Guide for a Healthy Pregnancy

BIRTH CONTROL AFTER PREGNANCY

Each family has different needs and wants about child spacing. If you are not breastfeeding, it only takes weeks after giving birth to become fertile. If you are breastfeeding, it is harder to tell when you become fertile again. Either way, you may want to consider some form of birth control if you are not ready just yet to have another child.

There are many types of birth control. Most methods are reversible, but some are permanent. See the chart below for the available methods of contraception. You should talk to your partner and clinician about which is best for you before you start having sex again after your pregnancy.

Over the Counter Methods

These methods are available from your local drugstore without a prescription. They are put on or inserted prior to sex.

Condoms

The male condom is a thin sheath made out of latex. It is worn over a man’s penis.

Female Condoms

The female condom is a plastic pouch that lines the vagina. An inner ring at the cervix and an outer ring at the entrance of the vagina help hold the female condom in place.

Contraceptive Sponge

The sponge is a round foam device that is moistened and inserted into the vagina at the time of intercourse.

Contraceptive creams, jellies, foams, films and suppositories (spermicides)

Spermicides come in a variety of forms and are inserted into the vagina before intercourse, where they immobilize sperm. Spermicides are available at most drugstores.

Reversible Prescription Methods

I. Barrier Methods

Barrier methods are methods that create a barrier between the sperm and the egg.

Diaphragms

The diaphragm is a round rubber dome that fits inside a woman’s vagina and covers her cervix and is used each time she has intercourse. Diaphragms must be fitted to each woman’s body, and are available through the OB/GYN Department.

Cervical Cap (FemCap®)

FemCap® is a small rubber cup that fits over a woman’s cervix. Suction and a small amount of spermicidal jelly helps keep it in place. It is left in place for at least six hours after sex.

II. Hormonal Methods

Hormonal methods involve taking a hormone medication to interfere with ovulation or prevent sperm from joining with an egg. This means that no egg is fertilized, even though you still get your period each month in most cases. Hormonal methods are not right for certain women. They are usually safe for women who have no cardiovascular risk factors (i.e., high blood pressure, clotting tendency) and don’t smoke. Hormonal birth control does not protect against sexually transmitted diseases, and requires a prescription or visit to your clinician.

The Pill

The Pill is an oral tablet that is taken every day. There are two basic types – combination pills (contains both estrogen and progestin) and progestin-only pills. Both types are made of hormones like those made naturally by a woman’s ovaries. Combination pills usually work by preventing a woman’s ovaries from releasing eggs (ovulation). Progestin-only pills also prevent ovulation, but they also work by thickening the cervical mucus; this keeps sperm from joining with an egg. Progestin-only pills can be used during breastfeeding starting at 6 weeks after birth, but are generally slightly less effective than combination pills. (They are quite effective in breastfeeding women.)

Combination pills are taken once per day for 21 days of active (real drug) tablets and then once per day for 7 days of placebo (sugar pill) tablets; and then the pattern is repeated. Your period usually occurs each month during the 7 days you are taking the placebo tablets. While on the Pill, your period may be lighter and/or shorter than otherwise.

Combination pills can be taken as active tablets only, with no break for placebo tablets (or a break every few months). You should not get a period until you stop taking the active tablets.

With Progestin-only pills, a medicated pill is taken every day, with no break.

The Pill has some side effects that usually clear up after two or three months of use, such as:

bleeding between periods
weight gain or loss
breast tenderness
nausea and rarely vomiting
changes in mood

You must see a clinician to tell whether you can take the Pill and what brand and dosage is right for you.

Ortho Evra®

Ortho Evra® is a contraceptive patch that is applied to the skin once per week for three weeks, followed by a patch-free week during which you will usually get your period. This method of contraception exposes women to more hormones than the Pill, and may not be right for some women.

NuvaRing®

NuvaRing® is a soft vaginal ring-shaped device that is inserted by a woman into her vagina. It releases hormones over 21 days, and then is removed for 1 week before a new ring is inserted again. The woman usually gets her period during the week without her ring.

Depo Provera®

Depo-Provera® is a prescription birth control. It is a hormone like progesterone, one of the hormones that naturally causes the menstrual cycle. Depo-Provera is a shot in the buttock or arm, and each shot can prevent pregnancy for 12 weeks.

Common side effects of Depo-Provera include:

Irregular bleeding
Periods become fewer and lighter for most women, while other women will have longer and
heavier periods
Possible significant weight gain
Possible bone loss with prolonged use

Please consider that the effects of using the shot cannot be reversed immediately if you wish to become pregnant. You may not be able to become pregnant for a full year after you stop using it. Also, some side effects may continue for up to eight months. Most women can use the shot safely. Women who should not choose Depo-Provera include women who:

Are pregnant
Want to become pregnant within 18 months
Have unexplained vaginal bleeding
Have a serious liver disease or growths of the liver
Have a known or suspected breast cancer
Are not comfortable with irregular bleeding or loss of your period

Implanon®

Implanon® is a small rod that is implanted by a specially trained clinician under the skin in the inside of the upper arm. It releases progestin over a three-year period to prevent pregnancy. Implanon does not protect against sexually transmitted diseases. Implanon may be used during breastfeeding starting on the 4th week after birth. Most women are fertile about 3 months after Implanon is removed, but can get pregnant as soon as one week after removal.

III. Intrauterine Devices (IUDs)

An IUD is a small plastic device that is inserted into the uterus by a specially trained clinician. It contains copper or a small amount of hormone which prevents an egg from being fertilized or a fertilized egg from implanting in the uterus. The hormonal IUD must be replaced every 5 years while the copper IUD can be in place for up to 10 years. Once the IUD is in place, you don’t need to do anything else to prevent pregnancy, but IUDs don’t prevent STDs.

Emergency Contraception

Emergency contraception consists of a high dose of birth control pills taken within 72 hours of unprotected sex. A second dose is given 12 hours later. Emergency contraception prevents ovulation in most cases, therefore preventing pregnancy.

There are 2 types of emergency contraceptive pills:

Plan B – contains only progestin. Plan B is available in Massachusetts without a prescription for women 18 years of age or older. It generally requires a prescription for women under 18. Plan B is the most effective form of emergency contraception and has fewer side effects.
Combination oral contraceptives – birth control pills that contain both estrogen and progestin. Combination products require a prescription.

Permanent Sterilization

If you and your partner are sure that your last pregnancy is the last child you want to have, sterilization is an option as a method of birth control. Sterilization is permanent, so you should be certain that you won’t change your mind.

Female sterilization can involve surgery, tying the fallopian tubes in order to block sperm from reaching and fertilizing an egg. Another non-surgical way to block the tubes is by inserting a plug through the cervix – a technique called Essure®.

Male sterilization (vasectomy) involves cutting or tying the tubes that sperm travel through so that no sperm are released when a man ejaculates. Talk to your clinician about male sterilization.

Remember you are at risk for pregnancy as soon as you resume sexual intercourse even if you are breastfeeding. Your obstetric clinicians are happy to answer any further questions. More information on birth control is available on these web sites:
www.plannedparenthood.org/health-topics/birth-control-4211.htm