Contraception

Issue 18
Contraception may be the furthest thought from your mind after having a baby but according to the Family Planning Agency, (FPA) many unplanned pregnancies occur in the first few months after childbirth. with the help of the fpa, flying start has put together a comprehensive guide to contraceptive choices after having a baby.

How soon can I have sex again?

When you start having sex again is up to you and your other half. Having a baby can cause many physical and emotional changes for both partners, and it may take some time before you feel ready to have sex. Feelings of anxiety are common but there is no reason why you can’t enjoy sex just as much as you did before you had a baby. If you do have worries it is important to talk to your partner.

If you have any discomfort, which might affect your enjoyment of sex, such as stitches that have not healed properly, consult your midwife, GP, nurse or health visitor. If you find that you are uncomfortably dry, you may want to try using a vaginal lubricant. If you are using latex (rubber) condoms, a diaphragm or cap you will need to use water-soluble lubricants like KY Jelly and Senselle, as oil-based products such as baby oil and Vaseline will damage the rubber.

When will my periods start again?

If you bottle-feed, or combine bottle and breastfeeding, your first period could start as early as five to six weeks after the birth. If you are breastfeeding, your periods may not come back until you stop. You can be fertile before you get your first period. This is because you can ovulate about 2 weeks before a period. How soon will I need to use contraception?

It is possible to become pregnant quite quickly after the birth, so it is advisable to think about which method of contraception you are going to use before you have sex.

You need to use contraception from three weeks after the birth. Don’t wait for your periods to return, or until you have your postnatal check, before you use contraception, as you could get pregnant before then.When can I start to use contraception?

You don’t need contraception until three weeks after the birth• You can use male and female condoms as soon as you want to

• You can start to use progestogen-only pill and the contraceptive implant from three weeks after the birth

• If you are not breastfeeding then you can also use the combined pill and the contraceptive patch from three weeks

• It is usually recommended that you will wait until six weeks after the birth to start the contraceptive injection because you may get heavy and irregular bleeding, but it is possible to use this earlier if there are no other alternatives you find acceptable

• An IUD or IUS is usually fitted from four weeks after a vaginal or caesarean birth. Both methods can be fitted within 48 hours of the birth, but at this time there is an increased risk of them being expelled (pushed out of the womb) or going through the womb or cervix (perforation).

• You can start to use a diaphragm or cap around six weeks after giving birth.

What are short-acting methods of contraception?

If you think you may want to have another baby in the next year or so, you could try a short-acting method of contraception: • The progestogen-only pill

• The combined pill

• The contraceptive patch

• Male or female condoms

• Diaphragm or cap with spermicide

• Natural family planning

If you are breastfeeding then it is usually recommended that you wait until the baby is six months old before starting the combined pill or the contraceptive patch. This is because these methods may reduce the milk flow.

If you used a diaphragm or cap before you became pregnant, check with your doctor or clinic to make sure it still fits. This is because your cervix and vagina change shape during pregnancy and birth. If you later lose or gain more than 3kg (7lb), you must get the fitting checked again.

Natural family planning can be more difficult to learn and use just after you have had a baby. If you used this method before your pregnancy, ask your natural family planning teacher for advice.

What are long-acting methods of contraception?

If you don’t want to get pregnant again for some time, one of the following long-acting methods might suit you: • Contraceptive injection- lasts 12 weeks (Depo-Provera) or eight weeks (Noristerat)

• Contraceptive implant- lasts three years

• IUD (intrauterine device) – lasts for three to ten years depending on type

• IUS (intrauterine system) – lasts for up to five yearsThese methods are very effective. You don’t need to worry about them for as long as they work, except for attending check ups.

If you use Depo-Provera your usual fertility may not return for several months after your last injection has worn off. If you want to get pregnant again fairly quickly this may not be the best method to choose.

Implants, an IUS or an IUD can be taken out at any time you choose and your normal fertility will return quickly.

What are the permanent methods of contraception?

If you are absolutely sure you never want any more children you may wish to consider sterilisation- a permanent method of contraception. It is not usually recommended for men or women to be sterilised at the time of childbirth, as you need time to be sure that you never want any more children. There is evidence to show that women, who are sterilised at the time of birth, or just after, are more likely to regret this decision later. The failure rate of female sterilisation may also be higher when it is done at this time. Will breastfeeding act as a contraceptive?

Breastfeeding can be up to 98 per cent effective in avoiding pregnancy when the following conditions all apply:• Your baby is less than six months and

• You are fully breastfeeding- this means you are not giving your baby any other liquid or solid food or

• You are nearly fully breastfeeding - this means mainly breastfeeding your baby and giving your baby other liquids very infrequently and

• You have no periods

Once you completely stop or are close to stopping breastfeeding you can get pregnant. Once your baby is over six months old, the risk of getting pregnant increases, so even if you don’t have periods and are fully or nearly fully breastfeeding, you should use another contraceptive method.

Will contraception affect the breast milk?

If you are using a hormonal method of contraception, a small amount of hormone will enter the milk, but no research has shown that it will harm your baby.

It is usually advised that you wait until the baby is six months old before you start using the combined pill or the contraceptive patch. This is because these methods contain the hormone estrogen, which can reduce your milk flow.Using the copper IUD does not affect your milk, and copper from the device does not get into

the milkSexually transmitted infections

Most methods of contraception do not protect you from sexually transmitted infections.

Male and female condoms, when used correctly and consistently, can help protect against sexually transmitted infections. If you can, avoid using condoms containing Nonoxinol 9 (spermicidally lubricated), as this does not protect against HIV and may even increase the risk of infection.

WHERE CAN I GET ADVICE?

You can find out more about contraception from your midwife or health visitor. You and your partner can also visit your doctor, practice nurse, family planning clinic or sexual health clinic.

You can also contact the FPA on 0845 3101334 (UK), Northern Ireland 028 90325488 (Belfast) or (Derry) 028 71260016 and Scotland 0141 5765088. Or visit the FPA’s website: www.fpa.org.uk

Image courtesy of Durex: www.durex.com/UK