Contraception for women after childbirth

Contraceptive methods after childbirth are aimed at preventing the onset of a new pregnancy and protecting against sexually transmitted infections. The difficulty in choosing a method of contraception lies in the fact that you need to take into account not only the woman’s contraindications, ease of use and effectiveness, but also lactation. Breastfeeding imposes restrictions on the choice of certain methods of contraception in the postpartum period.

Why use protection after childbirth?

Pregnancy and childbirth do not rejuvenate the female body, but increase the load on all organ systems. Even in young women, while carrying a child, pregnancy-associated diseases develop and chronic pathologies become aggravated. Therefore, after childbirth, a recovery period is necessary. The optimal period of contraception after natural childbirth is 2 years.

Those who gave birth by cesarean section need not only to wait 2-3 years, but also undergo an examination to make sure that the scar on the uterus is intact. Only after this can you start planning a new pregnancy. Those who ignore medical recommendations will face the following complications:

• anemia of pregnant women;
• threat of miscarriage;
• risk of feto-placental insufficiency;
• chronic fetal hypoxia;
• anomalies of labor;
• threat of uterine rupture along the scar;
• antenatal fetal death.

Therefore, postpartum contraception is a necessity that will help plan a new pregnancy, properly prepare for it and reduce the risks of complications.

Unplanned pregnancy can occur during lactation. But due to increased prolactin, a nursing mother has a higher risk of early abortion, and sometimes the fetus freezes at 5-6 weeks.

Advantages and disadvantages of natural contraception after childbirth

Birth control after childbirth must be effective. And natural contraceptive methods have a high Pearl index, which indicates a high pregnancy rate. For the calendar method, the indicator fluctuates at the level of 9-40, which depends on the correct assessment of the results of monitoring the menstrual cycle and the method of protection on dangerous days. This means that between 9 and 40 women out of 100 will become pregnant within a year if they use this method of contraception.

Natural methods of protection against pregnancy are suitable only for regular couples who are confident that their partner does not have a sexually transmitted infection. Those who prefer risky sexual behavior should use barrier contraception.

To protect yourself from pregnancy while breastfeeding using the calendar method, you must wait until the menstrual cycle returns. It is impossible to determine during what period this will happen during lactation. For a young mother who only breastfeeds, including at night, menstruation can begin as early as 4 months, but sometimes the first bleeding appears after a year, and it takes several more months to establish a regular cycle.

To start using the calendar method, you need to monitor your menstruation for at least 3 months, and the optimal period is 1 year. This will allow you to calculate:

• exact cycle duration;
• average number of days;
• the shortest and longest cycle;
• approximate time of ovulation.

This method of contraception is not suitable for nursing mothers after childbirth. Doctors allow sexual activity within a month from the birth of a child, so another method is needed that will allow you not to get pregnant before the due time.

After childbirth, the calendar method can be used by those who are not breastfeeding. It is necessary to wait for normal menstruation and begin monitoring its duration. To increase the accuracy of the results, you can additionally carry out:

• measurement of basal temperature;
• assess cervical mucus throughout the cycle;
• After the end of menstruation, check the position of the cervix daily.

The formation of a cycle after childbirth lasts individually, but by objective signs it is possible to determine the moment of restoration of fertility.

Breastfeeding women do not ovulate.
This condition is provided by the hormone prolactin. Its release outside the lactation period is suppressed by dopamine. But at the moment the baby is attached to the breast, a signal is sent from the nipple to the brain, which leads to the suppression of the release of dopamine. Therefore, the concentration of prolactin in the blood increases. Prolactin inhibits the secretion of follicle-stimulating hormone and gonadotropin-releasing factor. Therefore, the woman’s follicle does not mature, ovulation is inhibited, and a new pregnancy is impossible. Unprotected sexual intercourse during lactational amenorrhea is relatively safe. But its effectiveness gradually decreases after 3 months after birth.

A prerequisite for this method of contraception is completely natural feeding of the child and mandatory feeding at night. During sleep, the hormone melatonin is synthesized, which is also involved in the regulation of dopamine and the lactation process. Therefore, if you refuse night feeding, prolactin synthesis is inhibited and the cycle can be restored.

If a woman begins to introduce artificial mixtures into her diet, replacing night feedings or several day feedings with them, she needs to use other methods of contraception.

In ordinary life, the beginning of the menstrual cycle is counted from the first day of menstruation. But during the lactation period after childbirth, the restoration of the cycle occurs unnoticed: the concentration of prolactin in the blood decreases and FSH increases, follicle growth and estrogen synthesis are stimulated. Then ovulation occurs, the symptoms of which go unnoticed. If there has been no fertilization, menstruation will begin in 2 weeks, which will mark the end of the first cycle and the beginning of the next. If a woman becomes pregnant, she does not have periods. Therefore, many nursing mothers find out about a new pregnancy only after a few months.

Methods of contraception for a nursing mother

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Tatiana Kazachenok | 09/24/2015 | 1554

After giving birth, many couples think about contraception. And there are reasons for this: the new baby, the health of the mother, the financial capabilities of the young family.

How long after giving birth should you abstain from sex?

The therapeutic and protective regime after childbirth lasts 6-8 weeks. During this period, the function of all organs and systems of the female body is restored after childbirth, the uterus contracts completely, postpartum discharge stops, and the cervix is ​​finally formed.

When will the cycle be restored and is it necessary to use contraception immediately after childbirth?

Menstruation may resume after 2 months. If a woman is breastfeeding, be absent for 8 months or more. But even without menstruation, the likelihood of getting pregnant again is very high.

A non-breastfeeding woman, as well as a rarely breastfeeding woman, should use contraceptives immediately upon the onset of sexual activity. If you stop night feeding or introduce complementary foods, you must take precautions to avoid unwanted pregnancy.

Contraception issues for a nursing mother need to be carefully considered

Does breastfeeding prevent pregnancy?

This natural method of birth control is called lactational amenorrhea. The mechanism of its action is simple: during breastfeeding, the body produces the hormone prolactin, which is responsible for milk production and prevents the maturation of the egg.

However, this method is effective only in certain cases:

• in the first 6 months after birth;

• if a woman does not menstruate;

• The mother breastfeeds the baby on demand, without supplementing with formula. The intervals between feedings are no more than 4 hours during the day and no more than 6 hours at night.

Does contraception with spermicide harm the baby?

Spermicides are a group of topical chemical contraceptives that are inserted into the vagina. They come in the form of creams, tablets, suppositories. They do not pass into breast milk in any way, so they will not harm the baby. In addition, the high contraceptive effect of spermicides is combined with protection against sexually transmitted diseases. However, read the instructions carefully. Some spermicides do not tolerate soap. When in contact with it, the contraceptive effect is zero.

Lactational amenorrhea (a natural method of contraception) is effective only in the first 6 months. In case the mother feeds the baby on demand.

Is it possible to have an IUD after childbirth? Will there be pain while breastfeeding?

Provided that the cervix is ​​in good condition, an IUD can be inserted 4 weeks after birth. The copper included in the spiral, or the addition of the hormone, does not affect the quality of milk and feeding.

Sometimes nurses complain of discomfort or minor pain in the lower abdomen. They appear during breastfeeding, when the uterus contracts. One of the disadvantages of this method of contraception is that nursing mothers have a higher risk of the IUD falling out than non-breastfeeding mothers.

What birth control pills can you take if you are breastfeeding?

These are the so-called “mini-pills” - birth control pills containing small doses of progestin - an artificial analogue of the natural hormone progesterone. They do not harm the health of mother and child and do not affect milk production. You can take them from the 6th week after birth.

The downside of these drugs is the frequent development of intermenstrual bleeding. But combined oral contraceptive pills are not recommended during breastfeeding, since the substances they contain pass through the milk to the baby and, in addition, can inhibit lactation.

09/24/2015 Mom's health After childbirth (e) Breastfeeding

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Pros and cons of barrier products after childbirth

Barrier contraception after childbirth does not require a visit to the doctor or compliance with additional conditions of use. These methods do not affect lactation. They can be used as early as a month after birth. The advantage of barrier contraception is protection against sexually transmitted infections.

But some couples refuse them, citing decreased sensitivity during sex. Such statements have no basis; modern condoms are made of very thin latex.

After pregnancy, contraception using condoms is the safest method. The advantages of this method are:

• no effect on lactation;
• protection against infection;
• no doctor’s consultation or examination required;
• does not change hormonal levels;
• can be used by women with somatic diseases.

The condom can be selected according to size and additional properties.
To prolong sexual intercourse, there are condoms with anesthetics, and for latex allergies, special polyurethane products are used. In women during lactation, estrogen levels are reduced, which causes physiological vaginal dryness. Condoms solve another problem - they are treated with a lubricant, which reduces friction and discomfort during sex.

Instead of male condoms, you can use other types of contraceptives for women after childbirth:

• female condom;
• cervical caps;
• diaphragm.

The effectiveness of the use of femidom according to the Pearl index is 5-25, but the method of contraception is not widespread among women. Many of them complain of discomfort during sexual intercourse or pain; men also note psychological discomfort.

Caps and diaphragms have low contraceptive effectiveness, which can be increased through the simultaneous use of spermicides.

Diaphragm (vaginal cap)

The vaginal cap is somewhat similar to a condom: thin rubber is stretched over an elastic rim. Before you start using it, you need to contact a specialist to determine which size is right for you. The diaphragm must be inserted into the vagina before sexual intercourse so that one edge is located under the pubic bone and the other near the posterior vaginal fornix. Thus, a kind of obstacle is formed that prevents sperm from entering the uterus. The diaphragm should be removed from the vagina 3-4 hours after intercourse. When used correctly, they can provide protection of around 92-96%.

Vaginal diaphragms and caps can be used if:

• you do not want to take hormonal drugs;
• you are breastfeeding your baby;
• when using intravaginal products you do not feel discomfort;
• Do you smoke.

You should not use the cap if:

• you have no desire to use vaginal contraception;
• you are allergic to latex or spermicides;
• you are uncomfortable using spermicidal gel or cream;
• you are not going to interrupt caresses to use protective equipment;
• you have a tendency to infectious diseases of the reproductive system, especially the bladder;
• your perineal muscles are weak.

Intrauterine devices for women who have given birth

After childbirth, many women decide to have an intrauterine device installed. It will protect against pregnancy, but cannot prevent infection, so it is suitable for permanent married couples. Advantages of the intrauterine device:

• does not affect hormonal levels;
• can be used during breastfeeding;
• suitable for women with contraindications for hormonal contraception (overweight, diabetes, tendency to thrombosis);
• does not require constant monitoring;
• long term contraception.

To install the IUD, you need to see a doctor 3 months after birth. Women who are not breastfeeding need to wait until their cycle returns, because... the IUD is installed during menstruation.

A preliminary examination is required, which includes a smear to determine the degree of cleanliness of the vagina and an ultrasound of the uterine cavity. If signs of inflammation are determined, treatment is prescribed, contraception with a spiral is postponed for 3-6 months after the end of the course.

A metal-containing IUD increases the risk of ectopic pregnancy. Therefore, this method is not recommended for women who have undergone tubal surgery.

With the help of a spiral with hormones, women with hyperplastic processes in the uterus can be protected. If fibroids or endometriosis were diagnosed before childbirth, a hormonal IUD will help prevent the progression of the disease after childbirth.

Not all doctors recommend using an IUD to protect yourself after a caesarean section. It is believed that the focus of aseptic inflammation in the uterus increases the risk of scar failure and subsequent complications during childbirth.

Intrauterine system and IUD

The intrauterine system is a small plastic device that is inserted into a woman’s body for 5 years. It allows the progestogen to enter the blood in doses.

This remedy is suitable for you if:

• you can take hormones;
• you are breastfeeding your baby;
• you find it difficult to take pills regularly;
• you are not going to get pregnant again in the near future;
• you suffer from heavy, painful bleeding;
• you are satisfied with a method of contraception that stops menstruation.

It is better to avoid the intrauterine system if:

• hormones are prohibited for you;
• you suffer from a sexually transmitted or infectious disease;
• you have an abnormality in the structure of the uterus or a bad smear;
• you have a diseased heart, liver;
• you have been cured or are suffering from breast cancer.

An intrauterine device, or IUD, can remain in the uterus for 3 to 10 years. The spiral prevents the penetration of sperm or, in extreme cases, the attachment of a fertilized egg to the wall of the uterus.

A spiral can be used if:

• you are breastfeeding;
• you find it difficult to take medications regularly;
• you do not plan to become pregnant for the next few years.

There is no need to install a spiral if:

• you are allergic to copper;
• you suffer from abnormalities in the structure of the uterus and have a bad smear;
• you have been diagnosed with sexually transmitted or infectious diseases;
• your periods are heavy and painful;
• you are afraid that bleeding will increase during your period.

Both remedies can provide more than 99% protection against unwanted pregnancy.

Hormonal contraception after childbirth

Combined oral contraceptives are the most reliable means of protection against pregnancy, but after childbirth, birth control pills are contraindicated for nursing mothers, with rare exceptions.
Hormones taken orally pass into breast milk and further to the baby. But the main danger comes from estrogens. Therefore, hormonal contraceptives based on gestagens are allowed for nursing mothers. When you can start taking birth control pills after childbirth, your doctor should decide. After examining and assessing the condition after 30 days, he will select the appropriate drug. Safe for nursing mothers:

The drugs contain gestagens, they have a lesser contraceptive effect than in combination with estrogens, so it is important to strictly adhere to the time of taking the pills.

After childbirth, local hormonal contraception can also be used. The Nuvaring vaginal ring is available and contains levonorgestrel. It is placed in the vagina after the end of menstruation for 21 days. After this, the ring is removed, they wait for the onset of menstrual bleeding and move on to a new contraceptive.

Attention! Hormonal depot forms for contraception during breastfeeding are not used, because their active components penetrate the blood and act on the child.

Birth control pills

Combined oral contraceptives contain estrogen and progesterone. Such tablets should be taken in a course of 21 days (daily), after which a break of 7 days should be taken.

This method of contraception is suitable for you if:

• you do not want to use a method of contraception that must be used in advance;
• hormonal contraceptives are not prohibited to you;
• critical days pass painfully;
• the menstrual cycle is irregular;
• You experience heavy bleeding during menstruation;
• you have a hard time with PMS;
• you are prone to acne;
• you don't smoke.

You should not take these drugs if:

• you refuse to take hormonal pills;
• you continue to breastfeed your baby;
• you are over 35 years old and you smoke or quit this habit less than a year ago;
• you have heart or vascular disease;
• you find it difficult to take medications regularly;
• you do not want to change your menstrual cycle for a certain period;
• you have been diagnosed with breast cancer or got rid of it 5 years ago;
• you have suffered from complicated or normal diabetes for more than 20 years;
• you are overweight;
• sometimes you have migraines;
• you have gallbladder or liver disease and are taking medications.

Progestin-only birth control pills, or mini-pills, must be taken constantly – every day. These pills contain only progestogen.

You can use this contraceptive if:

• you can take hormonal pills;
• your menstrual cycle is irregular;
• you continue to breastfeed your baby;
• your critical days are painful;
• you do not want to use contraception in advance;
• you are over 35 and smoke;
• you have a hard time with PMS.

You should not take this hormonal drug if:

• you should not take hormonal pills;
• you find it difficult to take medications regularly;
• you have had breast or liver cancer;
• you had an ovarian cyst removed;
• you suffer from vaginal bleeding between periods;
• you are familiar with the problem of ectopic pregnancy.

The reliability of both methods of contraception is 99%.

Chemical methods of contraception

Chemical methods of contraception after childbirth include spermicides. These are various suppositories, tablets, creams that are placed in the vagina before sexual intercourse. They dissolve and form a protective film. The action is based on the destruction of sperm, and also provides protection against sexually transmitted infections.

The positive side of spermicides is that they provide additional lubrication for women with vaginal dryness. The active components of the products are not absorbed into the blood, therefore they do not affect the condition of the child, lactation and the health of the mother. After childbirth, spermicides can be used within a month.

But the contraceptive method has disadvantages:

• when using candles, abundant foam may appear during sex, which causes psychological discomfort;
• tablets are more likely than other drugs to cause a burning sensation;
• Do not use soap or other detergents after sex;
• Sometimes an allergic reaction is possible.

Spermicides do not affect uterine contractions or suppress fertility. Therefore, these remedies are often used after childbirth.

Contraceptive injections and patch

Contraceptive injections can be given for 12 or 8 weeks. To do this, a hormonal contraceptive is administered intramuscularly, and it gradually penetrates the blood.

You can give yourself similar injections if:

• you can take hormonal medications;
• you are breastfeeding your baby;
• you find it difficult to take pills every day;
• you are not going to get pregnant for at least a year;
• Do you smoke;
• you have a hard time with your periods and suffer from PMS;
• you want to protect yourself for a long time;
• you don't mind if your period stops.

It is better to refuse hormonal injections if:

• you should not take hormonal medications;
• you are afraid of injections;
• you plan to become pregnant in at least a year;
• you have a diseased liver and problems with blood vessels;
• you have or have been cured of breast cancer 5 years ago;
• you bleed after sex;
• you have been suffering from diabetes for a long time;
• you are afraid of gaining excess weight (about 3 kg).

The birth control patch releases a dose of estrogen that enters the bloodstream through the skin. It needs to be changed every 7 days.

This protection is suitable for you if:

• you can take hormonal medications;
• you have painful periods and PMS;
• you find it difficult to take pills regularly;
• you don't smoke;
• you are experiencing heavy bleeding.

It is better not to use the patch if:

• you are prohibited from taking hormonal medications;
• you are breastfeeding your baby;
• you suffer from heart disease, liver and gallbladder diseases, obesity;
• you have sensitive skin;
• you often have migraines;
• you have acute diabetes;
• you are taking other medications at the same time.

The guarantee of protection against unwanted pregnancy in both cases is about 99%.

Other methods of contraception after childbirth

If there are contraindications to the listed methods of protection against pregnancy, doctors may recommend additional means of contraception after childbirth in women:

• interrupted sexual intercourse - refers to unreliable methods, requires special skills for men, but can be used if other methods are contraindicated;
• surgical contraception – tubal ligation;
• emergency contraception - after childbirth is used if a possible pregnancy is suspected after unprotected sex.

Sterilization can be used in women after 30 years of age, as well as at a younger age if there are at least 2 children. Sometimes doctors suggest ligating the tubes for pregnant women during a caesarean section, if it has already been performed 3 times. Women with three scars on the uterus are not recommended to have a new pregnancy due to the high risk of complications, rupture along the scar, and placentation disorders.

For emergency contraception, drugs based on large doses of gestagens are used. Nursing mothers need to pump for 3 days after taking the pill, and then choose a suitable method of protection against pregnancy.

Non-hormonal methods

This group of protection includes intrauterine and barrier devices. They prevent the penetration of sperm into the vagina and cervix, and according to their method of action, they can be mechanical (condom, vaginal diaphragm, cap), chemical (spermicides).

Intrauterine contraceptives

The IUD can be inserted into a healthy woman on the second day after childbirth. If, due to contraindications, such a procedure was not performed, an intrauterine device is placed after birth at 8 weeks.

If there is a spiral in the uterine cavity, it acts as a foreign body and prevents the fertilized egg from implanting and attaching.

Advantages of the method:

• It is considered one of the most effective.
• Does not affect the lactation process.
• Without negative impact on the health of mother and child.
• Provides long-term (5 years) contraception.

Disadvantages of the intrauterine contraceptive:

• Placing and removing the coil is an exclusively medical procedure.
• Not allowed for women who have multiple sexual partners.
• Contraindicated for inflammatory and infectious diseases of the genitourinary system.
• In rare cases, periods become heavier and more painful.

A woman with an intrauterine device is required to visit a gynecologist once every six months. After 5 years the product must be removed.

Condom

Contraception after childbirth using condoms is the most popular, affordable and effective method, without negative effects on the body and lactation. Often in the postpartum period, women complain of vaginal dryness, and condoms with lubricants eliminate this unpleasant symptom.

In addition, this type of barrier contraceptive protects against any kind of infection of the dilated cervical canal, prevents cervical cancer, and is easy to use.

Spermicides

Chemical methods of protection include the use of local spermicides. The main active ingredients nonoxynol and benzalkonium chloride reduce motility and destroy sperm. Additional components allow the drug to distribute evenly into the vagina.

Dosage forms of drugs:

1. Suppositories (Pharmatex, Erotex, Sterilin, Patentex, Conceptrol).
2. Cream, capsules (Pharmatex).
3. Film (ABF).

The effect of the drugs begins within a few minutes and lasts about 6 hours.

Chemical methods of contraception after childbirth are suitable for women of any age and are approved for the lactation period. They are available and can be purchased over the counter.

Spermicides do not contain hormonal components; they are allowed to be used for a long time and combined (supplemented) with other contraception in the postpartum period. The effectiveness of the chemical method of protection is about 95%.

The group of barrier methods also includes diaphragms, caps and sponges, which, after deep insertion, close the vaginal lumen and protect the cervical canal from sperm. But today these funds are unpopular. Installing the diaphragm and caps requires some experience and skill.

Barrier methods do not pose serious medical risks. Side effects include irritation and allergic reactions.

Doctors' recommendations for choosing a contraceptive method

After giving birth, a woman needs to visit a doctor within a week from the moment of discharge from the hospital, and then again after 30 days to assess how the uterus has contracted and choose a contraceptive method. Doctors recommend using local hormonal methods as more reliable and safe. Those who are not breastfeeding are allowed to start using COCs immediately.

But if there are contraindications to hormones, it is necessary to select another method. For a married couple, a reliable remedy is an intrauterine device, if the birth took place without infectious complications. An alternative method is condoms and spermicides. Natural methods of contraception are not recommended during the postpartum period due to hormonal changes.

How to choose?

It is believed that it is undesirable to become pregnant in the first one and a half to two years after childbirth. The female body has not yet recovered enough to bear a child, and an abortion can cause dangerous complications in the reproductive and hormonal systems, and a death sentence for the reproductive system.

Therefore, the selection of optimal contraception should be carried out carefully, seriously, with mandatory consultation with a specialist. After all, when a woman is breastfeeding, the method should not affect lactation and the health of the infant.

Usually in this case, women are advised to combine and protect themselves in several ways.