Birth Control After You've Had a Baby: Your Best Options
Advice on pregnancy can be confusing. Here's what the experts say about when you can start birth control and which methods to use.
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If you were recently pregnant, birth control may be the last thing on your mind. But your body isn't quite as distracted.
Given the tremendous journey your body just went through, you'd think the reproductive system would take a breather before opening back up for business. But for many people, ovulation occurs within a few weeks of giving birth -- which means you'll be able to get pregnant again relatively quickly unless you interfere through birth control, or if you decide to exclusively breastfeed. Those who don't carry a pregnancy to term can also expect to start ovulating again within a couple of weeks.
"I do tell patients that it's an important facet of planning after you have a child, even during your pregnancy, to start thinking about what you want to use to prevent pregnancy in the future," says Dr. Shari Lawson, an OB-GYN and assistant professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine.
With a few exceptions, most birth control methods are safe to start in the weeks or days after pregnancy (sometimes immediately). But do they all work the same for someone who was recently pregnant? And does breastfeeding count as birth control? Here's what you need to know.
Read more: How soon can you get pregnant after stopping birth control?
Breastfeeding as birth control
If you exclusively and frequently breastfeed (which, according to the American College for Obstetricians and Gynecologists, means at least every four hours during the day and every six hours at night) your body won't ovulate, which means your menstrual cycle won't start and you can't get pregnant. This is nature's cool way of preserving your resources by spacing out pregnancy, and it can work for about six months.
But nursing on demand every few hours during the day and night isn't sustainable for many people, and using breastfeeding as birth control won't work if you also feed your baby formula for some meals, if you use a breast pump or do anything other than exclusively nurse. Interestingly, pumping is thought to interfere with the birth control effect because it doesn't send the same signal to your brain as an infant's suckling, so it doesn't keep ovulation suppressed.
Dr. Leena Nathan, an OB-GYN at University of California, Los Angeles Health, says she doesn't recommend breastfeeding alone as a contraceptive method to patients because it can be hard to predict when ovulation will start up again.
"I've definitely seen that in my patients -- where they're exclusively breastfeeding and then their period starts again," Nathan says.
Read more: Best nursing bras for 2022
Best birth control for breastfeeding parents: Can I start the pill right away?
Some researchers think that the estrogen found in combination birth control pills (the most common type of birth control pill) can cause a slight drop in breast milk production. That's one reason Nathan and Lawson recommend breastfeeding parents choose the progestin-only or "mini pill" if oral contraceptives are their preferred choice of birth control.
Instead, the progestin-only pill or "mini pill" may be prescribed as soon as someone has given birth. Although, it is a little more finicky than the combination pill because it has a lower dose of hormone and has to be taken within a narrower window of time in order to be effective.
Even if you don't choose to breastfeed, the ACOG recommends waiting three weeks after birth to start a combined birth control method with estrogen, which includes the combination pill, the ring or the patch. This is because estrogen increases the risk of deep vein thrombosis, or blood clots in the veins, for which there's already an elevated risk during the postpartum period.
Your doctor may also advise that you choose another birth control method other than the pill if you smoke, are over age 35, have a history of breast cancer or have migraines with aura.
Read more: What's the difference between a migraine and a headache?
Can I get an IUD right after birth?
Immediately after giving birth to your baby, you can have an IUD (intrauterine device) put in at the hospital by your doctor or midwife, or a "post-placental" IUD placement, Nathan says. There are a few IUDs on the market, and most work by releasing varying amounts of progestin, while the copper IUD is completely hormone-free. However, Nathan notes, there is a higher risk of IUD expulsion (your uterus spitting out the device) if you get one immediately after birth.
You can also get the birth control implant (Nexplanon) or the shot (Depo-Provera) immediately after a c-section or vaginal delivery.
What if I'm at risk for postpartum depression?
Many people experience postpartum depression or other mood issues during the dramatic hormonal and lifestyle changes that drive new parenthood. In general, Nathan says, the birth control pill and IUDs are well-tolerated by women with postpartum mood issues, and birth control is still recommended for those patients because having an unintended pregnancy "would cause a lot more mental stress than going on medication that may or may not cause any problems."
Nathan says she avoids Depo-Provera for patients with mood issues, however, because the shot can exacerbate the symptoms.
Because everyone's health history is unique, talk with your doctor about finding the right birth control for you if you're concerned about postpartum depression or are experiencing mood changes.
Birth control after pregnancy loss
If you've experienced a pregnancy loss and would like to start birth control for whatever reason and for whatever length of time, you can safely do so. Pregnancy loss or miscarriage is also a common experience. About 1 in 10 pregnancies will end in a miscarriage (the risk increases with age), and some estimates say the general number is actually much higher given the amount of losses that happen soon after conception, before many people even realize they're pregnant. The majority of these losses happen when the embryo doesn't develop properly, completely out of the pregnant person's control.
If you want to go back on birth control following any type of pregnancy loss, it's safe to start birth control pills right away. That's because the same blood clotting risk that's associated with the postpartum period isn't found after a first trimester pregnancy loss, according to Lawson. The majority of miscarriages take place during the first trimester, as well as the majority of abortions.
People who've had a first trimester miscarriage or abortion usually ovulate about two weeks after losing their pregnancy (some a little sooner, some a little later) as the body simply restarts its menstrual cycle.
Once all tissue has passed following a miscarriage or abortion, IUDs are safe to use. Miscarriages, Lawson notes, can be more prolonged and leave the cervix open longer, which can increase the infection risk. When that's the case, your provider may recommend an additional waiting period before placing an IUD.
(If you've had a second trimester pregnancy loss, you will likely have the same birth control options, but if you choose to have an IUD inserted right away, you may be at a slightly higher risk of it being expelled.)
