A couple of months ago, my best friend sent a message to our girls WhatsApp group to ask what contraception everyone used (if any). She’d just had her first baby and at her six-week postnatal check-up, the GP had asked her what she was planning to do contraception-wise. I remember being asked the same question six weeks after having my first child, and almost laughing out loud. Not only because said baby had been conceived via IVF, but because the very idea of having sex was about as appealing as going through my 48-hour failed induction and resulting c-section all over again.
I watched the replies ping in with interest – coil, natural cycles, withdrawal method – because my GP would soon be asking me the same thing again. Yep, after going down the no contraception route after baby no.1 – “why bother?!” thought naive old me at the time – I was pregnant with my second, conceived naturally when my son was one and a half. I hadn’t even got my period back, so seeing two lines appear on the pregnancy test was a BIG surprise.
There was a time I didn’t think I’d have any children, so I feel very lucky and content to have two beautiful kids. Also, as I was being stitched up after my second c-section, the consultant told me that having a third would require another surgical birth and likely result in permanent bladder damage. Needless to say, I’m taking the contraception question a lot more seriously this time around. The only problem was, I had no idea what kind to go for. Ten years on the pill had left me without a menstrual cycle and lead to fertility treatment, the idea of anything being inserted into my cervix makes me shudder and if I didn’t get a cycle back again this time, how could I track it naturally? A quick canvass of friends with children – all in their mid-thirties – revealed I wasn’t the only one flummoxed by the contraception conundrum, so I quizzed obstetrics and gynaecology junior registrar doctor Lauren Jackson about the pros and cons of each, finding the right one for you and exactly why you need to think about it so soon after having a baby.
Here’s what she had to say…
For many women, sex is the last thing on their minds six weeks after giving birth – why is it one of the first things a GP asks during a postnatal check-up?
“Contraception is actually important from 21 days after having a baby, as, amazingly, this is the point at which you become fertile again and could potentially get pregnant again. Now, a lot of women won’t be having sex again this soon (which is fine and completely normal), but some women will feel ready (which is also fine and completely normal!). Usually, women don’t want to get pregnant immediately (in fact the World Health Organisation recommend leaving 24 months between pregnancies to reduce risks of adverse outcomes), so contraception is an important thing to think about.”
“However, as a busy new mum doing things for yourself often comes bottom of the pile. We know contraception falls to the bottom of the list and so when we see new mums post-natally we like to offer contraception so it can opportunistically jump to the top of the list.”
Can you talk us through the contraceptive options available to women?
Coils (hormonal or non-hormonal)
Pros:
- “Fit and forget” – once it’s in, you don’t have to think about it
- Lasts for 5-10 years
- Some coils can make periods much lighter or stop completely (non-hormonal copper coils often make periods heavier though)
- Can be fitted immediately after birth or at caesarean
- Can help treat conditions such as PCOS or endometriosis
Cons:
- Needs to be taken out by GP or at a Family planning clinic
- 2-8/1000 failure rate (depending on coil type)
- If not fitted within 48 hours of birth you will need to wait until 28 days post-natal
Contraceptive implant
Pros:
- Another “fit and forget” option
- Lasts for 3 years
- Can make periods much lighter or stop completely
- Can be fitted immediately after birth
- Can help treat conditions such as PCOS or endometriosis
Cons:
- Needs to be taken out by GP or at a Family planning clinic
- 5/10,000 failure rate
- 3/10 women with an implant may experience frequent or prolonged bleeding
Condoms
Pros:
- Non-hormonal method of contraception
- Protect against STIs
Cons:
- 18/100 failure rate
Oral Contraceptive Pill
Pros:
- Able to stop and start whenever you like
- Can help treat conditions such as PCOS or endometriosis
Cons:
- Need to remember “pill rules” for missed pills (need to take pill at the same time each day)
- Roughly 9/100 failure rate
- Some pills increase your risk of blood clots (those that contain oestrogen)
Injection
Pros:
- Lasts for 8-13 weeks
- Can make periods much lighter or stop completely
Cons:
- Can take up to 1 year for your normal fertility to return
- May cause weight gain
- 6/100 failure rate
A lot of women are wary about hormonal contraception – are there any reasons women should avoid it?
“There are some reasons women should avoid hormonal contraceptives containing oestrogen and this is due to the increased risk of blood clots. Usually, women with a higher BMI, who are smokers, or who have a family history of blood clots will be advised against these types.
You don’t need to worry too much about this – it is the job of the person prescribing the contraceptive to make sure you take one that is safe for you.”
What is the best option if you do want another baby in the not so distant future?
“This is a very individualised choice and what is “best” for one person won’t necessarily be “best” for another. Coils are a great form of contraception and can be very easily and quickly removed, pills mean you can stop whenever you like, but do have a higher failure rate.”
Which type of contraception do you see women opting for most often post-baby?
“Currently, I work in a unit where we fit a lot of coils and implants.”
Do you need to take contraception while breastfeeding, and is it safe to?
“Yes, it is safe – you may need to wait a little longer to take the combined pill (be guided by your team). Some people use “lactational amenorrhea” (the absence of a period while breastfeeding) as a form of contraception, but this does have a high failure rate.”
Finally, how soon can you start taking contraception after having a baby?
“With most types straight away – a coil can even be put in as part of a caesarean!”
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