Q: Is it ok to start trying for a baby as soon as I come off the Pill, or should I wait to make sure that all traces of it are out of my system?
A: You don’t need to worry about traces of the oral contraceptive pill being ‘out of your system’ – the Pill contains hormones that are very similar to the ones your body produces naturally. And although we don’t recommend that you carry on taking the Pill when you’re pregnant, studies suggest that it doesn’t do any harm to the baby if you do take it without realising that you are pregnant.
But one reason why you might want to use another method of contraception (such as condoms ) for a few months after you stop the Pill is because the ‘periods’ that you have while you’re on the Pill aren’t real periods at all. They’re ‘withdrawal bleeds’ – you withdraw the hormones when you have your week off each month, and this stimulates your body to bleed. That means that you won’t know how long your natural cycle is while you’re on the Pill. Within a month or two of stopping, your body usually goes back to its normal menstrual pattern, so you’ll know how long your cycle is. This can help, when you get pregnant, to work out when your due date is.
Q: For our holiday, my husband and I will be having immunisations against yellow fever, hepatitis and malaria. When we get back, we want to start a family. Is there a certain amount of time after the injections and tablets to wait before trying for a baby?
A: Some malaria tablets, like chloroquine and proguanil, are safe during pregnancy. Others, like doxycycline and malarone, should be avoided. Only mefloquine involves avoiding getting pregnant, while you’re taking it and for at least three months after you stop. Your practice nurse can tell you which one is best for where you’re travelling to. As for the immunisations, it’s probably best to avoid most of them if you’re actually pregnant (unless you really have to travel abroad), which shouldn’t be a problem for you. Ideally, you should get your immunisations at least a few weeks before you travel. That means it will be at least a couple of months after you have the vaccine by the time you get back. It should be perfectly safe to try for a baby this length of time after yellow fever or hepatitis immunisations.
Q: We’re planning on starting a family but my partner is terrified if a normal birth. She was abused as a child and raped 7 years ago, resulting in a termination. She has also had incidences of psychosis in her past. Would these circumstances entitle her to a caesarean if she would prefer this option?
A: I’m so sorry to hear that your partner has had such a hard time in the past. Past psychological or sexual traumas can have an impact on the likelihood of getting postnatal depression, and a difficult time during delivery can be especially distressing. I think you have a very good case for discussing the possibility of an elective caesarean section with your consultant, who would make the final decision, but there’s every reason to believe that the doctors at the hospital would be sympathetic. They would explain all the pros and cons of caesarean delivery, so that your partner knows what is involved. For instance, the rate of medical complications is higher for caesarean operations rather than vaginal deliveries – although lower for electives rather than emergencies. You and your partner should discuss this with your doctor before she starts trying to get pregnant – that’s important if she’s taking any medication.
Q: I’ve been on the Pill for the past 3 years, but my partner and I have now decided to start a family. Can we start trying straight away, or do I need to wait for the contraceptive to clear my system?
A: There’s no medical reason why you shouldn’t start trying to get pregnant as soon as you stop taking the pill. The hormones in both the combined oral contraceptive pill (‘the Pill’) and the progesterone only pill (‘the mini-pill’) are basically the same hormones that your body makes itself. All these pills are doing is replacing some of your natural female hormones. This means that the rise and fall in hormones that normally goes on through your cycle and which causes changes in the mucus of your cervix or makes you produce an egg (ovulate), doesn’t happen.
If you forget a pill by more than 3 hours (for the progesterone only pill) or 12 hours (for the combined oral contraceptive) your body’s natural hormones can ‘kick in’ and you can get pregnant. The same applies when you come off the pill. You’re not more likely to have a baby who has any medical problems if you get pregnant straight after you stop the pill. It doesn’t seem that you’re more likely to miscarry if you get pregnant when you’ve just stopped the pill, either.
The only real reason for waiting is to see what happens to your periods when you stop the pill. If your cycle turns out to be 6 weeks instead of 4, for instance, you’ll know when you get pregnant that your due date will be 2 weeks later than it would be if your cycle was 4 weeks. But don’t worry – when you get pregnant, you’ll have an ultrasound anyway which will tell you when your baby’s due.