Post Natal Contraception
Contraception is essential for planning the size of your family and spacing children optimally for your individual family unit. A pregnancy that occurs within twelve months of giving birth can place extra stress on the mother and baby, and carry more risks of complications, so having effective contraception during this time is particularly important. It can be a good idea to talk to your doctor about this even before giving birth as some contraceptive methods can be started very soon after childbirth.
Contraception is not needed in the first three weeks following childbirth, but ovulation (the release of an egg from the ovary) can occur from as early as three weeks postnatal.
Your choice of contraception will depend on many factors, such as how effective the method is, suitability for your personal and medical circumstances, your personal preference, and whether or not you are breastfeeding.
CONTRACEPTIVE OPTIONS IN THE POST-NATAL PERIOD:
THE CONTRACEPTIVE IMPLANT (THE ROD)
- The contraceptive implant (Implanon) is a small plastic rod which is inserted beneath the skin on underside of the upper arm. It contains progestogen which prevents ovulation.
- It is over 99% effective.
- It can be inserted at any time after birth. Although the product information advises three weeks afterwards, evidence-based guidelines by contraception experts advise that it can be safely inserted earlier.
- The contraceptive implant can be used when breastfeeding.
INTRA-UTERINE DEVICES (IUDS)
- An IUD is a small plastic device that is inserted into the uterus. There are two types: the hormonal IUDs (Mirena® and Kyleena®) that last five years, and the copper IUD that lasts for five or ten years depending on the model. IUDs work in several ways: by stopping the egg and sperm meeting, by changing the lining of the uterus so it cannot support a fertilised egg, and hormonal IUDs also thicken the mucus in the cervix.
- Both types of IUDs are over 99% effective.
- An IUD can be inserted at four or more weeks following birth, but it is possible to insert earlier in some situations, and it can be removed at any time.
- Both the hormonal IUD and the copper IUD can be used when breastfeeding.
THE CONTRACEPTIVE INJECTION
- The contraceptive injection is a hormonal contraceptive containing a progestogen, which is given into the muscle of the buttock or arm every twelve weeks. It works by preventing ovulation.
- It is 96% effective.
- There can be a delay in return to fertility after stopping the contraceptive injection, therefore this method may be less suitable for anyone considering a pregnancy within two years.
- It can be started any time after delivery.
- The contraceptive injection can be used when breastfeeding.
THE PROGESTOGEN-ONLY PILL
- The progestogen-only pill (mini pill) is a pill which must be taken at the same time every day and works mainly by changing the mucus in the cervix
- The minipill is 93% effective at preventing pregnancy.
- It can be started immediately after delivery.
- The minipill can be used when breastfeeding.
THE COMBINED ORAL CONTRACEPTIVE PILL
- The combined oral contraceptive (‘the pill’) contains two hormones, oestrogen, and a progestogen. It works by preventing ovulation.
- The pill is 93% effective.
- It can be started six weeks after birth.
- The pill can be used when breastfeeding from 6 weeks after delivery.
CONDOMS: External Condoms
- A condom is a thin sheath that is placed over the penis during sex. They work as a barrier method, preventing sperm entering the vagina. Condoms are an effective method of contraception when used correctly and can be a good temporary choice following childbirth, especially if you are waiting to start another contraceptive method.
- Condoms are about 88% effective.
- They are readily available at chemists and supermarkets. Use of water-based lubricant is advised to make sex more comfortable and to reduce the risk of the condom breaking.
- They can be used as soon as you resume sex.
CONDOMS: Internal Condoms
- The internal condom is a thin pouch that is inserted into the vagina where it remains during intercourse. Internal condoms work as a barrier method preventing sperm entering the vagina.
- Female condoms are 79% effective.
- They are available to order online.
- Internal condoms can be used as soon as you resume sexual intercourse.
Diaphragm
- A diaphragm is a silicone dome which is placed into the vagina before intercourse and left in for a minimum of six hours afterwards. It is a barrier method that covers the cervix and prevents sperm entering the uterus.
- The diaphragm is 82% effective.
- It is advised that diaphragms are individually fitted by a specially trained nurse (e.g., at SHFPACT). You will then need to purchase a diaphragm of the correct size via online suppliers.
- The diaphragm can be used from six weeks after childbirth. If you were using a diaphragm before your pregnancy, you will need a check for the correct fit as sizing can change after the birth of a baby.
EMERGENCY CONTRACEPTION (EC):
Emergency contraception (EC) can be used to reduce the risk of pregnancy when unprotected intercourse has occurred, for example when no contraception was used, a condom broke, a diaphragm slipped, or a pill was taken late.
There are three types of emergency contraception available in Australia:
Levonorgestrel EC.
This is an oral pill that contains progestogen and works by stopping or delaying ovulation (release of an egg). It needs to be taken within three days (72 hours) of unprotected sex. The sooner it is taken the better. It is available over the counter at most pharmacies, the Walk in Centres in the ACT, SHFPACT, Canberra Sexual Health Centre and The Junction Youth Health Centre. It is safe to use while breastfeeding.
Ulipristal EC.
This is an oral pill that contains a progesterone blocker and works by stopping or delaying ovulation (release of an egg). It needs to be taken within five days (120 hours) after unprotected intercourse. The sooner it is taken the better. Ulipristal acetate EC has been shown to be more effective than the Levonorgestrel EC. It is available over the counter from pharmacies. If you are breastfeeding, you cannot breastfeed for a week after taking Ulipristal -EC and will need to discard any breastmilk expressed during this time.
The Copper IUD
A copper IUD can be used as emergency contraception and is 99% effective at preventing pregnancy. It needs to be inserted by a specially trained doctor within five days of unprotected intercourse and can be used from four weeks after childbirth. It can also be used as ongoing contraception.
STERILISATION
The two sterilisation methods available are vasectomy for people with a penis and tubal ligation for people with a uterus. They are both over 99% effective. As sterilisation is regarded as a permanent method, it is advisable to take the time to thoroughly consider all aspects before deciding. This includes consideration of whether a sterilisation decision may be regretted if the loss of partner or children through illness or accident were to occur. If you are interested in sterilisation talk to your GP or a doctor at the SHFPACT Clinic. You will need a doctor’s referral for tubal ligation.
LACTATIONAL AMENORRHOEA (FULLY BREASTFEEDING AS A CONTRACEPTIVE)
Lactational amenorrhoea is when breastfeeding is used as a method of contraception. It is very effective (98%) when used correctly. To use it correctly the following three criteria must be met:
- Your baby must be less than six months old.
- Your periods must have not returned.
- You must be fully breast feeding your baby. (This means no bottle feeds, and no longer than four hours between feeds during the day and six hours between feeds at night. If your baby misses any feeds or begins to sleep long periods at night your risk of pregnancy will increase, and you should use an additional method of contraception if you wish to avoid pregnancy).
Once your periods return, even if you are fully breastfeeding, contraception should be used if you wish to avoid pregnancy. Contraception is also advised once your baby turns six months old.
If there are any difficulties in establishing breastfeeding, if you are using complimentary feeds, or if you decide to bottle feed, you will need to use contraception as soon as you resume sexual intercourse.
WHEN CAN I RESUME SEXUAL INTERCOURSE?
There is no set time to resume sexual intercourse after having a baby, it is really an individual decision. You may or may not feel like having sex for a while after the birth of your baby. Be guided by your own emotions and how you feel physically.
You can find other ways to be intimate and sexually close with your partner until you feel ready to have sexual intercourse again. It’s important to talk to your partner and let them know how you are feeling about it.
WILL SEX BE UNCOMFORTABLE?
Many people worry that sex will be uncomfortable after giving birth. Discomfort may occur because vaginal lubrication is often decreased due to the hormonal changes of birth and breastfeeding. Discomfort may also be related to an episiotomy or tear which is still healing after a vaginal delivery.
Recovery usually takes place over a few weeks to months. It is a good idea to use lubricant to make sex more comfortable. This can be applied to the penis or the vaginal entrance before intercourse. Do not continue intercourse if it is painful or uncomfortable, wait a few days before attempting it again.
If sexual intercourse continues to be uncomfortable over an extended period, you should see a doctor to discuss it.
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