You gave birth to your first baby a few hours ago and have a lot on your mind.
Your boobs are swelling at an alarming rate as your milk comes in and your stitches make you wince when you breathe, let alone move.
You’re hollow-eyed with euphoria and exhaustion and are trying feebly to make yourself look presentable for all the visitors who will soon be crowding round your bed.
Then who should pop up but a cheery midwife clutching a clipboard.
‘Just a little chat about contraception, dear,’ she trills. You feel like shrieking: ‘Are you insane? I’m never having sex again!’
But you mumble something about condoms until, at last, she goes away. ‘As if I’d ever want to put myself through this again,’ you think, incredulous.
Yet it’s a fact that by the time they’re due for their first postnatal check, some women are already pregnant. They are just coming to terms with the demands of a new baby when they discover they’re facing the prospect of doing the same thing all over again in less than a year’s time.
So why does it happen? Angela Reynolds of the Family Planning Association explains: ‘Some women are misinformed about post-natal contraception and their knowledge of how their reproductive organs work is poor. Most really don’t want to discuss contraception after they’ve just given birth. And they certainly don’t want any advice about it.’
Few women plan to become pregnant so soon after having their first child, but fertility can return quickly.
Even if you’re breastfeeding, your periods can come back within three months, but they may take a few months to settle back into a pattern, so trying to calculate a ‘safe time’ could catch you out.
‘When you’ve just been through labour, sex may be the last thing on your mind,’ explains Angela Reynolds. ‘’Women say, and mean, that they are never going to have sex again. But even if you’re determined, it’s still worth planning your contraception, just in case you do change your mind.’
Contraception: all you need to know
Your body can be ready to bear children again 28 days after giving birth, so it’s important to know the facts about post-natal contraception:
Your baby’s sucking stimulates hormones which stop ovulation, so its effectiveness as a contraceptive depends on how long and how often he feeds.
You need to feed every three to four hours, day and night and give no other food to your baby for this to work. And if he sleeps through the night, even if you feed him breast milk all day, you need additional protection.
You also increase your risk by supplementing feeds with formula. The longer you breastfeed the less effective it is as a contraceptive.
You can’t guarantee protection through breastfeeding.
The Pill Breastfeeding women can take the mini-pill (progestogen-only) from 21 days after the birth. It has to be taken in the same three-hour period every day without a break. The combined pill (oestrogen and progestogen) isn’t suitable if you’re breastfeeding as it affects your milk. But non-breastfeeding mums can take it 21 days after birth.
Intrauterine device (IUD) or system (IUS) The IUD, otherwise known as the coil, can be fitted six weeks after a vaginal delivery, or eight weeks after a caesarean. The delay is to allow the uterus to return to its normal size and, in the case of a caesarean, for scar tissue to heal.
The IUD works by sitting inside the uterus and stopping sperm from reaching the egg or stopping a fertilised egg implanting. The IUS works similarly in that it is also an implant that fits inside the uterus, but it works by releasing a steady dose of progesterone, for up to ten years at a time. Both are safe for mums who are breastfeeding.
The cap This sits over the cervix to act as a barrier to sperm. You will need this re-fitted after birth because of your pregnancy weight gain. Have it checked each time you lose half a stone.
Injectable contraceptives You have a Depo Proven injection every 12 weeks, from six weeks after the birth, and it’s suitable for breastfeeding mums as it’s progestogen only.
The morning-after Pill You can take the morning-after Pill even if you’re breastfeeding. There’s a progestogen-only version, which won’t interfere with your milk supply.