Contraceptive Choices for New Mothers
By Laura E. Stachel
You've had your baby, your body is beginning to return to normal, and your post-partum check-up shows that you've healed from the delivery. Now is a good time to think about contraception.

Many women assume nursing is a foolproof way to space your children. In reality, even women who exclusively breastfeed their babies are only protected from conceiving for the first three months post-partum. After that, it is possible to ovulate any time during the next several months. Menses occurs only AFTER an egg is released. So you need to have a method of contraception in place BEFORE you have your first period.

Most contraceptive options you're familiar with are available to new moms. However, you will have additional considerations now. If you are breastfeeding (which provides the best nutrition for your baby), keep in mind that medication you ingest can enter your breast milk. Hormone manufacturers and most doctors are convinced that birth control pills, contraceptive patches or long-acting vaginal contraceptive rings are completely safe during lactation. While there is no evidence to dispute this claim, you may prefer to avoid any unnecessary exposure to hormones for your young baby. Some women wait until their baby is not relying on nursing as the only source of nutrition before beginning hormonal contraception. The benefits of hormonal contraception include: (a) reliability and high effectiveness, (b) predictable monthly menses, (c) ease of use, and (d) reversibility. Unwanted side effects can include headaches, nausea, depression, lower libido, and increased risk of blood clots.

Many women choose barrier methods of contraception in the initial post-partum months. Barrier methods include condoms and spermicidal foam, the diaphragm and the cervical cap. While these methods do not interfere with breastfeeding, they do require a commitment from both you and your partner to be used with every sexual encounter. Unfortunately, studies have shown the diaphragm and the cervical cap to have a disappointing effectiveness rate (less than 80% effective) in women who have already had children. It's not known whether this is due to anatomic changes such as loose vaginal tone, or to some lack of compulsion in using these contraceptives. Condoms used in conjunction with a vaginal spermicide are equal in effectiveness to the pill (99% effective). Some women complain of vaginal sensitivity in the first months after delivery; barrier methods may exacerbate this discomfort.

If you are pretty sure you've completed your family but want to avoid the permanence of sterilization, an IUD can be a terrific choice. This intrauterine device must be inserted by a skilled health care provider no sooner than six weeks after delivery. Once in place, it can effectively prevent pregnancy for up to 10 years! IUD's are safe if you do not have a current cervical infection or a history of pelvic infection, are monogamous, and desire a long-acting method of protection. Unwanted side effects include increased cramping and bleeding with your menstrual cycle. If heavy bleeding is a concern, a newer progesterone IUD is available that lessens menstrual flow considerably.

Sterilization is permanent and the most common form of birth control worldwide. There are in-office surgical sterilization procedures for men using local anesthesia (vasectomy), and procedures requiring general anesthesia for women (tubal ligation). A tubal ligation is the most effective method of birth control available (99.6% effective) and involves tying or cutting the fallopian tubes to prevent an egg from reaching the uterus. Your body's hormone levels will not be affected by this procedure, and menstrual cycles will continue normally until menopause. Many women choose sterilization immediately post-partum. This requires a brief operation before being discharged from the hospital, performed through a small incision near the navel. You must sign papers to arrange for this well ahead of your delivery; your decision will be permanent and should be thoroughly discussed with your doctor.

Obviously, your choice of contraception is a highly personal decision. In making your choice, it will be helpful to know if and when you plan to have more children, your comfort level with barrier methods of birth control, whether you prefer the ease and reversibility of a hormone contraceptive, and which method you are most likely to consistently use. Discuss your preferences and concerns with your health care provider, and realize that the choices you make immediately post-partum may change over time.