stressors for you. Or it may influence your mood further. This is where the decision is very personal.
It’s best to speak to an experienced health professional about your birth control options.
If you start hormonal birth control and you notice that you start having anxiety, depression, lethargy, extreme fatigue, crying all the time, disinterest in activities you once enjoyed, you should talk to your doctor about your birth control prescription because birth control is associated with mood changes.
For a deep dive into the effects of hormonal birth control on moods, check out my article Birth Control and Mood Swings.
How To Talk With Your Doctor About The Best Birth Control Choices For You
When you talk to your doctor about your birth control options, there are several factors you’ll need to consider.
Birth Control And Your Health
You’ll need to consider your health status both currently and when you were pregnant. Conditions such as high blood pressure, diabetes, thromboembolic disorders (blood clotting disorders), infections, and body mass index (BMI) will impact which birth control is suitable for you.
Birth Control And Your Personal Lifestyle
You’ll need to consider your lifestyle, schedule, and what you feel comfortable with. Do you want to use something only at the time of intercourse? Can you remember to take something every day? Is every month more realistic for you? Every three months? Or opt for a solution that lasts even longer? Are you comfortable with pills, needles, or implants?
Birth Control and Your Doctors Experience
Doctors that are inexperienced in women’s health may not recognize the link between birth control and mood. Aim to speak to an experienced health professional that specializes in women’s health and hormones if you can.
Birth Control And Your Gut Instinct
Remember that the decision is ultimately yours. Ask questions. If something doesn’t make sense to you, speak up. Ask more questions. And if something just doesn’t seem right, trust yourself. This is your body and your choice. No one knows you as well as you do.
Can I Start With The Same Birth Control I Was On Before I Got Pregnant?
It depends. Here are a few things to consider, but it’s always best to check with your doctor.
If you were on combined hormonal contraception, it’s best to avoid this for six months if you are breastfeeding or pumping and six weeks if you are not.
Remember that starting combined hormonal contraceptives within six weeks may increase your chance of VTE (blood clots). If you are breastfeeding, it may impact milk supply.
Before you start or restart any form of hormonal contraception, it’s best to check with your health professional. If you develop any health conditions in pregnancy, it may alter what forms of contraception are suitable for you.
For example, if you developed high blood pressure that has not stabilized or blood clotting disorders in pregnancy, some hormonal contraceptives may no longer be suitable.
Similarly, if you started any new medicines in pregnancy that you are continuing, you’ll need to check with your doctor or pharmacist for any possible interactions with hormonal contraceptives.
Finally, always check the expiration date of your birth control. Using expired birth control may decrease its effectiveness.
What To Do With All Of This Information
Volumes of information can be overwhelming, especially when you are a new mom. Decision-making can also feel a bit much when you are busy learning about your new tiny human.
Taking the time to speak to your doctor about a birth control option can help lighten the load. Your health and your options are individual to you.
For more postpartum support on topics beyond birth control, check out my first book, Healing Your Body Naturally After Childbirth.
KEEPING IT REAL, WHILE KEEPING YOU EDUCATED
Featuring a 28 day plan to take back your cycle and dozens of charts, checklists, and diagrams to help along the way.
- Cooper M, Cameron S. Postpartum contraception. Obstet Gynaecol. 2018. 20. 159-166.
- Makins A, Cameron S. Post pregnancy contraception. Best Pract Res Clin Obstet Gynaecol. 2020. 66. 41-54.
- Postpartum contraception: Counseling and methods.
- Yerby M. Physiology in Childbearing: With Anatomy and Related Biosciences. Fertility Control. 2005. 59-72.
- Rankin J. The Puerperium. Physiology in Childbearing: With Anatomy and Related Biosciences. 2005. 711-722.
- Brighten, J.. The Contraception Guide.
- Medical eligibility criteria for contraceptive use.
- Contraceptives, Oral, Combined. Drugs Lact Database.
- Postpartum Birth Control. ACOG.
- The Faculty of Sexual & Reproductive Healthcare. FSRH Guideline: Contraception After Pregnancy.
- Progesterone. Drugs Lact Database.
- Postpartum Blues or Baby Blues - Types of Postpartum Depression.
- Statistics on Postpartum Depression. Postpartum Depression Resources.
- Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of Hormonal Contraception With Depression. JAMA Psychiatry. 2016. 76. 1154-1162.
- Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of Hormonal Contraception With Suicide Attempts and Suicides. Am J Psychiatry. 2018. 175. 336-342.
- Birth Control Mood Swings & How to Feel Better.
- Causes of Postpartum Depression - Understanding Postpartum Depression.
- Combined estrogen-progestin oral contraceptives: Patient selection, counseling, and use.
- Weisberg E. Progetogen-only methods of contraception. Aust Prescr. 1999. 22. 6-8.
- Do Birth Control Pills Expire?.