Contraception

When will I start ovulating again?

It is difficult to predict when your fertility will return. If you are breastfeeding you may not ovulate for months but some breastfeeding women will ovulate as early as the fourth week following childbirth. Women who are not breastfeeding will ovulate even sooner. You can ovulate before your menstrual period returns. Ovulation for many occurs sooner than six weeks after delivery. With such unpredictability, it is very important to use contraception until you are ready to try for another baby. Plans for postpartum contraception should be made while you are still pregnant; the method chosen may be started before your six-week postpartum visit with your health care provider.

What are my options for contraception?

It is important to decide which birth control method is right for you and your partner and to have it in effect before you begin having sex again. Talk to your health care provider about your choices. Briefly, these include:

• Lactational amenorrhea. This is a natural birth control method. Breastfeeding causes the hormone prolactin to be released and prolactin inhibits ovulation. For this method to be effective, you must be exclusively breastfeeding, not have had a period since you delivered, and your baby must be less than 6 months old.
• Hormonal contraception. There are several methods of hormonal contraception, including the pill, the patch, the ring, and the shot. If you are not breastfeeding, you can use hormonal contraceptives starting three to four weeks after the birth of your child. If you are breastfeeding, some of these forms of hormonal birth control may decrease milk production. The progestin-only, or ‘mini-pill’, does not appear to interfere with lactation and can be started immediately after birth. Current combined estrogen-progestin birth control pills do not interfere with the quantity or quality of breast milk once feeding is established. If you are breastfeeding and would like to use another form of hormonal contraception, it is recommended that you start just after your baby is 4 weeks old. That way, breastfeeding will be well established and you can be sure your baby is gaining weight properly.
• Intrauterine devices (IUD). The IUD is a highly effective, long-acting, but rapidly reversible method of contraception. You can have an IUD inserted immediately after delivery, if you choose, or it can be inserted at your 6 week postpartum visit. Be sure to use another method as soon as you resume intercourse and until the IUD is inserted.
• Condoms. Condoms are effective contraception and also protect both partners from sexually transmitted infections.
• Sterilization. Permanent birth control measures include vasectomy or tubal ligation.
• Other choices. These include female condoms, spermicides, diaphragms, and cervical caps.