Breast feeding has documented benefits for both mother and baby (NEJM JW Women’s Health Jul 9 2014; [e-pub] and Am J Obstet Gynecol 2014; 211: 424.el). So when women are choosing birth control methods, it’s important to know the options regarding the effects of hormonal contraception on breast feeding performance, as well as ease of use and safety. The best time to talk about contraceptive options with your practitioner is during your pregnancy.
The CDC has recently updated the U.S. Medical Eligibility Criteria for Contraceptive Use (US MEC), which provides guidelines on the safety of available birth control choices for women with specific health conditions. Updates for breast feeding women were included based on risk for venous thromboembolism (VTE) and postpartum days. For instance, using combined oral birth control pills is not recommended within 21 days of delivery (rated category 4) due to the excess risk of VTE. It’s best to wait beyond 12 weeks postpartum to reduce the mother’s risk for blood clots. On the other hand, all progestin-only contraceptive methods are rated category 1 (low risk/no restrictions) or category 2 (advantages of the method generally outweigh its theoretical or proven risks) for breast-feeding women.
Here are some of the best options for breastfeeding moms:
1. Lactational Amenorrhea- This offers an effective temporary method of contraception (until menses return or milk substitutes are introduced). When women do not menstruate, they (usually) do not ovulate and cannot get pregnant. Some women will choose an additional method of contraception even while breast feeding exclusively to make sure they are protected from pregnancy…which I think is a good idea.
2. IUDs- There are several types of IUD’s which are safe and very effective. Some contain copper and others contain a hormone known as progestin, which is a synthetic progesterone. They can be used for many years and all can be removed as soon as you are ready to get pregnant again. An IUD can be placed in the uterus within 10 minutes of placental delivery which is very convenient, but risk for expulsion is higher when inserted this early. Many women prefer to wait until their 6-week follow-up appointment.
3. Implant, Shot, and Progestin-Only Pill- All 3 of these methods use the synthetic hormone Progestin. You can use any of these methods immediately after delivery. The implant is the most effective birth control available; even more effective than sterilization!!. Pregnancy can be achieved after removal of the implant. The Depo shot is also very effective as long as you are able to get the injection (given in the arm or buttocks) every 3 months. The progestin-only pill is least effective than the implant or shot mainly because there is more room for human error. The pill needs to be taken the same time everyday, which can be difficult when you have a baby to care for. A new option for women outside the U.S. is a progestin-only vaginal ring that is effective for about 1 year.
4. Emergency Contraception (EC)-This contraception is used only if your regular method of birth control has failed (forgotten pill, broken condom). If you are 17 years or older, you can get EC pills (Levonorgestrel) at the pharmacy without a prescription. Take them within 3 days of unprotected sex. A prescription-only EC pill, ulipristal acetate can be used up to 5 days after unprotected sex. Ulipristal is more effective than nonprescription EC. Small amounts of ulipristal has been found in breast milk so pumping and discarding breast milk is advised for 24 hours after taking ulipristal EC.
The most effective EC is having a copper IUD placed within 5 days after unprotected sex. This also provides you with a continuing and effective birth control method.
There are many safe and effective contraceptives choices after childbirth and when breastfeeding. Talk to your practitioner before having your baby to discuss your preferences when the time comes.
References: Chen, M, Schwarz, E. New guidance on contraception while breast-feeding, JWatch.org October 2016. p.77.
Curtis KM et al. U.S. medical eligibility criteria for contraceptive use, 2016. MMWR Recomm Rep 2016 Jul 29;65:1.