Which Birth Control Is Best After Childbirth?
Pregnancy is possible again even before the first period after birth. Choose a suitable method with your doctor based on breastfeeding, health and plans.
In this article 4 sections
Which birth control method is best after childbirth depends on whether you are breastfeeding, your health and when you want your next child. For breastfeeding mothers, the copper IUD (coil), the implant, the injection, the progestogen-only mini-pill and condoms are usually safe and effective options. Remember that you can become pregnant again before your first period returns, so it is best to decide on a method in advance. In the video, Dr Sharmin Afroz explains this topic briefly.
01Why contraception matters after birth
Many people believe that pregnancy cannot happen before periods return or while breastfeeding. But ovulation happens before the first period, so pregnancy is possible even without a period. The World Health Organization advises waiting at least two years before the next pregnancy. Becoming pregnant again too soon raises the risk of anaemia in the mother and of premature birth and low birth weight in the baby. After a caesarean, an early pregnancy can also put extra strain on the previous scar.
02Breastfeeding and natural protection
In the first six months after birth, if the baby is fed only breast milk, feeds regularly day and night, and the mother’s periods have not returned, breastfeeding gives some protection. This is called the lactational amenorrhoea method (LAM). However, if any one of these three conditions is not met, for example once the baby starts other food or periods return, this protection is no longer reliable and another method is needed.
03Which methods can be considered
Long-acting reversible methods
- Copper IUD: a small device placed inside the womb that works for several years and does not affect breast milk. It can be fitted soon after birth or a few weeks later. Fertility returns once it is removed.
- Implant: a small rod placed under the skin of the arm that works for several years and can be used while breastfeeding.
Shorter-acting methods
- Injection: given at regular intervals. After stopping, it may take some time for fertility to return.
- Mini-pill: a progestogen-only pill suitable for breastfeeding mothers. It must be taken every day on schedule.
- Combined pill: contains oestrogen, which for a while after birth can increase the risk of blood clots and may reduce milk supply. Your doctor will decide when it can be started.
- Condoms: can be used at any time and also protect against sexually transmitted infections.
Permanent methods
If both partners are sure their family is complete, female sterilisation (tubal ligation) or male vasectomy can be considered. Tubal ligation can also be done during a caesarean. These are permanent, so the decision should be made carefully.
When to see a doctor
- Discuss contraception at your postnatal check-up, or ideally before the birth
- If you need emergency contraception after unprotected sex, seek advice as soon as possible
- Fever, severe lower abdominal pain or foul-smelling discharge after an IUD is fitted
- A missed period with lower abdominal pain or bleeding while using a method: go to hospital promptly
- Leg pain and swelling, breathlessness or chest pain: seek emergency care
Q & A
Frequently asked questions
Breastfeeding protects only under specific conditions: full breastfeeding in the first six months with no periods. If these are not met, pregnancy can happen.
It depends on the method; some can be started right after birth. Decide with your doctor at your postnatal check-up, or before.
No. The copper IUD contains no hormones and does not affect breast milk.
Yes, a copper IUD can be used after a caesarean. Your doctor will advise on the right time for you.
Article & video by
Dr. Sharmin Afroz
Obstetrics, Gynaecology & Infertility Specialist and Laparoscopic Surgeon
Assistant Professor, Department of Obstetrics & Gynaecology, Anwer Khan Modern Medical College & Hospital.
