Contraception – your questions answered

Think you can’t get pregnant straight after giving birth? Then think again! You need to think about your contraceptive options

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The most unexpected thing a midwife asks you just days after you’ve given birth is: “What contraception are you going to use?” Exhausted and with baby at breast, most new mums don’t put sex at the top of their agenda. Yet once you feel human again, it’s important to think about contraception.

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“With the majority of mums juggling career with family commitments, many are too busy to focus on contraception,” says health expert Dr Miriam Stoppard. “They find themselves relying on methods such as condoms, or even withdrawal. But today’s contraception is more sophisticated, effective and reliable than ever.” So what are your options?

I’m breastfeeding – do I need contraception?

Yes, you do. You’re unlikely to get pregnant if you’re exclusively breastfeeding a baby under 6 months every two to four hours, with no missed feeds, and if you’ve not had any periods yet. But it’s still possible.

I want a long-term contraceptive solution I can manage myself

The Pill

The mini pill contains progestogen and can be used from 21 days after birth and when breast-feeding. Fertility returns as soon as you stop taking it. The combined pill contains oestrogen, which can affect milk supply, so if breastfeeding you’re usually told to wait until your baby is 6 months old.

If you’re not breastfeeding, your doctor can prescribe it from 21 days after you give birth. Fertility should return soon after you stop taking it. It may make periods lighter and reduce PMT, but some women gain weight and have skin problems.

Contraceptive patch

The contraceptive patch releases the same hormones as the combined pill. If you often miss pills, it’s a good option as each patch lasts seven days. Fertility returns as soon as you stop using it. From your doctor or family planning clinic.

Natural family planning

Natural family planning involves monitoring body temperature and cervical secretions. If followed to the letter, it can be up to 98% effective. You’ll need to avoid sex or use a barrier contraceptive during fertile times.

“I bought a book that explained how to do it,” says Liz, 37, mum to Ade, 2. “Although it took a few months to get the hang of it, it’s second nature now.”

I want contraception I can forget about

The latest generation of methods is called LARCS – long-acting reversible contraceptives. “There’s no need to remember a pill every day, and they’re more than 99% reliable,” says Dr Stoppard. “There are side effects, but the chance of these is generally low.”

For more info, visit the Family Planning Association.

IUS

This is a small, plastic T-shaped device that releases progestogen for up to five years. Inserted into the womb by a doctor or nurse six weeks after birth, it should make periods lighter and less painful. Some women report irregular periods and temporary acne or tender breasts.

IUD (coil)

This small plastic and copper device is inserted into the womb by a doctor or nurse as early as six weeks after birth, staying in place for 5 to 10 years, depending on the type. Some report heavier, longer, more painful periods.

“I had a coil fitted a few weeks after my daughter was born,” says Bec, 35, mum to Lucy, 3. “It was a bit uncomfortable to insert, but no worse than a smear. Once it was in, I just forgot about it.”

Progestogen injections

This hormone is injected into muscle every eight or 12 weeks by a doctor or nurse, from six weeks after birth. It can’t be reversed if you suffer side effects such as head-aches or skin problems. Fertility may not return for several months after injections stop.

Contraceptive implant

A small flexible rod is implanted under the skin of the upper arm by a doctor or nurse. It can be done 21 days after the birth. It slowly releases progestogen and lasts up to three years. Some women get headaches, skin problems and irregular periods, or periods may even stop altogether.

We don’t often have sex – I want a simple solution

Condoms

Condoms are an obvious choice, especially if you’re not having frequent sex. Up to 98% reliable and easy to use, they’re widely available (and free from your GP or FPA).

The diaphragm

The diaphragm is a flexible rubber dome used with spermicide and is put into the vagina to cover the cervix before sex. After sex, it’s removed. It must be fitted at a family planning clinic, and you can start using it six weeks after birth. If you used one before pregnancy, check with your doctor or nurse that it still fits you.

Mum’s story

“I got pregnant again, six weeks after birth”

“I got pregnant with Andrew the first time we had sex after Georgie was born. I wasn’t breastfeeding, but my periods hadn’t started yet. I knew we’d taken a risk, so I took the morning-after pill. At my six-week check I told my GP my periods hadn’t re-started and he did a pregnancy test – it was positive.

“I was in complete shock, especially as I’d taken the morning-after pill. My GP asked if I wanted to go ahead, but I couldn’t consider a termination. Looking back I’m glad things turned out the way they did.”

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Annie 38, mum to Georgie, 4, Anita, 3, and Frankie, 7 months

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