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Postpartum Protection

Birth Control Choices for New Moms
By Kendeyl Johansen

As a sleep-deprived new mom, you'd rather not worry about contraception. But hearing you're pregnant at your postnatal checkup would probably come as a shock. "Fertility can resume as soon as six weeks after giving birth," says Marilyn Kline, nurse practitioner for Planned Parenthood of Utah. To avoid the stress of unplanned pregnancy, discuss birth control options with your partner before having your baby or soon afterward. When evaluating contraceptive methods, consider their effectiveness, ease of use, effect on nursing and impact on future fertility.

Breastfeeding as Birth Control?
Does breastfeeding work as natural contraception? "When breastfeeding is practiced exclusively, and the baby is not taking any supplemental bottles or using any pacifiers or artificial teats, the mother can be assured that this lactation amennorhea method (LAM) is as safe as any hormonal contraceptive," says Carol Huotari, IBCLC, manager of the Center for Breastfeeding Information. The LAM is effective for the first six months following birth as long as a woman has not experienced a period. Menstruation signals that fertility is resuming, and if you have a period, you must use another contraceptive method to avoid pregnancy.

Permanent Options
If your family is complete, you may want to think about sterilization. Michelle Storrusten of Great Falls, Mont. opted for this method after condom failure and birth control pill failure resulted in two unplanned pregnancies. "Insurance wouldn't cover an IUD, and I'm too embarrassed to buy condoms, sponges and diaphragms. I finally got a tubal," she says. Storrusten's family was big enough, and she didn't want any more surprises.

Tubal sterilization for women and vasectomy for men permanently prevents pregnancy. Tubal sterilization, a minor procedure where a woman's fallopian tubes are cut and tied, can be performed immediately after giving birth. This procedure does not affect breastfeeding. Vasectomy, the blockage of sperm-carrying tubes, is simpler than tubal sterilization, and it can be performed in a doctor's office under local anesthetic. A vasectomy will not impair a man's sexual function.

Reversible Choices
Families desiring more children need a reversible birth control method. Both nursing and bottle-feeding moms have plenty of options. Of course, abstinence provides 100 percent protection against pregnancy, but most couples find this method unreasonable. Periodic abstinence, in which the menstrual cycle is closely monitored and intercourse is avoided on fertile days, is risky, with up to a 25 percent failure rate. This method may work well, however, for couples diligently keeping track of a woman's cycle. Withdrawal, in which the man does not ejaculate inside a woman, is another choice with a potential high failure rate since ejaculation can be difficult to control. There are no hormonal or side effects to abstinence or withdrawal. These contraception methods are safe for nursing mothers, and future fertility is not impacted.

More popular birth control options include the pill, the mini-pill, Depo-Provera and Norplant. "I chose Depo-Provera, the three-month shot, for its convenience," says Teisha Strelow of Ohio. Strelow liked not having to worry about birth control for three months at a time.

Nursing mothers can use Depo-Provera, Norplant and the progestin-only mini-pill six weeks postpartum. Depo-Provera is a hormone shot administered every 12 weeks. On the down side, Depo-Provera may delay pregnancy for a full year after shots are discontinued. Norplant, small capsules which a clinician inserts under the skin of the arm, contains hormones which prevent pregnancy for five years. "As soon as Norplant is removed, all of the effects are gone, and a woman can become pregnant," says Kline.

The pill, which is taken daily, contains estrogen and progestin and can be taken by bottle-feeding moms six weeks postpartum. "The pill isn't recommended for nursing mothers because estrogen can affect the milk supply, but progestin-only mini-pills contain no estrogen and are compatible with breastfeeding," says Kline. Discontinuing the use of the pill or mini-pill does not delay the return of fertility. Depo-Provera, Norplant, the pill and mini-pills are all nearly 100 percent effective when used as instructed.

Barrier methods, such as the diaphragm or condom, appeal to women who don't want to introduce outside hormones into their bodies. Diaphragms do not impact breastfeeding or the return of future fertility. The diaphragm is a latex cup which is filled with spermicide and inserted into the vagina prior to intercourse. The cervical cap is similar to a diaphragm but smaller. The cervical cap has a high failure rate among women who have had children, but the diaphragm is 94 percent effective if used correctly. The diaphragm may be inserted six weeks postpartum. Kline cautions that women using this method prior to pregnancy must be fitted for a new diaphragm after giving birth. Condoms are the only non-permanent birth control option currently on the market for men. Condoms have no impact on future fertility or nursing but some men balk at using them.

Less popular birth control choices include the intrauterine device (IUD) and the female condom. An IUD is a small, plastic device containing copper or hormones that a physician places in the uterus. IUDs made of copper may be left in place for 10 years. The IUD suffers stigma in the U.S. from a faulty IUD, the Dalkon Shield, which was banned. Internationally, IUDs remain the most popular method of reversible birth control, with up to a 99 percent effective rate. Some IUDs are safe for breastfeeding mothers, and fertility returns unimpaired after discontinuing use. Finally, the female condom, a polyurethane tube inserted deep into the vagina, can be difficult to use, resulting in a variable effectiveness rate. The female condom doesn't impact breastfeeding or future fertility.

There are many birth control choices available. Take a few minutes to decide which would work best for you.



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About the Author: Kendeyl Johansen is a contributing editor for iParenting Media and the mother of four.

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