Birth Control for Breastfeeding Women
Contrary to popular legend, breastfeeding women can become pregnant. But methods of birth control exist that present no problems for either the nursing mom or her baby.
The health benefits that breastfeeding offers newborns are widely known and well documented by numerous studies, and the convenience and cost savings associated with breastfeeding are significant. As a result, more and more women are choosing to breastfeed their newborn babies. While most women who choose to breastfeed do so until their baby gets his or her first teeth (age 4-6 months), some will continue for much longer, often into the child's second year.
Since most women resume sexual activity by six weeks after delivery, the need for effective birth control is an important consideration. The ideal method is one that is completely safe for the newborn infant, free of side effects for the nursing mother, and highly effective in preventing pregnancy. While no current method fits that exact description, there are several good options available to the woman who chooses to breastfeed.
Breastfeeding Is Not a Contraceptive
The common misconception that breastfeeding itself prevents pregnancy has consistently been proven wrong. While it is true that a nursing mom is less likely to become pregnant than a mother who bottlefeeds, there is no guarantee that pregnancy will not occur if birth control is not used. The methods available to breastfeeding women include hormonal contraceptives, barrier methods, the intrauterine device (IUD), and sterilization. If you plan to breastfeed, talk to your doctor before your delivery about which method might be best for you.
Many women fear that taking hormone medication while breastfeeding will harm their babies. Here are some safe hormonal contraceptives:
- The Mini-pill —Progesterone-only birth control pills are a popular choice for many nursing moms. Also called the mini-pill, this method is less effective than combination pills, but much less likely to suppress milk production. Most women will not menstruate as long as they remain on this pill—a welcome side effect for some women. When breastfeeding is discontinued, an easy transition can be made to a combination pill. It is essential that the mini-pill be taken everyday at the same time to be effective. Noncompliance can result in an unintended pregnancy.
- Depo-provera —This option is an injectable hormonal contraceptive, which is administered every three months. Breastfeeding women should wait until six weeks after delivery before receiving their first injection. The progesterone-like hormone contained in Depo-provera will not harm the nursing infant, is almost 100% effective in preventing pregnancy, and will not reduce your milk supply. Side effects include irregular periods or absence of periods and weight gain. The overall cost is similar to birth control pills. It is usually given 6 weeks after you deliver your baby.
Barrier methods of birth control include condoms (male and female), the diaphragm, and the cervical cap. All of these methods work by presenting a physical barrier that prevents the sperm from gaining access to the egg. Although side effects are minimal, the pregnancy rate is significantly higher when compared to hormonal methods. None of the barrier methods interfere with breastfeeding in any way.
- Condoms —To improve their efficacy, condoms should be used in conjunction with a spermicidal gel. The chemicals in these gels don't enter the breast milk and therefore are harmless to a nursing infant. Failure to prevent pregnancy is usually due to improper use, failure to use at all, or breakage. Latex condoms may cause an allergic reaction in some women, but will not affect the nursing infant in any way.
- Diaphragm —The diaphragm is a round, flexible, rubber, cup-shaped device that is inserted into the vagina prior to intercourse. When used with a spermicidal gel, its effectiveness at preventing pregnancy is similar to condoms. You must be instructed by your healthcare provider as to the proper way to insert and remove the diaphragm. The diaphragm should be removed within 6-12 hours after intercourse. With proper care, a diaphragm will last for 2-3 years, but should be refitted if you gain or lose a substantial amount of weight during that time. You can be fitted for a diaphragm at your postpartum check-up—usually 4-6 weeks after delivery.
- Cervical Cap —The less popular cervical cap fits more tightly against the cervix, is more rigid than a diaphragm, and can remain in place for longer periods of time.
The overall cost of a barrier method is usually less than that of any of the hormonal methods. Breastfeeding women sometimes develop atrophic vaginitis. This condition, a result of depressed estrogen levels, causes vaginal dryness, irritation, and painful intercourse. Insertion and removal of a diaphragm or cervical cap may be painful. If you suffer from this condition, a different method of contraception may be more acceptable.
The Intrauterine Device (IUD)
Although less popular than in the past, the IUD remains an effective and safe contraceptive method for breastfeeding women. The ideal candidate is a woman who has completed her family but doesn't want to undergo a tubal ligation, or who can't tolerate hormonal methods. Because this method provides long-term protection (up to 10 years), it is not a wise choice for younger women planning to have more children. Current IUDs either contain copper or are impregnated with a progesterone-like hormone. There are no adverse effects from the IUD or any of its chemical components on the nursing infant.
For women who have completed their families, permanent sterilization is a popular method of birth control. A tubal ligation can be performed shortly after delivery while you're still in the hospital, or, if preferred, at a later date as an outpatient. In either case, no interruption in breastfeeding is necessary. Anesthetics used during the procedure may be present in the breast milk for a short period of time, but not in quantities high enough to cause any harmful effects on a nursing infant. Recovery from this minor surgery is rapid, and breastfeeding can resume as soon as you are awake and alert. After surgery, a wide variety of safe pain medications may be used.
For most new mothers, the thought of becoming pregnant again right away is frightening. Effective birth control is therefore of paramount importance. Breastfeeding mothers are often concerned about medications that might be transferred to their babies in their breast milk. Fortunately, there are several safe methods available for prevention of pregnancy in women who choose to breastfeed their infants.
La Leche League International
Choosing a Birth Control Method
Association of Reproduction Health Professionals
Womens Health Matters
The College of Canadian Family Physicians
Herndon E. and Zieman M. New contraceptive options. Am Fam Physician. 2004;69:853-860.
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6/7/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Department of Health and Human Services Centers for Disease Control and Prevention. US medical eligibility criteria for contraceptive use, 2010. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/mmwr/pdf/rr/rr59e0528.pdf. Published May 28, 2010. Accessed June 7, 2010.
Last reviewed May 2009 by ]]>Rosalyn Carson-DeWitt, MD]]>
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