On my sixth-week, post-delivery check-up, my gynaecologist peered at me through her half-rimmed glasses and asked me if I wanted another baby soon. My mouth (literally) opened and shut a few times, as my sleep-deprived brain struggled to form a coherent response. ‘No thanks’, I muttered finally. ‘I’m still struggling with the brand new one I have’. She proceeded to whip out her letterhead and began writing down my options for contraception. She was halfway through the page when my slow-moving brain finally caught up, and I halted her mid-sentence. ‘Whoa, doctor! Too soon!’ I spluttered. My uterus had just gone through a nine-month, intensive inhabitation program. Surely it was on a much-deserved vacation? There was no way my anatomy was already plotting baby number two. My wise doctor shook her head and asked me if I knew anyone who had two kids less than a year apart. As my mind scrolled through my list of familiar mothers, I realized I knew quite a few. And then the puzzle pieces clicked together. These women didn’t plan another so soon, but it happened anyway. Right. May I have those contraception options in triplicate, please? I am not taking any chances.
Post-pregnancy contraception: myths busted
I knew a mother who complained of tender breast pain for a month and shrugged it off as just another side effect of breastfeeding. It wasn’t. She was pregnant. So many mothers think they are immune to pregnancy during the first few months after delivery. So many mothers learn the hard way that the fatigue, brain fog, and weight gain are less to do with their new baby, and more to do with another one that’s on its way. So here are two major misconceptions cleared up for you.
#1 You can’t get pregnant if you’re breastfeeding
Just like newborn babies who sleep all night, using breastfeeding as effective contraception is also a myth. You might have read about LAM (Lactational Amenorrhea Method) in a book or online. But this is a very tricky method that needs several factors working in your favour to produce results. And even then, there are no guarantees.
Here’s why this method stinks as much as your baby’s diaper:
- LAM only works for the first 6 months of breastfeeding
- It is no longer effective if you start menstruating within the first 6 months
- You must feed your baby every four hours during the day, and every six hours at night without fail
- You shouldn’t express milk
- You can’t feed your baby anything else besides breastmilk
- It doesn’t work if your baby has trouble suckling or latching
- Even if you fill all the criteria mentioned above, you still have a small chance of getting pregnant
#2 You can’t get pregnant if you haven’t started your periods
We all think of it: No period, no pregnancy. While this may be true soon after you give birth, things can change. If you feed your baby formula or a combination of breast milk and formula, your period could show up as quickly as six to ten weeks post-delivery. However, ovulation begins two weeks before menstruation. And there’s no sure way of knowing when that will be. So you might think you’re safe, but you’re ovulating before your first period postpartum.
#3 If your periods start while you’re breastfeeding, they will be exactly how they were before pregnancy
Firstly, there is no such thing (re-read it) as a safe day. We all know that by now. My gynaecologist gave me another rude shock when she informed me that even if my periods start while breastfeeding, they may not follow the pre-pregnancy schedule. Your periods will be erratic, and your dates will be uncertain. While breastfeeding, you may not be able to accurately calculate the supposedly ‘safe days’ for unprotected intercourse. So as long as breastfeeding was on the menu, my doctor firmly advised in favour of external contraception.
Contraception options during breastfeeding
So now that we’ve established that you need some form of external contraception to keep your uterus vacant let’s go through your options. We’ve looked at all the safe birth control methods available in India, that won’t affect your lactation. Your gynaecologist might have mentioned you should wait for four to six weeks after delivery before you resume sexual intercourse with your partner. This is irrespective of the type of delivery you’ve gone through.
When choosing a hormonal contraceptive, make sure to opt for progestin/progesterone-based birth control methods only. Avoid estrogen-based ones as they can cause the breast milk supply to lessen or dry up. Make sure to discuss with your GYN all the pros and cons before you opt for the hormone-based method.
These are different from traditional birth control pills as they only contain progesterone, instead of progesterone and estrogen. They come in a 28-day cycle, and they stop the ovaries from releasing an egg every month. However, you need to be cautious and always remember to take one pill every day at around the same time.
Take a 150 mg shot every three months, and the hormones released to ensure that ovulation doesn’t take place. Just make it clear that you want to take the progesterone-based injections, not estrogen.
Long term contraception
1. Intrauterine device
Although it has a slightly sinister, double hook-like appearance, the IUD is safe, long-lasting and popularly recommended by doctors as they are highly effective. Your gynaecologist inserts the device into the uterus through the vagina, and it’s attached to a string that allows for easy retraction. It can stay for five to ten years, but after that, you need to get it removed by a medical practitioner.
IUDs come in two forms:
Copper IUD: Copper ions are released and kill the sperm as they enter.
Hormonal IUD: slowly release hormones that prevent the sperm from reaching the egg in the uterus.
2. Male/female sterilisation
If you’re done having kids, you can opt for a tubal ligation or your partner can undergo a vasectomy. Both these procedures are safe and guarantee you won’t get pregnant again. They are irreversible, so better make sure first.
3. Barrier method:
The most commonly used and advertised method of birth control, condoms serve as a one time, fuss-free use that needs no prior preparation.
Available in gel, cream or tablet form and kills sperm on contact. Just apply as instructed, either directly into your vagina or on to a barrier apparatus, and keep it on for up to six hours post intercourse.
This dome-shaped, shallow cup and can easily fit into your vagina and block sperm from entering the uterus. Made of silicone or rubber, the diaphragm is more effective when combined with a spermicide. It can remain inside your body for unto 24 hours, following which you can take it out and wash it.
#4 Cervical cap
It’s similar to the diaphragm, except it fits over the cervix and is held up by suction. This one also blocks sperm from entering the womb, especially when spermicide is applied. You can keep the cap inside your body for up to two days, following which take it out and clean it with a good rinse.
I took heed of my gynaecologist’s words that day and marched out of her office with enough information to keep my body baby free for the next four years. I had my second baby when I was ready. We are actually lucky to live in an age with such a plethora of contraception at our disposal. Pick a contraception method that best suits you and your lifestyle, and be in control of your reproductive system.
Disclaimer: Please check with your gynaecologist before you start any of the contraception methods listed above. It is of absolute importance to follow a contraception method recommended by your doctor, that suits your needs and supports your body postpartum.