Your guide to birth control after baby

If you’ve just had a baby, you may be rethinking your contraception. Use this guide to find out what your options are. By Tammy Jacks

Birth control after baby

After conceiving, then being pregnant, and now feeling sleep deprived as a new mom, you may not have considered your birth control options and how your needs have changed. The good news is, whether you’re breastfeeding and need something temporary or you’re looking for a more permanent solution, there are plenty of safe, effective methods to choose from.

“The range of contraceptives available are designed to cater for women’s specific health needs,” explains Dr Sibongile Nomganga, medical advisor on women’s health at Bayer. Plus, they offer more than just birth control. For instance, some hormonal formulations help to control acne, while others are used to regulate menstrual cycles, reduce pain and minimise heavy bleeding.

Before you decide which method is right for you, consider the following, says Dr Nomganga:

  • If you’re breastfeeding, speak to your healthcare provider about alternatives to oestrogen-based hormonal contraceptives that can interfere with your milk supply.
  • Choose a simple, convenient method. Your choice of birth control shouldn’t interfere with your busy schedule. This means you might opt for an injection that lasts 12 weeks rather than a pill you’ll need to remember to take every day.
  • Chat to your partner about the age gap you’d like between your kids. This will give you an opportunity to decide on your preferred birth control method, and the consequences should it fail.

ALSO SEE: Your guide to birth control while breastfeeding

Hormonal contraceptives

Birth-control pill

The Pill is by far the most popular contraceptive among South African women today, says Dr Mark van der Griendt, an obstetrician and gynaecologist at Netcare Parklane Hospital in Johannesburg. “This is because it’s convenient and 99% effective,” he explains.

However, he warns that women still need to be diligent about how they take it. The combined pill delivers small doses of oestrogen and progestin (a synthetic form of progesterone) to suppress ovulation, while thickening cervical mucus to prevent sperm from entering the uterus. “Most combined pills work on a 28-day cycle, with 21 active pills and seven placebo, or non-active, pills. However, over the past five years, scientists have developed new formulations with fewer placebo pills and more active pills, which are available in South Africa,” he says. This increases the effectiveness, as women are taking more oestrogen, which stops ovulation and, in general, offers better menstrual-cycle control.

What you should know

  • The combined pill is considered safe for low-risk patients, and women can take it for many years after having kids, says Dr van der Griendt. “However, if you’re considering going onto a new formulation, it’s important that you consult your doctor first to assess your individual risk,” he adds.
  • If you have a history of blood clots in your family, or a genetic predisposition towards blood clotting, strokes or heart problems, it’s safer to avoid oestrogen altogether, advises Johannesburg-based obstetrician and gynaecologist Dr Tom Mokaya. Progesterone is a safer contraception option and doesn’t raise the risk of blood clotting. Progesterone-only forms of birth control include injections, the Mirena or a copper intrauterine device (IUD). Non-hormonal contraceptives such as the diaphragm and male and female condoms are also a good choice for high-risk patients, he adds.

Minipill

The minipill contains a low dose of progestin (no oestrogen). This pill also works on a 28-day cycle and you take one every day at the same time.

What you should know

The key to this contraceptive is that you have to take it at the same time every day to guarantee its effectiveness, advises Dr van der Griendt. So, although it’s safe to take while breastfeeding, and won’t affect milk supply, it requires planning and discipline (not ideal for sleep deprived moms). If the interval between taking each pill is longer than 24 hours, cervical mucus thins and could allow more sperm through to the egg.

Patch

The hormonal patch works like the combined pill, except it delivers gradual doses of progestin and oestrogen through the skin. The waterproof patch is placed on any area of the body and is worn for three weeks, with a one-week break before starting the cycle again.

What you should know

Some studies suggest that the patch carries a higher risk of blood clots and stroke than the Pill, but more research is needed in this regard.

Mirena

Also known as a type of IUD, the Mirena is a T-shaped device made from copper, which is inserted inside the uterus. This device releases progesterone slowly while the copper creates changes in the cervical mucus and inside the uterus. This kills sperm, or makes it immobile, according to the American Pregnancy Association. It also changes the lining of the uterus, preventing implantation should fertilisation occur.

What you should know

Having the Mirena inserted can be uncomfortable, and some women have reported that it causes back pain or period pain. It should be inserted by a professional at a hospital or day clinic to prevent complications, and a follow-up visit will then be scheduled two to three months after insertion. It can remain in place for up to five years to prevent pregnancy.

Vaginal ring (NuvaRing)

This plastic ring is inserted into the vagina just near the cervix and gradually releases a combination of progestin and oestrogen in lower doses than the Pill or patch. It works over a three-week period, changing the structure of the cervical mucus and the hormones suppressing ovulation. After this time, you take it out and replace it a week later.

What you should know

The vaginal ring isn’t painful and won’t interfere with sexual intercourse or tampon use should you experience spotting or mild periods. This method of contraception is safe and almost 100% effective, according to the US Food and Drug Administration. It’s not recommended for those with a history of blood clotting as it does release oestrogen.

Injection (progesterone only)

There are two types of injectable contraceptives, explains Dr Mokaya – a 12-week injection and an eight-week injection. They involve low doses of progesterone being released into the body during that time, which thickens the mucus in the cervix, stopping sperm reaching an egg. It also thins the womb lining.

What you should know

It may take longer for your menstrual cycle (and fertility) to return to normal after stopping the injection. Doctors suggest not using the injection for at least six months before trying to conceive. As the injection has been linked to bone density loss, it’s important to discuss the risks with your doctor if you have a family history of osteoporosis, or have had an eating disorder.

ALSO SEE: Your period after baby – what you need to know

Barrier methods

Female condom

A female condom is a long plastic sheath that’s inserted into the vagina (similar to how you’d insert a tampon), and held in place by flexible inner and outer rings. “If used correctly, female condoms are 95% effective in preventing pregnancy as they catch the sperm before it enters the uterus,” explains Dr Mokaya. An additional benefit of condoms is protection against sexually transmitted infections.

What you should know

The Centers for Disease Control and Prevention warns against using female and male condoms together, as this could cause one or both of the condoms to tear. The condom should be disposed of immediately after use.

Diaphragm

This form of contraceptive is a dome-shaped rubber or silicone cup that’s filled with spermicide and inserted into the cervix to prevent sperm from entering the uterus. Diaphragms aren’t popular in South Africa because they’re not readily available. “If used correctly, a diaphragm’s effectiveness is about 94%,” says Dr Mokaya. It should be left in for at least five to seven hours after intercourse.

What you should know

The spermicide can cause infections and irritation. The diaphragm should never be worn for more than 24 hours, as this can cause toxic shock syndrome.


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