What to Know About Postpartum Birth Control

When you’ve just had a baby, birth control is probably the last thing on your mind. At first, you are probably not even thinking about sex much—after all, your body still has a lot of recovery to do, and you are likely consumed and exhausted by the round-the-clock care of your newborn. Yet birth control is not something to neglect, even in the immediate postpartum period.

Many women believe that the risk of pregnancy in those early weeks and months is small, but that isn’t true at all, explained Dr. Taraneh Shirazian OB-GYN at NYU Langone Health, and founder of Saving Mothers, in an interview. “You can get pregnant as early as 6-8 weeks postpartum,” Dr. Shirazian says. “It’s really not that delayed. Your actually body wants to ovulate postpartum.”

How Soon Does Fertility Return After Having a Baby?

As the American College of Obstetricians and Gynecologists (ACOG) reports, many women do end up having intercourse in the early postpartum period (before six weeks) and 40–57% report having unprotected sex during that time. Most do so believing the risk of pregnancy is small during that time. But that is not always the case.

It’s important to understand that you don’t have to experience your first postpartum period to be fertile, because you ovulate about two weeks before you get a period. Of course, all women are different, and the timing of the return of your postpartum fertility varies based on several different factors, including whether you are breastfeeding or not.

The tricky thing is that you just can’t predict when that first ovulation is going to happen, and thus need to protect yourself from unintended pregnancy from the onset.

Here are some postpartum fertility statistics to be aware of:

• For non-breastfeeding women, ovulation occurs about 39 days postpartum.
• Some non-breastfeeding women ovulate as early as 25 days postpartum.
• The return to fertility for breastfeeding mothers is difficult to predict and varies depending on whether breastfeeding is exclusive, and whether bottles or pacifiers are used.
• About 70% of pregnancies are unintended in the first year after birth.
• Having your babies too close together (less than 18 months apart, according to Dr. Shirazian) puts your baby at risk for preterm birth and birth defects.
• Short-interval pregnancies can also result in adverse health outcomes for moms.

The Myth of Breastfeeding and Postpartum Birth Control

It is very common for breastfeeding mothers to believe that breastfeeding alone will protect them from getting pregnant. In fact, many women use breastfeeding as their sole method of birth control.

“I think the number one most common myth is that women can’t get pregnant because they are breastfeeding,” Dr. Shirazian says. “While it is true that breastfeeding inhibits ovulation, it is not 100% effective, and mothers can ovulate before menstruating.”

How Are Breastfeeding and Fertility Related?

According to the Academy of Breastfeeding Medicine, breastfeeding typically delays ovulation, and the more likely you are to answer “yes” to the following three questions, the lower your risk of pregnancy is:

• ‘‘Are you amenorrheic?’’ (meaning you have not had a postpartum period)
• ‘‘Are you fully or nearly fully breastfeeding?’’ (meaning no supplementary milks or foods)
• ‘‘Is your infant less than 6 months of age?’’

Still, answering “yes” to these three questions does not mean that breastfeeding will fully protect you from pregnancy, as Dr. Shirazian points out. Because of the risks of involved with unintended pregnancies while breastfeeding, Dr. Shirazian recommends using other, more reliable methods of birth control postpartum.

When To Begin Discussing Birth Control Options

There is no reason to delay having a talk about postpartum birth control options with your healthcare provider—you can even begin this discussion while you are pregnant. Most women will have the discussion either at the end of pregnancy or soon after birth. Remember that it’s vital to start using birth control as early as possible, well before the six week postpartum visit, as you may be able to get pregnant if you have intercourse before then.

Be open with your healthcare provider about any concerns you have about birth control in the postpartum period, and feel free to ask any and all questions (don’t worry: your provider has heard them all!). Your choices of a birth control method may depend on:

• Your past experience with contraceptives
• What your future plans are for childbearing
• Your partner’s preferences
• Concerns about side-effects
• Medical concerns
• Your comfort-level with a particular kind of birth control
• Your ability to use the contraception method effectively

When Should You Begin Using Birth Control Postpartum?

The timing of starting birth control is something you and your healthcare provider will discuss, and it will vary from woman to woman based on lifestyle, preferences, and medical needs. However, a plan should be in place in the immediate postpartum period, advises Dr. Shirazian.

In fact, Dr. Shirazian explains that certain long-acting, reversible contraceptives (LARC) can be placed directly after birth. These include IUDs and progestin-only birth control pills. Other methods, including combined birth control pills, should not be started until 6 weeks postpartum.

“It used to be that we told women to wait till 6 weeks postpartum to think about longer term reversible contraception, but now we can place them at delivery,” Dr. Shirazian says. “This is most effective way to birth space and optimize birth planning.”

Summary of Options

There are many kinds of contraceptive methods, most of which can be used postpartum, including: 

• Barrier Methods (male and female condoms, spermicides, diaphragms, cervical caps, the sponge)
• Birth Control Pills (progestin only, or estrogen/progestin combined hormonal method pills)
• Intrauterine Devices, or IUDs (hormonal IUD or copper IUD)
• Contraceptive Implants
• Injections (Depo-Provera)
• Sterilization (tubal ligation or vasectomy)
• Lactational Amenorrhea Method
• Natural Family Planning

All of these methods can be utilized by postpartum mothers. Each birth control option has a different effectiveness, and effectiveness can vary depending on how well the methods are followed. Here are some points to keep in mind:

• A postpartum mother may have a less predictable schedule, so remembering to take a birth control pill at a certain time of day may be an issue for some; you should also factor in fatigue, which can affect your memory.
• Methods like the Lactational Amenorrhea Method and Natural Family Planning are difficult to follow for many postpartum mothers, and failing to follow these properly often results in unwanted pregnancies.
• ACOG reports that the sponge and cervical cap lose their effectiveness among mothers who have given birth.
• If you use a diaphragm for birth control, you should get refitted, as childbirth can affect the size and shape of your vagina.

Are Any Contraception Methods Contraindicated for Postpartum Moms?

Dr. Shirazian warns that combined hormonal method pills are not appropriate for women in the immediate postpartum period because they increase the risk of blood clots (deep vein thrombosis), a serious health concern for women who have recently given birth. You should wait until 6 weeks postpartum to begin this contraceptive method.

Additionally, the estrogen contained in combined hormonal method pills may lower milk supply in some breastfeeding moms, so progestin-only birth control pills are recommended, notes Dr. Shirazian. If you have further questions about how different birth control methods may affect your milk supply, contact your healthcare provider or a lactation consultants (IBCLC).

Other Common Questions

In Dr. Shirazian’s experience, many mothers question the use of hormonal birth control methods. “The reluctance is that they want to feel like themselves and are concerned that hormones may change that,” she says. Hormonal birth control methods usually do not have side effects, but if you have concerns—and especially if you have a history of mental health issues or postpartum depression—speak to your healthcare provider about options.

There are so many options out there, including effective methods that don’t include hormones (like Cooper IUDs), so your provider can help you find one that works for your needs. “We weight any negative feelings against the real risks of being pregnant too soon,” says Dr. Shirazian.

Can Birth Control Prevent Postpartum Depression?

Many women with a history of mental health issues or previous experiences with postpartum depression may wonder if hormonal birth control methods could prevent PPD. “There is no birth control that we think helps with postpartum depression,” Dr. Shirazian commented.

However, some hormonal birth control methods have the side effect of depression for some women (ACOG mentions hormonal IUDs or birth control implants as having these potential effects). For peace of mind, Dr. Shirazian suggested that mothers concerned about the effects of hormonal birth control on their mental health start with the progestin-only pill, as it has fewer known side-effects.

A Word From Verywell

If you just had a baby, it’s understandable that you might feel like you don’t have the time, headspace, or inclination to think about birth control. After all, you have a lot on your plate, and considering all the options, timing, and side-effects of different contraception methods can feel overwhelming. However, for most of us, an unwanted pregnancy would much more overwhelming than any of those things, and because you are at risk of getting pregnant even a few weeks postpartum, you really do need to consider your birth control options.

The good news is that you aren’t alone. Your healthcare provider is there for you, and will help you find the method that is simplest, most user-friendly, and that fits your lifestyle. So make sure you check this one off your list as soon as possible. You will be relieved once you have a postpartum birth control plan in place—and then you can go back to snuggling your baby, and hopefully slipping in a few extra naps along the way.