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Falling in Love Again

By Adair R. Heyl, Ph.D., and Peter S. Heyl, M.D.
2010-07-14 12:00:13

Take charge of planning your future pregnancies.

It has been six weeks since your baby’s birth, and you and your partner might be ready to resume lovemaking. Your doctor may have told you to wait a full year before conceiving again to help ensure that your next pregnancy will be as healthy as possible. If you don’t use contraception, you can become pregnant before your first period after giving birth, so you should choose the method that best satisfies your preferences now. While breastfeeding has been thought of as nature’s way of preventing pregnancy, it is not as reliable as other contraceptive choices.

Barrier Method
New parents often use barrier methods, such as a condom combined with a lubricant, or a diaphragm or cervical cap. Spermicidal condoms might irritate the vagina and, if so, should be avoided.

If you prefer using a diaphragm or cervical cap, talk with your obstetrician at your  first post-delivery visit about being fitted properly. If you used either before pregnancy, you may need a different size following the birth.

Injectable progestin
The long-acting injection works by stopping ovulation and thickening the cervical mucus. While it can be administered five days after delivery, side effects such as heavy bleeding are less likely if you wait six weeks. The method may be used while breastfeeding. Long-term use may lead to thinning of the bones but this is reversible after stopping use. Many women who cannot take oral contraceptives can use this method because it does not contain estrogen. An injection lasts 12 weeks.

Intrauterine contraceptive device (IUCD)
IUCDs are an effective, popular form of reversible contraception worldwide. IUCDs can be used by most women, including those who have never been pregnant and those with a history of ectopic pregnancy or sexually transmitted infection. The small T-shaped plastic device can be inserted by a physician at an office visit four to six weeks after delivery. Since there are different types, check with your doctor about which IUCD is best for you, and ask about possible side effects. Some women have increased menstrual cramping, and bleeding or spotting between periods.

Implants
Contraceptives inserted under the skin are another option. The small rod, implanted by a physician in your upper arm as early as three weeks after delivery, releases progestin into the bloodstream for up to three years. An implant is very effective in preventing pregnancy. Like all progestin products, it can cause irregular spotting and bleeding but can be removed at any time if the side effects outweigh the benefits.

Pill and Patch
The combination pill or patch contains both estrogen and progestin and is not recommended for women who are breastfeeding until six months after delivery. However, recent research shows that either is probably quite safe for nursing infants. Women who do not breastfeed can start the pill, patch or vaginal ring as early as three weeks after delivery.    

The progestin-only pill (POP) is appropriate for women who are breastfeeding or who should not take estrogen for medical reasons. You may start using a POP anytime after you give birth.

An extended-cycle birth control pill that reduces the number of menstrual cycles from an average of 13 per year to only four came on the market in 2003. Another contraceptive pill being tested would eliminate all menstrual periods while being taken.

Rhythm Method
The rhythm method calculates the most fertile time of a woman’s cycle, when abstinence is recommended to avoid pregnancy. To identify the fertile period, a woman keeps a calendar of her menstrual cycle. Keeping track of her temperature helps determine the time of ovulation, because the basal body temperature rises one half to three quarters of a degree one to two days prior to ovulation. Checking cervical mucus is another way to determine ovulation. At ovulation, the viscosity of the mucus is thinner and the amount greater than at other times during the cycle. The rhythm method is effective at preventing pregnancy between 75 and 80 percent of the time as practiced. For the calendar rhythm method to be effective, a woman must learn exactly how to recognize these signs of ovulation.

Vaginal Ring With Hormones
A disposable vaginal ring is placed in the vagina much like a diaphragm. A good alternative for women who appreciate the benefits of a contraceptive pill but have trouble remembering to take a daily pill, it contains the lowest effective dose of both estrogen and progestin. You only have to insert the ring once a month and remove it after three weeks. As with all hormonal contraception, you must wait until it takes effect before relying on the method. A barrier method such as a condom should be used for the first week, or even a month to be really safe. You will continue to have regular monthly periods.

Emergency Contraception
The morning-after pill is an effective backup if a condom breaks or you forget to take two or more birth control pills during the month. It works because it contains a higher dosage of the same chemical hormones found in other forms of birth control. The pill is available at most pharmacies without a prescription; however, it is designed for emergency-use only. If taken within 72 hours after unprotected sexual intercourse, it is 89 percent effective. This means that seven out of eight women who would have become pregnant following unprotected sex during the three days around ovulation would not conceive. Side effects may include abdominal pain, headache, nausea and vomiting, dizziness and breast tenderness. If you are already pregnant and take it, you will not abort the fetus.

Your physician can provide explanations of all  birth control methods so you can make the best choice for you and your partner. See www.planned-parenthood.org for additional information.

Adair R. Heyl, Ph.D., is an assistant professor, and Peter S. Heyl, M.D., is an associate professor, at the Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk.

Do you have questions about family planning? Send them to us.editor@cwcomms.com.

 

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