None of Carina Bezuidenhout’s children was planned. But her third was definitely the “most unplanned”. She successfully relied on breastfeeding as a form of contraception when she nursed her first born. Relying on the same degree of success while exclusively nursing her second child, Carina was shocked and overwhelmed to find that she’d fallen pregnant with her third child when Ciane was just four months old.
Here’s what you need to know about birth control while breastfeeding:
The lactational amenorrhea method (LAM) that Carina had relied on as a form of family planning delays fertility by inhibiting ovulation in postpartum women, explains obstetrician and gynaecologist, Dr Amy Wise.
Obstetrician and gynaecologist Ebrahim Bera explains when LAM can work:
- If you don’t have your period. Your period constitutes two consecutive days of bleeding or a bleed similar to your menstrual bleed after the first eight weeks post-delivery.
- You breastfeed exclusively, both day and night.
- You are within the first six months after giving birth.
Wise cautions that breastfeeding mothers must be aware that:
- Pumping milk can make LAM less reliable.
- Once there’s mixed feeding, the risk of conception will be high.
Lam isn’t a contraception guarantee
If all the conditions required for LAM to work are met, the risk of pregnancy is 2% in the first six months post-delivery. But the interaction between breastfeeding hormones and the hormones responsible for ovulation vary, so it’s possible to ovulate during this time, cautions Bera.
“Because the egg is released 14 days before menstruating, breastfeeding mothers waiting for their first period can’t predict when the first egg will be released,” warns obstetrician and gynaecologist Dr Carol Thomas. She doesn’t recommend solely relying on breastfeeding as a contraceptive method.
Contraception options need to be considered carefully, so that you can keep on breastfeeding.
Best birth control options while breastfeeding
Barrier methods and withdrawal
“Female and male condoms, when combined with the effect of breastfeeding, are good contraceptive choices during the breastfeeding period. In other words, two not-so-perfect methods make a good contraceptive method in combination,” advises Thomas.
As for withdrawal, although commonly practiced, it’s not as safe as one might think. “It’s a misperception that sperm is only present when ejaculating.” Early male lubricationor pre-ejaculate may be less, but more concentrated. Think condensed milk versus skim,” says Thomas.
The addition of oestrogen – in the combined oral contraceptive referred to as ‘the pill’ – can decrease and even stop breastmilk supply, cautions Thomas. Therefore, all hormonal methods of contraception during lactation contain progestogen only.
Progestogen causes cervical mucus to become viscous and hostile to sperm and thins the uterus lining, which inhibits implantation. Some hormonal methods may also inhibit ovulation.
Because progestogen methods stop the uterine lining from forming, it’s common not to get a period. “Should the lining become too thin, irregular bleeding and spotting may occur, but this doesn’t mean that the method is ineffective. It is easily treated or can be ignored,” says Thomas
The available progestogen-only methods are:
- The progestogen-only pill or ‘mini-pill’(Hy-An®, Microval®)
- Progestogen injectables (Depo Provera®, Petogen®, Nur-Isterate®)
- The progestogen sub-dermal implant (Implanon NXT®)
- The progestogen intra-uterine device (Mirena®)
The mini pill is a progestogen-only pill taken daily that can be started three weeks post-delivery. This contraceptive method is ideal for women who are diligent about taking pills daily.
- “During breastfeeding its efficacy approaches 100%. It doesn’t affect breast milk supply and the breast milk only contains minute amounts,” she counsels.
- It’s easy to take.
- Taking the tablets isn’t timed to sexual intercourse.
- The return to fertility upon discontinuation is rapid.
“It needs to be taken religiously at about the same time every day,” warns Thomas. “This may not fit into the routine – or non-routine – of women who’ve just had a baby.”
According to bera, other possible side-effects include:
- Irregular bleeding
- Breast tenderness
- Weight gain
Progestogen sub-dermal implant
“The Progestogen sub-dermal implant is a 40mm x 2mm rod with progestogen that is implanted into the upper arm under the skin every three to five years,” explains Bera. It can be inserted four to six weeks post-delivery. This contraceptive method is ideal for women with adherence problems.
- “It won’t affect breastfeeding,” counsels Wise. “It’s as reliable as injectables, intra-uterine devices and female sterilisation,” says Thomas.
- It’s long lasting.
- It may be difficult to remove and subsequently cause scarring.
- Breast tenderness
- Mood changes
A progestogen-only injection administered every two to three months. It can be administered immediately
after delivery, says Wise. This is ideal for women who forget to take pills daily.
- “The injectables are highly effective and are as reliable as female sterilisation, but obviously aren’t permanent methods,” explains Thomas.
“It doesn’t affect the milk quality or have an effect on the baby,” says Wise.
- You don’t have to set an alarm for a daily pill.
- It can reduce menstrual and pre-menstrual symptoms.
- Contraception isn’t timed to sexual intercourse.
- “The injectables shouldn’t be used in women who may be at risk of postpartum depression,” counsels Thomas.
- Possible headaches.
- Weight gain – up to 2-3kg a year.
- It’s non-reversible for two to three months once the injection has been given.
- Delay in a return to fertility – up to nine months.
There may be an increased risk of breast cancer.
Intra-uterine device (IUD) and system (IUS)
The copper intra-uterine device is placed inside the womb. “It prevents pregnancy by changing the lining of the womb,” explains Bera. It also has a toxic effect on sperm and ova and decreases sperm motility.
“It can be inserted four to six weeks after a normal vaginal delivery and six weeks after a caesarean section. Depending on the product, it’s effective for a minimum of five years. It can be removed before that
if fertility is desired. As it’s non-hormonal it doesn’t affect breastfeeding,” says Wise.
The IUS is a progestogen rod that is placed inside the womb. “The progestogen contained in it mainly acts locally and so has no effect on breast milk,” explains Wise.
Both are over 99% effective.
Advantages of IUD and IUS:
- Doesn’t interrupt sex, as your partner shouldn’t be able to feel it.
- There’s no need to remember contraceptive precautions.
- There’s rapid return to fertility after it’s removed.
Disadvantages of IUD and IUS:
- Both require trained health-care workers for insertion.
- Menstruation can be longer and heavier when using the IUD, cautions Bera.
Xanet is an award-winning journalist and Living and Loving’s digital editor. She has won numerous awards for her health and wellness articles and was a finalist for the Discovery Journalist of the Year in 2009 and again in 2011 for the Discovery Best Health Consumer Reporting and Feature Writing category. She is responsible for our online presence across social media channels and makes sure our moms have fresh and interesting articles to read every day.