What you need to know about contraception when you’re breastfeeding

This week is World Breastfeeding Week. Spinoff Parents editor Emily Writes speaks to Family Planning doctor Beth Messenger about what contraception is the best to use while breastfeeding and after you’ve given birth.

So you’ve had your baby, and if it was a relatively recent experience you’re probably thinking that your vagina will never be back in business. But the day will come when you feel like feeling it again – and if you’re into P in V sex you need to think about contraception.

And you need to think about it before you have sperm near your nether regions so you don’t get knocked up if you don’t want to be knocked up.

I asked Family Planning New Zealand doctor Beth Messenger to fill me in on how to avoid babies if you don’t want babies and what the myths and truths are around breastfeeding and contraception.

Right off the bat I’m going to ask what the deal is with breastfeeding as contraception? Because everyone knows someone who got pregnant while breastfeeding.

Breastfeeding can also be a form of contraception for the first six months after giving birth, but this method is difficult to use effectively. If you breastfeed, we recommend non-hormonal or progestogen-only methods of contraception, as research shows these methods are safe for breastfeeding mothers and the development of their babies.

Does how you feed your baby – breast or bottle – make a difference with what contraception you can use?

Yes. Some options are not considered safe to start immediately if breastfeeding, like the combined pill, which can increase risk of Venous thromboembolism (VTE) for mother, and may have a negative impact on breastfeeding. VTE is a disease that includes deep vein thrombosis and pulmonary embolism. Having a copper IUD inserted while breastfeeding can have a slightly higher risk of perforation during breastfeeding or up to nine months after giving birth, but it is still usually recommended as a safe method.

The risk is usually about one in 1000 insertions, and it’s about six times higher with breastfeeding. Although this risk is slightly higher, overall as the IUD is such an effective long acting contraceptive, it is considered to be worth accepting this risk for most women to prevent unplanned pregnancy. This risk needs to be explained before the insertion of course, and is written on our consent form.

Can you just go straight back onto whatever contraception you were on before?

No, you should speak to your midwife, GP, or come into Family Planning. Choosing the right contraception if you choose to breastfeed is an important part of your post-partum plan.

Some options include the contraceptive implant (Jadelle), the Depo Provera injection, the progestogen only pill, or condoms. The emergency contraceptive pill can also be used safely any time while breastfeeding.

Other forms of contraception, like an IUD or the combined oral contraceptive pill, can’t always be used straight after delivery. It’s a good idea to talk to your nurse before you have your baby about your options to decide on what contraception is going to work best for you.

An IUD

How soon after you give birth can you have an IUD put in?

The intra-uterine device (IUD) is a copper or hormonal IUD and it can usually be inserted immediately after delivery, but it is more common to have it inserted six weeks later. It lasts for up to five plus years (depending on type) and can be removed at any time. A copper IUD can be inserted as emergency contraception in certain circumstances.

Do you have to wait to get a contraception implant? What exactly is a Jadelle?

No. The Jadelle is a contraceptive implant. It lasts for five years and can be removed at any time. It is very effective and can be inserted immediately after delivery.

The Jadelle Implant

What other options are there?

There’s the Depo Provera injection. This injection is given every 12 weeks and is very effective. It can be started immediately. There’s also condoms. They’re safe and affordable and can be used at any time. You should always use a condom with a new partner.

The Emergency contraceptive pill can be used any time after delivery and can be taken up to three days after sex. The ECP is less effective for women who weigh more than 70kg – an emergency IUD is best in this instance.

Where do you get an emergency contraceptive pill?

You can buy it from a chemist or get it from our clinics or your doctor on prescription. You can have it at home just in case and having it handy means you can take it as soon as you realise there is a problem. It’s not harmful if you use it more than once and it won’t cause an abortion if you are already pregnant. The ECP is not as effective as other contraceptive methods, doesn’t protect you from sexually transmissible infections (STIs) and doesn’t protect you from pregnancy for future sex, so it’s unwise to use it as a regular method of contraception.

Condoms – your best way to protect yourself from STIs

What about the pill? Can you be on the pill when you’re breastfeeding?

If you’re not breastfeeding you can start taking the pill 21 days after delivery. Heavier women need to wait until six weeks, so talk to your nurse or midwife if this applies to you.

If you’re partially breastfeeding – you can start taking the pill after six weeks.

If you’re fully breastfeeding – you can start taking the pill after six months.

Risk of VTE is higher in pregnancy than for non-pregnant women, and this risk persists for a few weeks after giving birth, which is why there is a delay before starting the pill even if you’re not breastfeeding. The risk with the pill is nowhere near as high as in pregnancy but as with anything the benefit must be weighed against the risk, and other contraceptives are effective without the VTE risk.

The pill may also interfere with breastfeeding in terms of milk quality/quantity and so it is recommended that we avoid it for longer post-partum with breastfeeding women than women who are formula feeding.

What is the difference between the combined oral contraceptive pill (the pill) and the progestogen-only pill (POP)?

The POP is a pill is especially recommended for women who are breastfeeding and women who cannot use the combined oral contraceptive pill for medical reasons. It contains one hormone, progestogen. It does not contain any oestrogen. Some POPs work mainly by thickening the mucus in the cervix so sperm can’t travel through it.

Cerazette also works by stopping a woman from producing a monthly egg, and changes the lining of the womb so it is less likely to accept a fertilised egg. Typically the POP is 92% effective, which means eight women out of 100 will get pregnant each year.

When pills are taken perfectly – meaning no pills are forgotten – it can be more than 99% effective in preventing pregnancy.

The combined oral contraceptive pill works because oestrogen and progestogen stop eggs being made, so no egg is released from the ovary. This pill is normally 92% effective. This means 8 in 100 people will get pregnant each year.

It can be 99% effective if it’s taken correctly and continuously. Taking the pill continuously is when you take the 21 hormone pills, then start a new packet straight away. This means missing the non-hormone pills and skipping your period. This is the most effective way to take the pill.

The Combined Oral Contraceptive Pill (or the pill) and the progestogen-only pill (POP) and the

Why do you have to wait? Is it not safe?

The POP can be safely started any time after giving birth. The safe time to wait before starting the combined pill depends on whether you are breastfeeding or not due to the risk of venous thromboembolism (VTE).

What about getting your tubes tied?

Tubal ligation is permanent female contraception or sterilisation. It is a procedure to close both fallopian tubes which means that sperm can’t get to an egg to fertilise it. The tubes are closed using rings or clips or by cutting and tying. It is usually done by putting a tiny telescope called a laparoscope in through a small cut near the belly button and closing the tubes through another small cut near the pubic hair.

If a laparoscope can’t be used then a longer cut is made near the pubic hair. Tubal ligations are done in hospital and the woman has a general anaesthetic. Depending on the type of operation she may go home the same day or stay one to two days in hospital. The failure rate for tubal ligation is one in 200.

And vasectomies?

A vasectomy is a simple operation. It can be done at doctors’ surgeries or hospitals. The doctor or a vasectomy counsellor will explain the operation and answer questions you or your partner may have.

In no-scalpel vasectomy the doctor feels the tubes under the skin and holds them in place with a small clamp. The doctor makes one tiny puncture with a special instrument. The same instrument is used to gently stretch the opening so the tubes can be reached. The tube is brought to the surface through the small opening. Different doctors use different techniques but all are designed to ensure the two ends of the cut tubes remain separate. The second tube is treated in the same way through the same hole. There is very little bleeding with this technique.

No stitches are needed to close the opening, which heals quickly without leaving a scar. Overall, 1 in 300 may fail. After you have had two negative sperm counts the chance of failure drops to 1 in 2000.

What can parents do if they’re pregnant and they don’t want to be?

See a doctor or nurse as soon as you think you could be pregnant. They will be able to confirm the pregnancy and help you decide whether to get an abortion, and refer you to an abortion provider.

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