• Birth Control for Breastfeeding Women

    woman breastfeeding Contrary to popular legend, breastfeeding women can become pregnant. However, methods of birth control exist that present no problems for either the nursing mom or her baby.
    The health benefits that breastfeeding offers newborns are widely known and well-documented by numerous studies, and the convenience and cost savings associated with breastfeeding are significant. While most women who choose to breastfeed do so until their baby gets her first teeth (age 4-6 months), some will continue for much longer, often into the child's second year.
    Since most women resume sexual activity several weeks after delivery, the need for effective birth control is an important consideration. The ideal method is one that is completely safe for the newborn infant, free of side effects for the nursing mother, and highly effective in preventing pregnancy. While no current method fits that exact description, there are several good options available to the woman who chooses to breastfeed.

    Breastfeeding Is Not a Contraceptive

    The common misconception that breastfeeding itself prevents pregnancy has consistently been proven wrong. While it is true that a nursing mom is less likely to become pregnant than a mother who bottlefeeds, there is no guarantee that pregnancy will not occur if birth control is not used. The methods available to breastfeeding women include hormonal contraceptives, barrier methods, the intrauterine device (IUD), and sterilization. If you plan to breastfeed, talk to your doctor before your delivery about which method might be best for you.

    Hormonal Contraceptives

    The Pill and Mini-pill

    The combination birth control pill, commonly referred to as the pill, combines estrogen and progesterone hormones. Progesterone-only birth control pills, also called the mini-pill, only contain progesterone. Mini-pills are a popular choice for many nursing and nonnursing women. Mini-pills are less effective than combination pills. However, it is often recommended over combination pills after delivering your baby because combination pills increase your risk of developing a blood clot. Also, despite insufficient evidence to prove it, many organizations are concerned that combined oral contraception may suppress milk production, so they do not recommend them in breastfeeding women. Most women will not menstruate as long as they remain on the mini-pill—a welcome side effect for some women. When breastfeeding is discontinued, an easy transition can be made to a combination pill. It is essential that the mini-pill be taken everyday at the same time to be effective. Noncompliance can result in an unintended pregnancy.

    Depo-provera

    This option is an injectable hormonal contraceptive, which is administered every three months. Breastfeeding women should wait until six weeks after delivery before receiving their first injection. The progesterone-like hormone contained in Depo-provera will not harm the nursing infant, is almost 100% effective in preventing pregnancy, and will not reduce your milk supply. Side effects include irregular periods or absence of periods and weight gain.

    Barrier Methods

    Barrier methods of birth control include condoms (male and female), the diaphragm, and the cervical cap. All of these methods work by presenting a physical barrier that prevents the sperm from gaining access to the egg. Although side effects are minimal, the pregnancy rate is significantly higher when compared to hormonal methods. None of the barrier methods interfere with breastfeeding in any way.

    Condoms

    To improve their efficacy, condoms should be used in conjunction with a spermicidal gel. The chemicals in these gels do not enter the breast milk and therefore are harmless to a nursing infant. Failure to prevent pregnancy is usually due to improper use, failure to use at all, or breakage. Latex condoms may cause an allergic reaction in some women, but will not affect the nursing infant in any way.

    Diaphragm

    The diaphragm is a round, flexible, rubber, cup-shaped device that is inserted into the vagina before sex. When used with a spermicidal gel, its effectiveness at preventing pregnancy is similar to condoms. You must be instructed by your healthcare provider as to the proper way to insert and remove the diaphragm. The diaphragm should be removed within 6-12 hours after intercourse. With proper care, a diaphragm will last for 2-3 years, but should be refitted if you gain or lose a substantial amount of weight during that time. You can be fitted for a diaphragm at your postpartum check-up—usually 4-6 weeks after delivery.

    Cervical Cap

    The less popular cervical cap fits more tightly against the cervix, is more rigid than a diaphragm, and can remain in place for longer periods of time.
    Breastfeeding women sometimes develop atrophic vaginitis. This condition, a result of depressed estrogen levels, causes vaginal dryness, irritation, and painful intercourse. Insertion and removal of a diaphragm or cervical cap may be painful. If you suffer from this condition, a different method of contraception may be more acceptable.

    The Intrauterine Device (IUD)

    The IUD is an effective and safe contraceptive method for breastfeeding women. The ideal candidate is a woman who has completed her family but does not want to undergo a tubal ligation, or who cannot tolerate hormonal methods. Because this method provides long-term protection (up to 10 years), it is not a wise choice for younger women planning to have more children. Current IUDs either contain copper or are impregnated with a progesterone-like hormone. There are no adverse effects from the IUD or any of its chemical components on the nursing infant.

    Sterilization

    For women who have completed their families, permanent sterilization is another method of birth control. A tubal ligation can be performed shortly after delivery while you are still in the hospital, or, if preferred, at a later date as an outpatient. In either case, no interruption in breastfeeding is necessary. Anesthetics used during the procedure may be present in the breast milk for a short period of time, but not in quantities high enough to cause any harmful effects on a nursing infant. Recovery from this minor surgery is rapid, and breastfeeding can resume as soon as you are awake and alert. After surgery, a wide variety of safe pain medications may be used.

    Safe Solutions

    For most new mothers, the thought of becoming pregnant again right away is frightening. Effective birth control is therefore of paramount importance. Breastfeeding mothers are often concerned about medications that might be transferred to their babies in their breast milk. Fortunately, there are several safe methods available for prevention of pregnancy in women who choose to breastfeed their infants.

    RESOURCES

    Association of Reproduction Health Professionals http://www.arhp.org/

    La Leche League International http://www.lalecheleague.org

    CANADIAN RESOURCES

    Womens Health Matters http://www.womenshealthmatters.ca/

    The College of Canadian Family Physicians http://www.cfpc.ca/

    References

    DynaMed Editors. Breastfeeding. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated April 28, 2011. Accessed May 13, 2011.

    Herndon E. and Zieman M. New contraceptive options. Am Fam Physician. 2004;69:853-860.

    Lesnewski R, Prine L. Initiating hormonal contraception. Am Fam Physician. 2006;74:105-112.

    Queenan JT. Contraception and breastfeeding. Clin Obstet Gynecol. 2004 Sep;47(3):734-739.

    World Health organization. Medical eligibility criteria for contraceptive use. 4th ed. 2010. World Health Organization Website. Available at http://whqlibdoc.who.int/publications/2010/9789241563888%5Feng.pdf. Accessed May 13, 2011.

    6/7/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Department of Health and Human Services Centers for Disease Control and Prevention. US medical eligibility criteria for contraceptive use, 2010. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/mmwr/pdf/rr/rr59e0528.pdf. Published May 28, 2010. Accessed June 7, 2010.

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