Birth control options for breastfeeding moms

By Jean Samuel, RN, IBCLC, CCE on September 18, 2012
The most common type of contraception used by breastfeeding women in North America is the barrier method: condoms, contraceptive foams, diaphragms and spermicidal jellies.

These have no side effects for mother or baby and are relatively inexpensive and highly effective when used as directed (especially combined with the natural contraceptive effects of breastfeeding). If you used a diaphragm before pregnancy, it has to be re-fitted after your baby is born. Couples find the main drawbacks to barrier methods are aesthetic. Some find it unpleasant to interrupt their intimacy to use barrier contraception.

Intrauterine devices (IUDs)

Intrauterine devices (IUDs) have no effect on breastfeeding. Some studies have shown an increased risk of perforation of the uterus during lactation; others have shown no effect at all. Talk to your doctor. If this is the choice for you, an IUD will be inserted at your six-week check-up.

Oral contraceptives

Progesterone-only birth control pills are safe while breastfeeding if you prefer oral contraceptives. Small amounts of the hormone may pass into your milk, but this is not considered harmful to the baby.

Some experts feel combination estrogen-progesterone pills may cause decreased milk supply. Others feel the dosage of estrogen in today’s combined pills is too low to be of concern and are acceptable once breastfeeding is established (around six weeks after the birth).

The amount of estrogen in breast milk for women using combination birth control pills compares with levels in breastfeeding mothers not using the pills.

If low milk supply is a problem while you take combination oral contraceptives, you may decide to discontinue them and use a barrier method while you rule them out as a cause. (True low milk supply is uncommon.)

Sterilization

Tubal ligation and vasectomy are surgical procedures that are considered permanent.

In a vasectomy, a man’s vas deferens (the small tube that carries sperm from the testicles) is severed. In tubal ligation, a woman’s fallopian tubes are severed. There is a very short separation of mother and infant. The procedure requires brief hospitalization and general anaesthetic. There should be no impact on breastfeeding.

Breastfeeding as a contraceptive

Monthly periods and the release of eggs from the ovaries are suppressed in breastfeeding mothers, but the timing of the return of menstruation varies among women.

For some women, breastfeeding just once a day suppresses menstruation. For others, any decrease in the frequency of breastfeeding over 24 hours can result in fertility. There is no way to know.

Ovulation can occur before the first menstrual period after the birth, although hormones necessary to support a pregnancy are usually insufficient.

The LAM method of family planning

Couples who choose natural family planning may choose the Lactational Amenorrhea Method (LAM).

For this method of contraception to be effective, your baby must be fully breastfed (no supplements, soothers, restricted or timed feedings, bottles and other foods), your monthly periods must not have yet returned and your baby should be less than six months old.

The LAM method is highly effective when guidelines are strictly observed, and it has no side effects. Talk to your lactation consultant, midwife or physician.

Originally published in ParentsCanada: Best Wishes, Spring 2012.

By Jean Samuel, RN, IBCLC, CCE| September 18, 2012

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