Why contraceptives are important after giving birth

It is an old joke that having a baby is the best contraceptive. However, exclusive breastfeeding gives just three months’ protection, and if not breastfeeding, you can fall pregnant as soon as six weeks after giving birth, even if your periods have not resumed, says Pretoria obstetrician and gynaecologist Dr Elizabeth de Gouveia.  

This means it is important to use contraception every time you have sex after having a baby, unless you are open to getting pregnant again quickly – and authorities such as Mayo Clinic and the World Health Organization advise waiting 18 to 24 months after giving birth. Another pregnancy within six months has a higher risk of health problems such as anaemia, as it may not give your body time to recover and can lower your store of nutrients such as folate and iron. This in turn can raise your risk of premature birth, a baby with lower birth weight, even one with congenital disorders.

“It's best to talk to your health professional or clinic about contraception while still pregnant, so you can be prepared,” says Dr De Gouveia. All methods are safe, but some are more effective than others, some have possible side effects, some may not suit your body, health profile or lifestyle, and some – like the pill, ring or patch – may be hard to remember to take or change regularly when you are an excited but exhausted new mom.

Contraceptive methods to consider

Some contraceptive methods are also better for use immediately after birth, while for others it is recommended you wait a few weeks.

• Straight after birth, even if you are breastfeeding, you can use the implant, the progestogen-only pill, condoms, female (internal) condoms), or an intrauterine contraceptive device (IUCD). “However, it is best to have an IUCD fitted at six weeks – immediate placement after birth often leads to expulsion,” Dr De Gouveia says.

• Three weeks after birth, if you are not breastfeeding, and your health professional has checked that you have no risk for a blood clot, you can usually start using the combined pill, the vaginal ring, or the contraceptive patch. These all include oestrogen, and so are best avoided if you are breastfeeding. “Use of oestrogen at any stage of breastfeeding is contraindicated,” says Dr De Gouveia. 

• Six weeks after birth, if not breastfeeding, you can usually begin using a diaphragm or cervical cap. However, if you used one before the birth, your health professional will need to check that it still fits or advise you on a new size. “It is best to be refitted for a diaphragm after each birth,” Dr De Gouveia says. 

Some women use breastfeeding as a form of contraception, but this is effective only if you breastfeed exclusively and your baby is under three months old. It’s vital to start using another method if your baby is older than three months; if you give them anything apart from breast milk, (formula, solid foods, even a dummy); if your periods begin again (even with light spotting); if you stop night feeds and start to breastfeed less often; or if the intervals between feeds lengthen, during the day and at night.

If you need to use emergency contraception while breastfeeding, the levonorgestrel morning after pill is safe to use; the ulipristal acetate pill is not recommended.

There are many things to consider when deciding on the type of birth control after having a baby, but your health professional, pharmacist or clinic sister can guide you, and help you plan the family you and your partner want.

Clicks offers family planning consultations and information on contraception, cycles, hormones and fertility. Mother and baby services include tablets administered as per your doctor's prescription. Click here to make a booking. 

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