Birth control for breast-feeding women

Breast-feeding is not a contraceptive

The common misconception that breast-feeding itself prevents pregnancy has consistently been proven wrong. While it is true that a nursing mom is less likely to become pregnant than a mother who bottle-feeds, there is no guarantee that pregnancy will not occur if birth control is not used. The methods available to breast-feeding women include hormonal contraceptives, barrier methods, the intrauterine device (IUD), and sterilization. If you plan to breast-feed, talk to your doctor before your delivery about which method might be best for you.

Hormonal contraceptives

Many women fear that taking hormone medication while breast-feeding will harm their babies. Here are some safe hormonal contraceptives.

• Combination pills – Oral contraceptives (commonly called birth control pills) offer excellent pregnancy protection, but can sometimes interfere with your milk production. The majority of pills are combination pills containing two hormones, estrogen and progesterone. The estrogen component in some pills may suppress milk production to a degree that makes breast-feeding difficult or requires supplementation. The quantities of these hormones excreted in the mother's milk are not enough to harm a newborn baby; however, if your baby has been delivered prematurely, it may be best to avoid combination pills.
• The mini-pill – Progesterone-only birth control pills are a popular choice for many nursing moms. Also called the mini-pill, this method is less effective than combination pills, but much less likely to suppress milk production. Most women will not menstruate as long as they remain on this pill—a welcome side effect for some women. When breast-feeding is discontinued, an easy transition can be made to a combination pill. It is essential that the mini-pill be taken every day at the same time to be effective. Noncompliance can result in an unintended pregnancy.
• Depo- provera is an injectable hormonal contraceptive that is administered every three months. Breast-feeding women should wait until six weeks after delivery before receiving their first injection. The progesterone-like hormone contained in Depo-provera will not harm the nursing infant, is almost 100% effective in preventing pregnancy, and will not reduce your milk supply. Side effects include irregular periods or absence of periods, and weight gain. The overall cost is similar to birth control pills.

Barrier methods

Barrier methods of birth control include condoms (male and female), the diaphragm, and the cervical cap. All of these methods work by presenting a physical barrier that prevents the sperm from gaining access to the egg. Although side effects are minimal, the pregnancy rate is significantly higher when compared to hormonal methods. None of the barrier methods interfere with breast-feeding in any way.

• Condoms – To improve their efficacy, condoms should be used in conjunction with a spermicidal gel. The chemicals in these gels don't enter the breast milk and therefore are harmless to a nursing infant. Failure to prevent pregnancy is usually due to improper use, failure to use at all, or breakage. Latex condoms may cause an allergic reaction in some women but will not affect the nursing infant in any way.
• Diaphragm –The diaphragm is a round, flexible, rubber, cup-shaped device that is inserted into the vagina prior to intercourse. When used with a spermicidal gel, its effectiveness at preventing pregnancy is similar to condoms. You must be instructed by your health care provider as to the proper way to insert and remove the diaphragm. The diaphragm should be removed within six to 12 hours after intercourse. With proper care, a diaphragm will last for two to three years, but should be refitted if you gain or lose a substantial amount of weight during that time. You can be fitted for a diaphragm at your post-partum check-up—usually four to six weeks after delivery.
• Cervical cap – The less popular cervical cap fits more tightly against the cervix, is more rigid than a diaphragm, and can remain in place for longer periods of time.

The overall cost of a barrier method is usually less than that of any of the hormonal methods. Breast feeding women sometimes develop atrophic vaginitis. This condition, a result of depressed estrogen levels, causes vaginal dryness, irritation, and painful intercourse. Insertion and removal of a diaphragm or cervical cap may be painful. If you suffer from this condition, a different method of contraception may be more acceptable.

The intrauterine device (IUD)

Although less popular than in the past, the IUD remains an effective and safe contraceptive method for breast-feeding women. The ideal candidate is a woman who has completed her family but doesn't want to undergo a tubal ligation, or who can't tolerate hormonal methods. Because this method provides long-term protection (up to 10 years), it is not a wise choice for younger women planning to have more children. Current IUDs either contain copper or are impregnated with a progesterone-like hormone. There are no adverse effects from the IUD or any of its chemical components on the nursing infant.

Sterilization

For women who have completed their families, permanent sterilization is a popular method of birth control. A tubal ligation can be performed shortly after delivery while you're still in the hospital, or, if preferred, at a later date as an outpatient. In either case, no interruption in breast-feeding is necessary. Anesthetics used during the procedure may be present in the breast milk for a short period of time, but not in quantities high enough to cause any harmful effects on a nursing infant. Recovery from this minor surgery is rapid, and breast-feeding can resume as soon as you are awake and alert. After surgery, a wide variety of safe pain medications may be used.

Safe solutions

For most new mothers, the thought of becoming pregnant again right away is frightening. Effective birth control is therefore of paramount importance. Breast-feeding mothers are often concerned about medications that might be transferred to their babies in their breast milk. Fortunately, there are several safe methods available for prevention of pregnancy in women who choose to breast-feed their infants.