Breastfeeding-compatible Birth Control

One commonly held myth is that a breastfeeding woman cannot become pregnant. As with all myths, this is not true but contains some truth. Breastfeeding is indeed a very reliable form of contraception (98% effective), but only when certain conditions are fulfilled:

(1) You have not yet started your periods;
(2) You breastfeed at least every four hours over the day and six at night; and
(3) All of your baby’s sucking needs are met at the breast: pacifiers, bottles of tea or expressed milk, and even extensive thumb sucking are not allowed.

Although many women do not become pregnant for as long as they are breastfeeding, as soon as one of the above conditions is not being met you should consider yourself fertile and use another form of contraception unless keen to conceive again quickly. Here is a short overview of some of your many birth control possibilities.

Natural Family Planning (NFP): In this method, a woman notes her body temperature, cervical mucus consistency, and the degree of opening of her cervix every day to identify the days in which she is fertile and avoids sex (or actively initiates it when wanting to become pregnant) on these days. This method is 91-99% effective when used properly, but a breastfeeding woman has very subtle signs and it might be difficult to begin practicing NFP while breastfeeding.

Barrier Methods: Condoms, diaphragms and the like offer a very good birth control option when used correctly, and they can be used in conjunction with other methods (e.g., NFP). They have no effect on breastfeeding and are inexpensive and widely available, but can be inconvenient. Condom usage, and indeed sex in general, may be difficult because of the vaginal dryness and tightness caused by the low estrogen levels associated with breastfeeding, especially in the early months. Liberal use of a water-based lubricant can help.

Hormonal Methods: There are many hormonal birth control options available: tablets, implants, injections, and hormone-IUDs, to name a few. Contraceptives containing estrogen (“the pill”) are not a good choice for breastfeeding women because their use very often will cause a decrease in milk supply, but progestin-only methods of contraception (“the mini-pill”) are considered to be breastfeeding-compatible. If you decide to use estrogen-containing contraceptives, it is recommended that you wait until at least six months postpartum, when breastfeeding has been well established and the child is taking in some solids to compensate for the loss of milk. Progestin-only contraceptives can be introduced as early as about six weeks after birth. If you opt for one of the long-lasting methods (injection, implant, or IUD), it is perhaps best first to carry out a trial using tablets because these can be more easily left aside if you experience any undesired side effects.

Non-hormonal IUDs: These are highly effective in preventing pregnancy and are considered compatible with breastfeeding. To reduce the risk of expulsion, it is recommended that an IUD be inserted either within the first two to four days after birth or at least six weeks postpartum.

Sterilization: If you and your partner are absolutely certain that you want no more children, sterilization is an option. This procedure is very effective in preventing pregnancy (virtually 100%) but is irreversible. Neither mother nor child is affected when the man undergoes a vasectomy; with a tubal ligation, however, breastfeeding may be affected indirectly, particularly if it is performed immediately after birth. Full or partial hysterectomy does not directly affect milk production.

I urge you to consult your gynecologist when deciding what form of birth control is best suited to you and your situation. But even when this has been taken care of, do not expect things to return quickly to how they were before the baby arrived. Many women are not the least bit interested in sex for many months postpartum, while others have more appetite for sex than they had before the pregnancy. Wherever you stand in this broad spectrum of sexual interest, it is important to keep the channels of communication with your partner open and not to forget your relationship as a couple in the euphoria of the new love affair with Baby.

By Beth Brupbacher

Beth is the mother of three daughters, all conceived and born in Switzerland. She has been an LLL leader for five years and runs English LLL meetings in Oerlikon (www.lalecheleague.ch ).

Illustration by Lara Friedrich

Currently a senior at the Kantonsschule Ausserschwyz in Nuolen, Lara is a freelance illustrator for Mothering Matters journal and a demo singer for the songwriter Kate Northrop. She has also written an article for the newspaper Marchanzeiger and is bilingual in English and German with a Cambridge First Certificate in English.

This article first appeared in the printed version of Mothering Matters in 2012.