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Postpartum Birth Control

What to do about postpartum birth control

After the birth of your child you will have several decisions to make from work to day care to strollers. Luckily, birth control isn’t a very difficult one. There are many options available to you when you are ready.

IUD

mirena-iudThe best option by far is an IUD. An IUD is an intrauterine device. The IUD is safe, effective, reversible, and there is nothing to remember to take every day. The IUD is placed at a regular office visit in about 5 minutes. We usually wait until 4-6 weeks after delivery to place it.

Some women will not consider the IUD. They don’t want something foreign inside them. While others will remember back to the 1970s, when all IUDs were temporarily removed from the market because of One bad IUD. The “bad one” was the Dalkon Shield. We knew then, and we know now, that the Dalkon Shield was bad…and that IUDs are GOOD. In fact, the IUD is as close to “perfect contraception” as one can get.

Perfect contraception is effective, without side effects, and is easy to use. It should not be something one has to remember, and it shouldn’t be something you have to “do.”

Once the IUD is in, it can stay in place for up to 5 or 10 years, depending upon which one you get. And it can be taken out at any time without lasting effects and fertility returns immediately.

Other Options

Alternatives to the IUD include the pill/patch/ring, the Depo Shot, and a (newer) implantable rod, called Nexplanon.

The MINIpill

The progesterone-only birth control pill (MINIpill) is supposed to be most compatible with breast feeding. It is also the method most likely to fail. The regular birth control pill is simple, safe, effective, etc…but it has been accused of drying up the milk supply, though this is not exactly true. The literature accusing the pill of doing this is not very reliable. So, maybe we just don’t know. In any case, we rarely use the regular pill in breastfeeding women.

Seeing as the goal is to prevent pregnancy, I discourage the progesterone-only “mini-pill.”  What good is a pill that does not reliably prevent pregnancy?  The “issue” with the progesterone-only pill is the Time of Day that you Take the Pill. The progesterone only pill MUST be taken at the same time every day. For example, you probably need to take it between 12p and 1p every day, or it will not reliably prevent pregnancy.

The progesterone pill may not prevent pregnancy if you are not able to take it daily, AT THE SAME TIME EACH DAY.

The Pill

For comparison, the “regular pill” is effective if you take it daily. It is not sensitive to exactly When you take it and remains effective, even if you miss a single day per month.  Patients should take the missed pill As Soon as they remember, or take two pills the next day.

The regular pill may not prevent pregnancy if you miss two pills in one cycle.

ringThe Patch & The Ring

The patch and the ring are medically the same as the regular pill. The patch gets placed weekly on the skin like a sticker.  The ring goes in the vagina (as shown), at the same time each month.

depoProvera Shot

The depoProvera shot is a reversible, “don’t have to remember” method that has Not been accused of interfering with breast feeding.  Each depoShot is effective for 3 months.  And you can get even get the first shot before you leave the hospital after delivery.  DepoProvera can be used as temporary, safe, reliable contraception for three months, while women consider their other postpartum contraceptive options. The depoShot may cause irregular bleeding…very light spotting, but it can go on and on and on. And some women don’t like how they feel on Depo.

Nexplanon

Nexplanon has a similar mechanism to DepoProvera, the MINIpill and the progesterone IUD Mirena. Nexplanon is an implantable medicine stick. It is placed just above the elbow, on the inside of the arm.  It is effective for three years. The primary side effect is light, irregular bleeding.  And, like DepoProvera and the IUD, it has not been accused of causing problems with breast feeding.