Control for Breastfeeding Mothers
decision about birth control is very personal. When deciding,
you may think about your past experience with different
types of birth control. You may also consider your future
plans for children, religious beliefs, and whether or not
you are exclusively breastfeeding. Health factors such as if you smoke, have liver disease, have blood clots or a family member that has had blood clots, and if you are taking medications or herbal products are all very important to discuss with your care provider. By learning about birth control,
you can choose methods that work best for you and your family
at each stage of your childbearing years.
methods prevent pregnancy by blocking sperm from entering
the uterus and reaching the egg. They are widely used by nursing mothers because
there is no worry about medications that could pass into
the breastmilk or affect milk supply. Male and female condoms,
contraceptive sponges with spermicide, cervical caps with spermicide, and contraceptive gels are sold over-the-counter.
The diaphragm is a dome-shaped flexible disk with a flexible rim to cover the cervix. Spermicidal jelly is put on the inside of the diaphragm before it is put into the vagina. A doctor
or midwife fits it to the cervix at least six weeks after
the baby is born. The diaphragm must be refitted after each
pregnancy and after any weight loss or gain of more than
15 pounds. Barrier methods are not as reliable in preventing
pregnancy compared to birth control pills and other hormonal
Non-Hormonal Intrauterine Devices (IUDs)
copper IUD is a reliable, long-term, reversible method of
birth control. Unlike hormone containing IUDs, the copper
IUD has no effect on breastfeeding (1). It releases copper,
causing the lining of the uterus to shed more often than
normal. This blocks the implantation of fertilized eggs.
In a few women, the copper IUD may cause heavy vaginal bleeding
and anemia (low blood count). Compared to non-nursing mothers,
breastfeeding mothers experience less pain during insertion
of the copper IUD and have lower removal rates due to bleeding
or pain (2).
Combination birth control pills contain the hormones estrogen
and progesterone. The monthly shot, the patch, and the vaginal ring also contain both estrogen and progesterone.
estrogen and progesterone in birth control pills has not
been found to be harmful to nursing babies. However, studies
show estrogen causes reduced milk supply and let-down even
when started after the breastmilk supply is well established
(3,4). Another study showed a 41.9 % drop in milk volume
in nursing mothers using estrogen-containing birth control
(5). Because of their effects on milk supply, these contraceptives
should be avoided until the baby is at least six months
old and eating solid foods regularly.
The mini-pill, the
Depo Provera shot, the Implantable Rod and some IUDs contain
only the hormone progesterone. These are good choices for
breastfeeding mothers who wish to use birth control medication.
Depo-Provera shot provides contraception for up to 12 weeks
and is highly effective in preventing pregnancy. It may
cause spotting between periods or other undesired side effects
in some women.
progestin-containing intrauterine device (IUD) works by
keeping eggs from implanting in the lining of the uterus.
Unlike other progestin-only contraceptives, the IUD delivers
its hormone directly to the uterine lining. As a result,
it is very effective and has fewer side effects. It should
be placed at least four to six weeks after the baby is born.
pills have a higher rate of failure than combination pills.
They must be taken at the same time each day to work. Even
taking the mini-pill a few hours late could result in pregnancy.
Because of this, some mothers use a barrier method as extra
protection while taking the mini-pill. If the mini-pill
is used, the mother should contact her doctor or midwife
when the baby is weaned. At that time it may be best to
switch to combination birth control pills.
is considerable controversy about whether progesterone-only
contraceptives affect breastmilk supply. In one study, women
taking the mini-pill actually had a higher than average
milk supply (1). Another study found that the mini-pill
caused a 12% drop in milk supply (5). There is some concern
that even progestin-only birth control can cause low milk
supply in certain women. A natural drop in the hormone progesterone
after childbirth stimulates the milk making process. Women
may wish to wait at least three days after the baby is born
before starting progestin-only birth control (6). If desired,
waiting six weeks may prevent even more milk supply problems.
shot, implantable rod and IUD contain long-acting progesterone. A recent
study showed that the Depo Provera shot had no impact on
short-term breastfeeding success when given in the first
few days after the baby is born (7). However, some still
are concerned that women who use these birth control methods
cannot easily stop if their milk supply goes down. Breastfeeding
specialist Dr. Jack Newman recommends trying the mini-pill
first to see how the milk supply reacts. If there is no
drop in milk supply after one month, contraceptives containing
long-acting progesterone are probably safe to use (8).
Lactational Amenorrhea and Natural Family Planning
Lactational Amenorrhea Method (LAM) is a good option for
mothers who do not want to take birth control pills during
the early months after the baby is born. LAM has been found
to be 98% effective (9) as long as all of these are true:
these conditions are not all met, another birth control
method must be used if contraception is desired. LAM cannot be used as birth control if breastfeeding and formula feeding
prevents pregnancy when all or most of baby’s sucking
is on the breast. Exclusive breastfeeding means no supplemental
feedings and little or no pacifier use. The baby feeds regularly,
day and night. The return of fertility varies from mother
to mother. Even with 100% breastfeeding, some mothers have
their first period within a few months after childbirth.
Others will not have a period for twelve months or longer
even if the baby does not breastfeed regularly.
Vaginal bleeding after delivery (lochia) normally lasts
two to four weeks. After that, nursing mothers may not have
a period for several months. The first period (or any spotting
that lasts more than a couple days) is a sign that fertility
has returned. Irregular periods are common during breastfeeding.
No matter the age of the baby, once a mother has her first
period, she must use another form of birth control if she
does not want to become pregnant (10).
Some women who use LAM also use Natural Family Planning
(NFP). NFP is a method of tracking ovulation by charting
changes in vaginal discharge and body temperature. With
correct use, NFP can work as well as birth control pills.
It takes time to learn NFP. Those interested in NFP should
learn the method from a qualified teacher. Call Intermountain
Fertility Care Services at (801) 364-7662 and visit www.aafcp.org, or www.creightonmodel.com for more information.
are two kinds of "morning-after pills" available. These are used when condoms break or a
couple has unprotected sex and should be taken within 72
hours. There are combination estrogen-progestin pills and a progestin-only pill. Both types of
pills may be used while nursing a baby. They work by stopping the ovaries from releasing an egg or stop sperm from joining the egg. The combination
estrogen-progestin pill may cause a temporary drop in milk
supply. If the mother continues to nurse her baby often,
the amount of milk should return to normal within a few
days. Emergency contraceptive pills should only be used
as a last resort, not as a regular method of birth control.
and Female Sterilization
is a highly effective form of permanent birth control. It
should only be considered if the couple does not want to
have any more children. Reversal is costly and does not
always work. Male sterilization (vasectomy) is easier and
costs less than female sterilization (11). It is also less
risky. The risks of female sterilization (tubal ligation)
are similar to other abdominal surgeries. Women who have
their tubes tied in the hospital after giving birth may
nurse as soon as they feel able to do so after the surgery
are many methods of birth control that are safe and effective
to use while nursing a baby. For your health and the health
of your children, it is best to space pregnancies at least
two years apart. Take the opportunity to discuss your plans
for birth control or pregnancy spacing during your prenatal
care visits. Together, you and your care provider can find
the method that will work best for you.
Last updated: August 2011
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