Postpartum – Wonderful Pregnancy

Life goes on after you’ve had a baby. Here are few things to think about.

Birth Control.

There are lots of choices for birth control postpartum. We talk about birth control choices in three tiers. Tier 1 choices are most effective, while Tier 3 choice are least effective.

Tier 1
- Intrauterine Devices (Mirena, Skyla, Kyleena, Liletta, ParaGard)
- Implant (Nexplanon)
- Sterilization (female and male)
Tier 2
- Combined oral contraceptive pills (OCPs – “The Pill”)
- Birth control vaginal ring (NuvaRing)
- Birth control patch (Xulane)
- The shot (Depo-Provera)
- Minipills (norethindrone-only pill)
Tier 3
- Condoms
- Withdrawal method
- Spermicides
- Fertility awareness-based methods or natural family planning (NFP)
- Sponge
- Diaphragm

When picking a birth control method, ask these questions:

How well does the method work?
Can I use it while breastfeeding?
Will it affect my ability to breastfeed?
How soon can I start it?
How well do other women like it?

This chart answers these questions for you:

Notice that aside from male sterilization methods, the hormonal IUDs are associated with the highest efficacy and highest patient satisfaction. This high rate of patient satisfaction reflects a low rate of complications and side effects. The Tier 1 methods in general are the best choices, with the lowest rates of unintended pregnancies, highest continuation rates, highest patient satisfaction rates, and lowest side-effect rates.

None of the Tier 1 methods interfere with breastfeeding. Though the IUDs and implant can be started immediately after delivery, most hospitals in the United States don’t offer this choice; most women still get them in the office at 4-6 weeks after delivery.

There is a myth that combination birth control pills can’t be used with breastfeeding because either they will diminish milk volume or because the hormones will pass through the breast milk and affect the baby. Neither of these things are true. However, because the systemic hormones in the Pill, Patch, and Ring can increase your risk of blood clots, they shouldn’t be started immediately postpartum.

For more information and pros and cons of each method, read here for more.

Postpartum Blues/Depression.

Planning for the Next Baby.

Here some common postpartum questions:

When can I have sex again?

Whoa! Hold your horses! Although we classically tell women to wait 6 weeks after delivery to resume sex, many do not and there isn't really any science behind this advice. The actual answer varies by woman, and likely depends on how you delivered (vaginally or cesarean), if you had problems (a bad tear or no tear), and whether you have the energy and interest.

Here are some things you should know:

If you aren't lactating, you will probably ovulate again about 25 days after delivery. This means you could get pregnant from sex that happens as early as 3 weeks after delivery. Since the time of return to ovulation is variable, then just assume that you are fertile any time after two weeks or so postpartum
If you are breastfeeding, you probably won't ovulate in the first 6 weeks, but you shouldn't count on this.
If you had a vaginal delivery with a tear, you may need four weeks to heal before sex is comfortable (and sometimes much longer if the tear was severe or it's not healing well).

So when should you have sex? When you feel like and you feel healed; but make sure you use birth control or you might have two babies in the same year! Most women have sex before their 6 weeks postpartum check-up and most of those women have sex the first time at 3-4 weeks after delivery. It's really up to how you feel.

What birth control should I get?

Great question. For most women, the most appropriate birth control choice is one of the long-acting, reversible contraceptives or LARCs. The LARCs include the hormonal IUDs (Mirena, Liletta, Skyla, and Kyleena), the copper IUD (ParaGard), and the implant (Nexplanon). These methods are the most effective, have the highest success rate (as much as 80 times more effective than The Pill), have the lowest side-effect profile and lowest complication rate, and the highest patient satisfaction. They also don't interfere with breastfeeding, and they will protect you for 3-10 years depending on which one you choose. All are immediately reversible if you want to get pregnant and none decrease your chances of pregnancy in the future.