Postpartum Contraception
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.


• 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.