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BIRTH CONTROL AFTER THE BABY IS BORN
By Raymond C. Lackore M.D.

If you have just had a baby, there are some special considerations.  You may restart egg release (ovulation) as soon as three weeks following delivery (before a you realize you are at risk!).  Planning for birth control after the baby is born should begin before birth.  If you are breast-feeding, this should influence your choice.  A newborn takes a LOT of work so your birth control method should be as convenient for you as possible. You may simply avoid intercourse for a while as you method of birth control. 

PRIOR TO LEAVING HOSPITAL  Breast-feeding is strongly encouraged.  You should receive information about lactational amenorrhea - a special way to use breast-feeding to reduce your risk of pregnancy.
• Pelvic rest (no douching, no sex, no tampons) is generally recommended for 4-6 weeks. Many women choose NOT to follow this advice in spite of increased risk for infection. Some clinicians encourage women to become sexually active when they feel comfortable and ready 
• Avoid intercourse until bleeding from childbirth has stopped and you are no longer sore.

LEARN AHEAD OF TIME and HAVE A PLAN !

• THE MINI-PILL:
 (progesterone only pill) may be provided (Ortho-Micronor), specially formulated for breast-feeding. Slightly less effective and must be taken at roughly the same time every day +/- 3 hours.  Started on the first Sunday after your baby is one month old and taken every day of the month like a vitamin pill.  Associated with slightly higher irregular bleeding. Have a back-up method as needed if started when you are not on your menses.

• The IUD - usually Mirena - may be inserted if uterus has returned to normal size. (breast-feeding not affected)

• CONDOMS Condoms may be used as a transitional method AS NEEDED for return of menses, decrease in breast-feeding, or passage of 6 months time since birth.  Will also reduce risks of infections; withdrawal can be used at any time

• THE BIRTH CONTROL PILL:  (combined oral contraceptives) may be prescribed for non-breastfeeding women starting 4 weeks postpartum (risk of blood clots in the legs associated with pregnancy reduced by that time).  While a low dose pill may also be safely taken with breastfeeding, they are known to reduce breast milk production.  This may reduce your baby’s chances for successful breastfeeding. 

• DIAPHRAGM  may be fitted after pelvis/cervix returns to normal size and shape at 8 weeks.

• WITHDRAWAL ( good luck – you’ll need it!) 

• EMERGENCY CONTRACEPTION (Pills) may be given if needed.

• TUBAL STERILIZATION OR VASECTOMY – only if you are ABSOLUTELY sure… its permanent.

• NATURAL FAMILY PLANNING (NFP) AND FERTILITY AWARENESS METHODS (FAM) should await resumption of normal cycles.

LACTATIONAL AMENORRHEA (LAM).  Exclusive Breastfeeding (with no bottle supplementation) may be used as birth control as long as  All 3 (three) rules are met:  (I put LAM  at the end because busy, tired, new moms forget these rules easily)
  1. Exclusive breastfeeding - no supplements
  2. First six months only (following birth) 
  3. No return of menses after the first 56 days, defined as any two days of bleeding or more. 


    Last updated 7/21/13 by R. Lackore MD.