When you’re up to your elbows in newborn nappies, sex isn’t the first thing on your mind, let alone preventing another little bundle of fun. The Family Planning Association on contraception options after birth

Many women feel pressurised to get ‘back to normal’ as soon as possible after having a baby but it’s important to take your time and do things at your own pace. This is a time of physical and emotional upheaval, not just for you but for your partner too and it can take a while before you want sex again. When you do though, contraception is something you’ll need to think about.

When will my periods start again?
If you are fully breastfeeding, your periods will not return until you stop. If you bottle feed or combine bottle and breastfeeding, your first period could start five to eight weeks, maybe a bit longer, after the birth. How quickly could I conceive again?
If you are not fully breastfeeding you can be become pregnant again quickly after birth. You can ovulate (release an egg) within four weeks of birth. So when is an ideal time to start using contraception?
You can use male and female condoms any time as soon as you want to have sex. Hormonal methods of contraception (pills, implants and injections) can be started three weeks (21 days) after birth. Diaphragms or caps and IUDs or IUS can be used around six weeks after giving birth. If you have had a caesarean, you usually have to wait until about eight weeks.

Does breastfeeding really act as a contraceptive?
Yes, it’s a very effective contraceptive when you are fully breastfeeding a baby under six months old. This is also known as LAM (Lactational Amenorrhoea Method). But remember, fully breastfeeding means what it says:

• Breastfeeding at regular intervals, day and night
• Giving your baby no other food or drink, so breastfeeds are never missed
• Having no periods.

Which contraceptive method should I choose?
Having a baby, finding yourself with a new partner or changing your lifestyle can often be a trigger to rethink your contraceptive needs. It can be useful to ask yourself some questions to help pinpoint what you want now:

• Do I want a short-term method because I would like a baby in the next year or two?
• Do I want a long-term method because I definitely do not want to get pregnant again soon?
• Do I want to use the method I used before?
• Do I want something permanent because I definitely do not want any more children?

If you think you’ll want to have another baby in the next year or so and you don’t want to use a method that has to be used for a long time, you could try:

• Oral contraceptives
  - the combined pill
  - the progestogen only pill
  
• Male or female condoms
• Diaphragm or cap with spermicide
• Natural family planning.

Oral contraceptives
Combined pills contain two hormones, oestrogen and progestogen. They prevent ovulation and you take them for three weeks out of four each month.

• The combined pill is not suitable if you are breastfeeding as the oestrogen component in these pills can reduce your milk.
• Progestogen only pills are suitable; they don’t alter your breast milk or harm the baby. Progestogen only pills are taken continuously with no break.

  There are lots of myths about the Pill. Many women believe it is dangerous or unnatural, yet it has been available for 40 years and research shows that, when properly prescribed to women who don’t smoke and have no medical problems, it is extremely safe. Safer, in fact, than being pregnant and going through birth.

  Male and female condoms, diaphragms and caps
  Male condoms come in a variety of guises – latex or polyurethane – and can be ideal for use just after a baby, giving you time to think about what you really want to use. Using female and male condoms gives you the opportunity to have ‘his and her’ methods.

  Diaphragms and caps work by covering the cervix – the entrance to the womb – and preventing sperm from getting through to meet an egg. If you used a diaphragm or cap before your pregnancy you will need to check that it still fits because your cervix and vagina change shape during pregnancy and birth. If you gain more than 3 kg you must get the fitting checked again. Watch this space – because new caps are being introduced during 2001.

  Natural family planning (NFP)
  NFP allows you to identify the infertile and fertile times in your menstrual cycle so you can plan or prevent a pregnancy. It’s not Russian roulette and when properly taught and used well, it is very effective. NFP can be more difficult to learn and use just after you have had a baby so get advice from a trained NFP teacher. There are also a number of devices, recently on the market, which can help you calculate when your ‘safe’ times are. Ask your local chemist for details.

  Long-term methods of contraception

  If you don’t want to get pregnant for some time, one of the following long-term methods might suit you. They have the added advantage that you don’t have to think about them once they’re in place. Because of this they are extremely effective.

  Injections
  These slowly release progestogen (like the hormone in the progestogen only pill) and last for twelve or eight weeks depending on which you use.

  Implants
  A tiny, flexible tube which slowly releases progestogen is inserted in the arm (it doesn’t show). It lasts for up to three years.

  IUD (Intrauterine device)
  Today’s IUDs (used to be called coils) offer many choices; they last from three to ten years depending on type.

  IUS (Intrauterine system)
  A progestogen-releasing IUD which is fitted inside the womb and works for up to five years.

  Permanent methods of contraception

  Sterilisation
  Only a good idea if you are absolutely sure you never want any more children. Find out more about female sterilisation and vasectomy.

  Information and advice on all methods of contraception or any issue relating to sexual health can be obtained from the fpa helpline on 0845 3101334 or the Family Planning Association website.