Breastfeeding and Birth Control

Having a baby is a time of discovery for new parents: from learning all about your baby’s personality to figuring out their wants and needs. Some new mothers will find themselves navigating the process of breastfeeding during this special time.

In the middle of all this excitement, birth control may be the farthest thing on your mind. However, unless you're ready to add another new sibling to the family, it's important that you don’t overlook your postpartum birth control needs.

Can You Get Pregnant While Breastfeeding?

Though breastfeeding can be considered a birth control method, there are specific conditions that must be met in order for it to be effective.

Many women believe that they will not be fertile again until they get their first period after giving birth. However, your period is not always an accurate indicator of fertility.

Ovulation occurs before you get your period. If you have unprotected sex around the time that you ovulate, you can become pregnant.

If you are breastfeeding and want additional birth control, you'll have several contraceptive options to choose from. Once you've become familiar with your options, talk to your doctor to help decide which one is best for you.

Breastfeeding birth control options fall into four categories: progestin-only hormonal methods, non-hormonal methods, natural methods, and permanent methods.

Here's a list of birth control methods that are considered safe to use while breastfeeding.

Progestin-Only Methods:

Mother breastfeeding baby
Getty Images/KidStock

Progestin-only contraceptives are hormonal birth control methods that require a prescription from your doctor.

The progestin may enter your milk supply, but it will not harm your baby or cause a drop in milk production.

Progestin-only birth control methods tend to be more effective than non-hormonal alternatives.

Mini-Pill

The "mini-pill" is a progestin-only birth control method. Unlike combination birth control pills, the mini-pill does not contain any estrogen.

The pills come in a 28-day pack and every pill in each 4-week pack contains progestin (there are no placebo pills).

Nexplanon

Nexplanon is also known as the contraceptive implant. It is a newer version of Implanon, which is slowly being phased out by the manufacturer.

The thin, plastic implant is inserted under the skin of your arm where it continually releases a low dose of progestin over three years to provide pregnancy protection.

Implanon or Nexplanon can be removed at any time during the three-year period.

Depo-Provera

Depo-Provera is an injection that slowly releases progestin into your bloodstream over a period of 11 to 14 weeks.

With this method, you are protected from pregnancy as long as you are receiving the shots. It is important that you get your scheduled Depo-Provera injections on time to prevent their effectiveness from being compromised.

Mirena or Skyla

Intrauterine devices (IUDs) are implanted into your uterus where they release a small amount of progestin over a specified time frame (three to five years depending on which one you choose).

IUDs must be inserted and removed by your doctor. The two that are available are highly effective at preventing pregnancy.

  • Mirena
  • Skyla

IUDs are a completely reversible method of birth control. If you want to become pregnant, either can be removed at any time.

Non-Hormonal Methods

With a few exceptions, these non-hormonal birth control options are available over-the-counter. Many are considered barrier methods because they act like a wall to block sperm from reaching (and fertilizing) an egg.

Male Condoms

Condoms come in many types, sizes, and materials (such as latex, polyurethane, lambskin, and polyisoprene). A condom is used to cover a penis before, during, and after ejaculation.

While some condoms are pre-lubricated, breastfeeding moms sometimes have low estrogen levels, which can cause vaginal dryness. If you find that condom use is irritating your vagina, you may want to add more lubrication (like Astroglide or Wet Naturals).​

Female Condom

Female condoms are a birth control method consisting of a pouch made from polyurethane with flexible rings at each end. It holds semen and does not allow the sperm to enter your body.

This method can take a little practice when you're learning how to properly insert the condom. It may take time for you to feel comfortable and confident using one.

Spermicide

While they come in different forms, all spermicides basically work the same way. The products are inserted deep into the vagina right before sex where they melt or bubble to form a barrier to block sperm.

These products usually contain nonoxynol-9, a spermicide that immobilizes and/or destroys sperm.

Today Sponge

The sponge is a round, foam device with an attached nylon loop for removal. It blocks the cervix (the opening to the uterus) to prevent sperm from getting in. The sponge also releases a spermicide that can stop sperm from swimming.

Having a good understanding of your anatomy, along with some practice, will make it easier for you to learn how to insert the sponge.

Diaphragm

A diaphragm (or its smaller alternative, a cervical cap) is a barrier device. These cannot be used until it has been six weeks since you have given birth.

Diaphragms and cervical caps must be fitted by your doctor.

These devices are inserted into the vagina to block the cervix. Both are most effective when used with spermicidal cream. The device blocks sperm while the cream immobilizes sperm.

ParaGard

ParaGard is a hormone-free IUD. Copper is coiled around the device, which acts as a spermicide. Like other IUDs, ParaGard has to be inserted by your doctor.

ParaGard provides 10 years of pregnancy protection but can be removed at any time should you want to become pregnant.

Natural Methods

Natural birth control methods, also known as behavioral methods, do not rely on devices or hormones. Natural methods consist of behaviors you can use to avoid becoming pregnant.

Continuous Breastfeeding (Lactational Amenorrhea Method)

When performed correctly, the Lactational Amenorrhea Method (LAM) can postpone ovulation for up to six months after giving birth. If no egg is released, there is nothing for a sperm to fertilize.

Continuous breastfeeding is effective because the hormone that triggers milk production also prevents the release of the hormone that signals ovulation. ​

However, you should not rely on this method for longer than six months or if you have had a period since giving birth.

LAM is only effective if you breastfeed your baby at least six times a day with both breasts and do not alternate other foods for breast milk. You must also be breastfeeding your baby every four hours during the day and every six hours at night.

Natural Family Planning (NFP)

Natural Family Planning (NFP) methods rely on monitoring body changes to determine when ovulation occurs. NFP uses symptom-based methods (like the Billings method) and calendar-based methods (like the Standard Days method).

While there is no rule that states NFP cannot be considered as a breastfeeding birth control choice, the World Health Organization (WHO) cautions that fertility awareness methods may be less effective in breastfeeding women.

Instead, you may want to wait to rely on NFP options until you begin to notice fertility signs (such as cervical mucus), you have had at least three postpartum periods, and you have begun to substitute breast milk with other foods.

Permanent Options

If you know that this baby is your last, you can always consider permanent options as your breastfeeding birth control choice.

Sterilization is a permanent and non-reversible option.

Some women feel "hormonal" while breastfeeding. You may also be experiencing postpartum depression. In either case, it may be best to postpone the decision to seek permanent birth control until you are in an emotional place where you feel confident about making a choice.

Female Sterilization

Permanent methods for women include traditional, surgical tubal ligation procedures (often referred to as having your tubes tied).

Tubal ligation requires anesthesia, which can pass into your breast milk and affect your baby (including inducing drowsiness that can cause difficulty with feedings).

Another permanent option is called Essure. It's a non-surgical alternative to tubal ligation that doesn’t require anesthesia.

Both traditional surgical tubal ligation and Essure work by sealing off or blocking the fallopian tubes. This prevents eggs from traveling to the uterus and sperm cannot enter the fallopian tubes to reach an egg.

Vasectomy

Male sterilization has no effect on breastfeeding. A man’s body still makes semen after a vasectomy, but it no longer contains sperm.

Men can choose between traditional vasectomies where a small incision is made in the upper part of the man’s scrotum or the no-scalpel vasectomy where the surgeon punctures the skin (no incisions are made).

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