I've heard that you can't get pregnant while you breastfeed. Is that true?
Not necessarily. During breastfeeding, the chance of getting pregnant is lower. However, women can still get pregnant. A woman’s chance of getting pregnant is low if a woman is within six months of the birth, AND not having any periods, AND fully or nearly fully breastfeeding (exclusively breastfeeding or the vast majority [≥85%] of feeds are breastfeeds). If all of these conditions apply, then no additional contraceptive protection is needed during those six months. Otherwise, women should use contraception to avoid accidental pregnancy.
When should I start using contraception?
It's a good idea to discuss contraception with your clinician before you give birth. Breastfeeding women have many birth control options. Many contraceptives can be started immediately after birth, including intrauterine devices (IUDs), arm implants, Depo-Provera® shots, and progestin-only pills. The most effective contraceptives are intrauterine devices (IUDs such as Mirena® and ParaGard®), and the arm implant called Nexplanon®. This means there is a much lower chance of getting pregnant when using an IUD or an arm implant, as compared to a birth control pill, Depo-Provera shot, condoms, or any other contraceptive.
Non-hormonal methods of contraception
Condoms with or without spermicides: These can be used with no impact on breastfeeding. The vagina of the nursing mother might be dryer than normal, which can make condoms irritating. If this is a problem, use additional lubrication. It is important to know that this method has a much higher chance of pregnancy as compared to the hormonal methods.
Barrier methods: These methods, such as the diaphragm and cervical cap with spermicides, have no effect on breastfeeding. Check with your clinician to refit the device because you might need a larger device after having a child. It is important to know that this method has a much higher chance of pregnancy as compared to the hormonal methods.
PARAGARD is an intrauterine device (IUD), which is non-hormonal. This type of IUD is made of copper. The IUD does not affect the quality and quantity of breast milk. PARAGARD IUD is safe and effective for 10 years.
Tubal sterilization: This is a surgical, permanent form of birth control, known as “having your tubes tied,” that only affects breastfeeding if general anesthesia is required. (That means you are put to sleep for the operation.) Anesthetic medicine can pass through the breast milk. There is a different method of a surgical, permanent form of birth control called the Essure device. This is often done in the office, where metal coils are inserted into the tubes to scar them to close, preventing pregnancy. The Essure® device does not require the use of anesthesia.
Hormonal methods of contraception
Progestin-only oral contraceptives, or “The Mini-Pill,” contain only a progestin (a female hormone). The method, when used daily, is highly effective for breastfeeding women. This method of contraception has a slightly higher failure rate than oral contraceptives (OCs) containing both estrogen and progestin. During breastfeeding, however, women are not as fertile. A small amount of hormone passes into the breast milk but has no known bad effects on the infant. In fact, some studies have suggested a good effect on the quantity and quality of breast milk. When the woman stops breastfeeding the baby, or when menses returns, some clinicians suggest switching to combination OCs, which have a slightly higher effectiveness.
Combination oral contraceptives, or "The Pill," contain both estrogen and progestin. The American Academy of Pediatrics has approved the use of low-dose OCs in breastfeeding women once milk production is well established. A vaginal ring (NuvaRing®) and a skin patch (Ortho Evra®) contain estrogen and progestin, similar to combination oral contraceptives, or "The Pill." You should discuss with your doctor if this is an appropriate option for you during breastfeeding. Most often, products which don’t contain estrogen are preferred during breastfeeding (preferred products are Mini-Pill, IUDs, progestin only arm implants, etc.).
The Mirena IUD releases a very small amount of hormone into the uterus, where it works locally. This IUD does not affect the quality and quantity of breast milk. The Mirena IUD is safe and effective for five years. There is a smaller, lower dose version of the Mirena IUD, called Skyla, and is effective for three years. Skyla is often a better choice for women who have never had a baby.
Medroxyprogesterone (Depo Provera): This is an injection or shot that can be safely used during breastfeeding and does not suppress milk production. At least one study suggests that this method of contraception might have a beneficial effect on the quality of breast milk in terms of its fat concentration, calories, minerals, and protein composition.
A progestin-only implant, called Nexplanon, is inserted into the upper arm. This is done via a simple office procedure. This is one of the most effective birth control options, and is effective for three years. This can be inserted immediately after delivery of the baby.
Remember: If you are at risk for a sexually transmitted disease (STD), use condoms to protect yourself. Sexually transmitted diseases can happen to anyone who is sexually active, even during breastfeeding. Don't stop taking or using your birth control method on your own. Always call your clinician to talk things over.