Best and worst post-birth contraceptives

YOU are six weeks post-childbirth and have officially been given the stamp of approval by your health care provider to resume intercourse. But while you and your significant other might be anxious to reclaim your sexual intimacy, obstetrician-gynaecologist (ObGyn) Dr Robyn Khemlani said that if you are not using birth control, then you should consider your options to reduce your chances of an unplanned pregnancy.

“It is possible to get pregnant very soon after having a baby if you have sex and do not use birth control. Some women can become pregnant even before their menstrual period returns. Starting a birth control method immediately after you have a baby can help you avoid an unintended pregnancy. It also lets you control if or when you want to become pregnant again,” Dr Khemlani told All Woman.

She pointed out that there are several birth control options available to women, which they may be able to access very soon after giving birth. A woman will, therefore, have to decide which option best suits her individual needs, taking into consideration her breastfeeding status.

One method you can install almost immediately after giving birth is the hormonal or non-hormonal intrauterine device (IUD).

“An advantage of the copper IUD is its lack of hormonal content, avoiding any theoretical effect on breastfeeding. Although previously concerns were raised that hormonal methods could have a negative effect on breastfeeding outcomes, now several reviews found that progestin-only contraceptives do not appear to adversely affect a woman’s ability to successfully initiate and continue breastfeeding or an infant’s growth and development,” Dr Khemlani reasoned.

She said that the IUD, either non-hormonal or progestin-only, is a small, T-shaped device that your ObGyn inserts into your uterus. It can be done immediately after delivery, meaning within 10 minutes of a Caesarean section or vaginal delivery; however, she said doing it at this time increases the chances of expulsion.

“Immediate insertion plays a significant role in preventing a rapid repeat and unintended pregnancy; however, when placed immediately there is a higher rate of expulsion of the IUD. If you are concerned about this then you can insert it at four weeks post-partum,” Dr Khemlani advised.

Once inserted, she said, you do not have to do anything else to prevent pregnancy. However, you must use a condom to protect yourself against sexually transmitted diseases. She said that the use of IUD also does not interfere with sex or daily activities.

Another available contraceptive method is the birth control implant. This method, according to Dr Khemlani, is a progestin-only method which consists of two flexible rods approximately the size of a matchstick that your ObGyn inserts under the skin in your upper arm.

“This method, like the IUD, can be inserted immediately after delivery regardless of breastfeeding status. This method allows you protection against pregnancy for up to five years. Like the IUD method, you can have you ObGyn remove it before this time lapses,” Dr Khemlani outlined.

One of the more common methods used by Jamaican women is the birth control injection. It contains a type of progestin called depot medroxyprogesterone acetate (DMPA) which works by preventing ovulation. Dr Khemlani said that your ObGyn will give you a shot of DMPA in your arm or buttock every three months. The first shot can be given right after a vaginal or Caesarean delivery.

“Another method popular among women is the combined oral contraceptive pills. They contain oestrogen and a progestin. They are not recommended in the post-partum period, since women have a higher risk of developing blood clots in veins located deep in the body. The condition is called deep vein thrombosis (DVT). Combined hormonal methods could increase the risk of DVT even further; however, if a woman does not have any additional risk factors for DVT, then she can start using these methods three weeks after childbirth,” Dr Khemlani advised.

Another downside of using this contraceptive method is the fact that there is a very small risk that the oestrogen in these methods can affect your milk supply if you are breastfeeding. Dr Khemlani recommends that you avoid these methods for the first four to six weeks after childbirth until breastfeeding is established. Also, combined hormonal methods have been linked to a small risk of stroke and heart attacks.

“Combined oral contraceptives are also not recommended if you are older than 35 years and smoke; have high blood pressure or a history of stroke, heart attack, or DVT; have a history of migraine headaches with aura; have certain medical conditions; or have breast cancer or a history of breast cancer,” Dr Khemlani warned.

Another option that women can utilise is the barrier method — these include spermicides, male and female condoms, the diaphragm, the cervical cap, and the sponge. These methods work by preventing the man’s sperm from reaching the woman’s egg. While condoms can be used once you start having sex again post-childbirth, Dr Khemlani said that the cervical cap, diaphragm, and sponge can be used starting six weeks after childbirth when the uterus and cervix have returned to normal size. If you used a diaphragm or cervical cap before childbirth you should be refitted after childbirth.