Birth Control for Breastfeeding Moms: What Options Are Safe?

How soon to use birth control after delivery?

Don’t take any risks with contraception after giving birth. As soon as you are ready to become sexually active again, it’s time to start thinking about birth control options. 

Some forms of birth control take a few weeks from when you start using them until they become effective. Make sure you get all the information from your doctor, and either abstain or use barrier methods until your birth control starts to work. 

Having to deal with an unintended pregnancy soon after birth can be a real shock. Luckily, there are many birth control options for breastfeeding mothers so that you don’t have to get yourself in such a situation. 

Doesn’t breastfeeding prevent pregnancy?

Let’s make it clear once and for all: breastfeeding is not an effective form of contraception.

It’s true that when you exclusively breastfeed elevated levels of prolactin affecting hypothalamic-pituitary-ovarian axis prevent ovulation. However, you cannot surely predict when that first ovulation after delivery occurs, and you’ll have no way of knowing until after the fact. The problem is that you’ll find out in one of two ways: either you’ll get your period, or you’ll find out that you’re pregnant.

Chances are low, but it’s possible to ovulate just 2-3 months after giving birth even if you are exclusively breastfeeding. And 50% of women who are not fully breastfeeding ovulate before 6 weeks after childbirth. For this reason, if you’re serious about not getting pregnant, it’s best to protect yourself with other forms of birth control that are safe for breastfeeding moms.

Birth control options for breastfeeding mothers

There are many different types of birth control available today. Still, considering the vast differences in each and every woman’s body, some may argue that there isn’t enough variety. 

The birth control that your best friend chooses may not be right for you. The “best birth control for breastfeeding” is really just the one that you find most closely suits your personal needs, whatever they may be. And since your body has gone through so many changes, birth control that worked for you in the past may not necessarily work well for you now. 

It’s important to get to know all of the options in order to make an informed decision about birth control while breastfeeding.   

The hormone estrogen has been linked with low milk supply. Therefore, any form of birth control that releases estrogen — such as the combined oral contraceptives, the contraceptive patch, or the vaginal ring — is not recommended while breastfeeding. Because of a hypercoagulable state during the early postpartum period, even nonbreastfeeding women should avoid estrogen-containing hormonal contraceptives for at least 3 weeks after delivery.

Hormonal birth control pills

Many women wonder “Can I take birth control while breastfeeding?” You may have heard that using birth control pills while breastfeeding is dangerous. While combined oral contraceptives pose no threat to your baby, they do risk compromising your milk supply. 

Combined oral contraceptives contain both progesterone and estrogen. Since estrogen has been linked to low milk supply, breastfeeding mothers are usually advised to stay away from combination pills as a form of birth control while breastfeeding. The WHO recommends that if combined hormonal methods are going to be utilized, they should not be initiated until at least 6 months postpartum after breastfeeding skills and patterns are well established.

If you still prefer oral contraceptive, you may consider taking a progestin-only pill (POP), also called the mini-pill. Some women have had great experiences using the mini-pill, while others have reported struggling with spotting for a long time on the pill. Some have reported a decrease in milk supply on the mini-pill, although such reports are rare. 

The mini-pill is an equally effective form of birth control as the combination pill, although it requires diligence, and must be taken at exactly the same time every day to be effective. It is reported to be between 87 to 99.7% effective at preventing pregnancy. Its effectiveness depends on the regimen of its intake so make sure you follow the prescription precisely.

IUDs

Intrauterine devices (IUDs) are currently the most effective birth control out there. They’re a good choice for those looking for a long-term form of birth control, but they are completely reversible. 

There are two types of IUDs: non-hormonal (copper) and hormonal. Since the hormonal IUDs contain only the hormone progesterone, both types are considered safe birth control options for breastfeeding mothers. 

The copper IUD is the non-hormonal option. It’s a small coil wrapped in copper that is placed in the uterus. It is effective in preventing pregnancy for up to 10 years. The copper IUD prevents implantation, sperm movement, and fertilization. Since it does not release hormones, you don’t need to worry about the copper IUD affecting your supply. 

Many women who use copper IUDs report longer, heavier periods, so it may not suit you if your periods are already heavy or are accompanied by strong cramps. 

The hormonal IUD releases progesterone, but the hormone is delivered straight into the uterine lining, and only a very small amount enters the bloodstream. It is unlikely that a progesterone-releasing IUD will have any impact on your milk supply. 

The effectiveness of IUDs is more than 99% it means that fewer than 1 in 100 women with an IUD will become pregnant during the first year of use. This contraceptive device method unlike other forms of contraception is effective and convenient because it doesn’t require regular user compliance.

If you’re planning on using birth control for at least a year, the IUD is a safe and effective choice. When you decide you’re ready to start trying to get pregnant, you must schedule an appointment with your doctor to have the IUD removed. Once it is removed, you can start trying immediately. 

Implants

The implant is another form of long-term birth control that is highly effective. Your doctor will implant a small rod — about the size of a matchstick — under your skin on your upper arm. Once implanted, this device can prevent pregnancy for 3-4 years. 

The implant releases the hormone progesterone and is therefore considered a safe method of contraception after giving birth and while breastfeeding. 

Injections

If you’re not looking for a long-term solution but you don’t want to have to pop a pill every day, you may consider injections — yet another hormonal method of birth control. Once every three months, you will be given a shot of progestin. 

Injections are more than 99% effective as a birth control if used correctly. Women who delay getting a shot or are off schedule are less protected than women who get the shot every 13 weeks (once in three month) and need additional birth control barrier method such as condom for example.

It should be noted that it may take a long time — close to a year — until your fertility returns after discontinuing progesterone injections. 

Barrier methods

Those who wish to avoid hormonal birth control altogether have many options. Barrier methods are used to stop sperm from getting to the uterus. They are used only during sexual intercourse, and most of them are available without a prescription. The following barrier methods are all safe forms of birth control while breastfeeding. 

• Male condoms

Male condoms are the most widely used form of barrier method contraceptive. They are the most affordable and the most accessible, and they also happen to provide the best protection against sexually transmitted infections (STIs).

When used correctly with every use, the male condom can be 98% effective at preventing pregnancy. However, with «typical use» - the way it's used by a lot of people in real life, it is only 80%- 85% effective. 

When using a latex condom which is the most effective in birth control, make sure to use only water-based or silicone lubricant, as oil-based lubricants break down latex — the material that condoms are made of. 

• Female condoms

The female condom is a thin, plastic, loose-fitting pouch with a ring on each end to hold it in place. It can be inserted into the vagina up to 8 hours before sexual intercourse. The female condom can be used both for protection from getting pregnant and from STIs.

If used correctly its effectiveness is 95%. In «typical use» the female condom is 79% effective at preventing pregnancy if it is the only form of contraceptive being used long-term. 

• Diaphragm, cervical cap/shield

A diaphragm or cervical cap/shield are saucer- or cup-shaped pieces of silicone that are inserted inside the vagina before intercourse to cover the cervix, preventing sperm from reaching the uterus. Used alone, these methods may not provide ample protection from becoming pregnant. They work best when used with spermicide — a cream or gel that kills sperm. But even if they are used in combination their effectiveness is from 94% to 88 % depending on how correctly its used.

These barrier methods are available by prescription only, since they need to be fit by a doctor for proper use.

• Sponge

A contraceptive sponge is a small piece of foam that is inserted into the vagina before intercourse to prevent pregnancy. The sponge contains spermicide, and it covers the cervix to prevent sperm from getting through. 

But keep in mind that spermicide can cause burning, irritaion and allergic reaction 

The sponge is 88% effective at preventing pregnancy with typical use, but its effectiveness drops after childbirth to 76%. 

• Spermicide

Spermicide is a general name used to describe a chemical that kills sperm. It comes in cream, gel, foam, suppository, and film form. 

Used alone, spermicide should be inserted into the vagina as close to the cervix as possible. It should be placed 10-15 minutes before intercourse and is effective for up to one hour after insertion. Do not remove the spermicide for at least 6 hours after sex. When used alone, spermicide is about 70% effective at preventing pregnancy. For this reason, women who use spermicide usually use it with a diaphragm or cervical cap.

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