Babies out. Bleeding is on. Boobs are big. Belly is still large. Sounds awesome. With all of these bothersome symptoms, “bonking” is completely out of the question. Let’s face it: when you look and feel like you have been through the wringer, intimacy is probably the last thing on your mind. But before you know it, all systems will be healed, and sex will be a go. And while those days seem further away than your first full night of sleep, it will happen. We promise! And when it does, even if you are breastfeeding, you can get pregnant without contraception. To avoid that major oops, here’s how best to prevent pregnancy postpartum.
Let’s do a quick Obstetrics 101 review. In most cases, it takes at least three weeks before ovulation resumes. Prior to this, elevations in your hormones (think hCG, progesterone, and estrogen) will keep ovulation in a holding pattern. After about one month, these levels will drop, and ovulation will resume. However, in women who are breastfeeding, prolactin (the hormone that helps you produce milk) will arrive and stay on the scene until you are ready to move on to formula or milk. In high levels, prolactin can function similar to hCG and prevent ovulation for some time.
No ovulation = no egg = no embryo = no pregnancy
The sticking point is that “some time” can be anytime; how long you can use breastfeeding as contraception depends on how frequently you are feeding/pumping, how many other “things” (a.k.a. formula or food) your baby is taking in, and your own body. Women with the exact same routines can start ovulating at very different times. Bottom line: breastfeeding is not a completely reliable source of contraception. You need a back-up mechanism.
So, what are your options? While there aren’t as many choices as for non-breastfeeding women, you do still have choices. Think about the contraceptive choices for breastfeeding women as a three-choice exam. Option A = oral contraceptive pills (a.k.a. OCPs), Option B = IUD, and Option C = barrier devices (condoms or a diaphragm).
You can go with any of the three and achieve pretty good results—if they are taken correctly! Which you select really depends on what is best for you, your medical history, and your personal needs. The first few months after bringing a baby home can be exhausting and hectic, to say the least. Remembering to take a pill daily at the same time may be harder than it sounds. The OCP prescribed to breastfeeding women, a.k.a. the “mini-pill,” only includes progesterone and must be taken at the same time daily to remain effective. While the toothbrush or shower trick may help, believe it or not, some days you might not make it into the shower (or even brush your teeth)! If you go with an Option B (IUD), you won’t have to think at all. Combined with its good contraceptive benefits, this may B the right choice for you!
If you have decided to go right to the bottle (aka formula)—and trust us, there is no judgment in that statement—you need post-partum contraception ASAP. This convo will usually commence at your six-week postpartum visit. Remember: sex before six weeks is off limits anyway! The options for women who are not breastfeeding are no different than for women who are breastfeeding. Where things diverge is in the type of oral contraceptive pills (a.k.a. hormones) that one can take.
Non-breastfeeding women can take good old-fashioned estrogen + progesterone pills as well as progesterone-only pills. Usually, the former is preferred due to slightly more flexibility in how perfect your timing when it’s taken needs to be. Because milk production is not an issue, the suppressive effect of estrogen on milk production is no big deal. If OCPs are not your speed (or medically a no go), you can also go with the patch, the ring, implantable devices, Depo-Provera, the IUD, condoms, or diaphragms.
Basically, barring any underlying medical issues, the sky is the limit. Pick what’s best for you and your busy lifestyle. Just remember: fatigue will be an issue, so the less you have to think, the better. Whatever you choose, be sure to commit; otherwise you may find yourself expecting way before you were expecting!