I have just worked out an utterly staggering and shocking statistic; over the past 5 and half years I have either been pregnant or breastfeeding for approximately 70% of the time. That accounts for 2 children, one about to pop out and a couple of miscarriages thrown in for good measure. Blimey…I think this may explain a couple of things, namely my extremely poor memory and my general zombie like state much of the time. So as I come to the end of this pregnancy my mind beings to turn to the small matter of contraception…. Yup after sprog3 arrives this will be it for us (probably, possibly, most likely…..)
One of the things GP’s always harp on about at the 6 week baby check is contraception. On many occasion a mothers eyes have locked with mine in horror, to even suggest that they might have the energy, let alone the inclination to be getting jiggy a mere 6 weeks after their child’s arrival! None-the-less thinking about contraception post-pregnancy is important, unless you are inclined to crack on with the next whilst your tot is still in the Moses basket!
Lots of people are still happy to use breast-feeding as a natural contraceptive. My advice to that is usually along the lines of ‘if you don’t mind too much getting pregnant in the next year be my guest, but if you really really do not want another nipper so soon…don’t do it!!’ (obviously I sound a little more professional when at the surgery). I distinctly remember some years ago having this precise conversation with a mum, who already had 2 children very close together. When she returned red-eyed and inconsolable 3 months later, wondering how she was possibly going to cope with 3 under 3 (just!) I had to bite my tongue very hard. So ladies – assuming natural methods aren’t going to cut it, what else is there?
The initial question is are you bottle or breast-feeding? Most contraception options fall into one of three categories: combined hormones (usually oestrogen and progesterone), progesterone only contraception or hormone free. If you are bottle then the contraceptive world is your oyster! If you choose to breast-feed then avoiding contraception containing oestrogen is advised as it can interfere with milk production. Here is a little run down of what you can use and when;
21 days post delivery
As this contains both progesterone and oestrogen it is only recommended if you are bottle-feeding. It is taken daily for 3 weeks, and then omitted for 7 days, during which you should have a bleed.
The pill is a highly effective contraception & starts working straight away – as long as you remember to take it! The other bonus is your fertility theoretically can return very quickly, making it a good option if you are considering more children in the near future.
Progesterone Only Pill (POP) – or the ‘mini’ pill as it is still often called.
This only contains the hormone progesterone so can be taken if you are bottle-feeding, breast-feeding or a bit of both. It differs from the COC in that you take it every day without a break.
Many people don’t have any bleeding when taking the POP, however some do suffer with irregular bleeds which can be a nuisance. Like the COC fertility usually returns pretty rapidly once stopping the mini pill, so can be use ‘in-between’ babies quite easily.
The contraceptive implant also only contains progesterone so can be used by all mums. It is a very small rod about the width of a biro nib and is inserted under the skin of your inner arm.
Once in it stays put for 3 years, and fertility typically returns pretty sharpish once it has been removed. It is therefore quite a useful choice if you want a slightly longer gap between children but worry you might be a bit forgetful in taking the pill.
As with the POP the side effect of irregular bleeding can occur – but often does settle after a few months.
You can start using condoms whenever you feel ready to start having sex. They are good for protecting from STI’s, but in my mind are not really sufficiently good in fully protecting against undesired pregnancies. If you fall into the ‘if it happens, it happens’ category when it comes to having more children, then this would be fine, however if you want to have more control over your family planning my advice would always be to use something in addition this.
8-6 weeks post delivery
I’m a bit of a coil fan I must say. Once you’ve got your head around having it put in, I think there are a lot of positives to be found with this form of contraception. I’ve noticed that over the years a mere mention of the coil can be off-putting to some women – and I firmly believe urban myths are in part to blame for this. That said there are some risks that can indeed occur with coil insertion, such as pelvic infection (approximately 1 in 100 people) and perforation of the womb (approximately 1 in 1000).
Both of these types of contraception are suitable if you are breast or bottle-feeding. There are two types of coil – one with hormones (Intrauterine System or IUS) and one without (Intrauterine Device or IUD).
The IUD can make periods a little heavier, so it is only really recommended if you have had light periods to begin with. It is hormone free which is appealing to some ladies and starts working straight away. Most types of IUD last 10 years – so once it’s in you can forget about contraception for a fair while.
The IUS has the hormone progesterone embedded into it, which as well as the contraceptive benefits, results in around 65% of women stopping periods altogether and up to 90% of people experiencing lighter periods. In fact this type of coil is often used as a treatment for heavy periods rather than being just a contraceptive.
As with all other progesterone only contraception, a minority of unlucky women will suffer with erratic bleeding or spotting. Once inserted it lasts 5 years and fertility usually returns to normal straight away.
The Contraceptive Injection
This is a small injection given into the buttocks every 3 months. It too contains the hormone progesterone so can cause periods to stop or become very light, but also can in some cases result in erratic bleeding and spotting. This main issue with this in terms of post pregnancy contraception, is that is can result is fertility being delayed for up to a year after stopping it. I therefore wouldn’t recommend it as a ‘in-between kids’ contraceptive choice.
Also, out of all the available types of contraception this one does seem to result in genuine weight gain – so probably not ideal for most of us struggling to lose excess baby weight!
I know there are a million and one things to think about after having a baby, but please don’t forget this too…. you might thank me for it!
Have a good week, X