Contraception After Delivery – A Great and Important Option

By Jennifer Hyer

If you are pregnant or thinking of getting pregnant, there’s a very important question that many women forget to ask themselves: “What contraception will I use after I deliver my baby?” Of course, many women don’t consider this a high-priority issue because you’ve got baby on the brain—baby items, baby feeding, baby sleep, baby care, baby you-name-it. Not to mention the physical demands of pregnancy and delivery lead many women to swear off intercourse forever. Well, maybe not forever forever, right? So, unless you want to have another baby in the next 10 months, you’re going to want to make a post-baby plan sooner rather than later.

Contrary to popular belief, starting on birth control really can’t wait until your 6-week postpartum visit. Most women—even those who are breastfeeding—have their first ovulation at around 45 days, which means you could be at risk for unplanned pregnancy without the proper protection. The good news that is there are lots of quick and easy options, including many that are safe while breastfeeding, and even some you can take care of before you even bring baby home.

OPTION 1: The Implant

Nexplanon is the brand name for a progesterone implant that is inserted into your arm and lasts for up to 3 years. For most women the implant can be inserted right after delivery—or any time after—and is safe to use while breastfeeding. Many young women in Colorado have been using Nexplanon right after delivery to help create some space before getting pregnant again.

OPTION 2: IUDs

An intrauterine device (IUD) can be placed immediately after your baby is born. We call this “postplacental placement” because the goal is to place the IUD within 10 minutes of delivering the placenta. The chance of expulsion (having the IUD fall out) after a postplacental placement is a tiny bit higher than for those placed 6 weeks after delivery, but the chances of that are incredibly slim and the benefits outweigh the risk by far. Just think: you can have your baby AND get an effective, reliable form of birth control within minutes. One and done.

Mirena and ParaGard IUDs are used for postplacental placement because they are both safe for breastfeeding and provide great pregnancy prevention for years to come. You can find details about both brands in our Birth Control Method Selector, but here are some fast facts:

  • The Mirena IUD has progesterone and works for up to 5 years. It can make your periods go completely away, but it may also cause spotting or unpredictable bleeding.
  • The ParaGard IUD is made of plastic and copper and works for up to 10 years. You will have your regular period, but you may have cramping or slightly longer bleeding. The ParaGard is 100% hormone-free.
  • You can have either one removed at any time if and when you decide that you are ready for another baby.

OPTION 3: The Shot

While it’s a little less convenient than the more permanent implant or IUDs, the “Depo” shot (dubbed for its brand name Depo-Provera), doesn’t contain any estrogen, so you can get your first one right away. Non-breastfeeding women needn’t worry about the estrogen question, but for those who are breastfeeding, you need to wait at least 21 days before starting a method that includes the hormone.

OPTION 4: The Mini Pill

Unlike traditional contraceptive pills, the mini pill, aka the progesterone-only pill, is safe to start immediately after giving birth. It doesn’t contain any estrogen, and is often used by women who are sensitive to combination pills or who prefer an option they can do themselves versus having it inserted or injected.

Starting any of these methods just after delivery can go a long way in ensuring safe future pregnancies and no unintended “oops” moments. Typically, it’s best to allow between 18 months and three years between pregnancies to give your body time to recuperate and prepare for what’s to come. So if immediate postpartum contraception may be in your future, talk to your health care provider about your options. Depending on where you have your baby, certain methods may not be offered, which means you’ll definitely want to plan ahead. Hospitals including Denver Health and University of Colorado are excellent choices for a wide range of care.

Written by Jennifer Hyer, MD, FACOG