Choosing Contraception

Birth control options, from a doctor’s point of view.

When you are still pregnant or the parent of a newborn, it might seem a bit strange to hear your healthcare provider asking you which method of birth control you would like to use — but it’s actually a very important part of postpartum planning.

The World Health Organization (WHO) advises that the best interpregnancy interval (time from the end of one pregnancy to the beginning of another) is between two and five years. Pregnancies conceived outside of this time frame may have a slightly increased risk of certain complications.

This means that the majority of new moms should be considering a reliable method of contraception early in the postpartum period. There are factors that may change the WHO recommendation. Your provider is the best resource for your specific questions.

Most women are advised to abstain from intercourse for at least six weeks after delivery. As there are increased risks with using certain birth control methods less than a month after your baby’s birth, it may be best to wait until one month postpartum to start many of the available options, which still gives at least two weeks of use to establish efficacy prior to resuming normal sexual activity.

The fact that many breastfeeding moms may not have regular periods does not mean that breastfeeding alone is a reliable method of birth control. Most doctors advise an additional option. The top doctor-recommended, reversible methods of postpartum contraception, ranked in order of effectiveness, follow.

If your family is complete, you may think about permanent sterilization for you or your partner. Highly effective at preventing pregnancy, sterilization should be considered only if you are absolutely certain that you don’t want more children, as it’s not meant to be reversed. In addition, sterilization will not provide any non-contraceptive benefits, such as lightening or regulating periods or decreasing painful menstrual cramps.

The only 100-percent effective method for preventing pregnancy is abstinence. While not having intercourse may be the best option for some moms, most hope to return to some regular sexual activity. It’s important to recognize that sex after having your baby may be very different from sex before parenthood. Sleep deprivation, stress, schedule changes and some physical changes may affect frequency — along with enjoyment. If you have a hard time initially finding the energy for sex, try focusing on other ways to maintain intimacy with your partner, such as cuddling, massage or even just doing nice things for each other. Over time, most couples find a new rhythm that works for them.

Postpartum contraception is important to consider toward the end of pregnancy. Discuss it with your provider. Also tell your provider if you’re worried about postpartum lack of desire or discomfort with intercourse. Often interventions can help improve this aspect of your life as a new parent.

Lynsey Caldwell Owen, MD, FACOG, is an ob/gyn at Malcolm Grow Medical Clinic on Andrews Air Force Base and at MedStar Southern Maryland Hospital Center.