Contraceptive methods to avoid pregnancy while breastfeeding

After the birth of the baby, if the mother does not breastfeed, the state of postpartum amenorrhea (absence of menstruation) can last about 6 weeks . If, on the other hand, the woman is breastfeeding, the amenorrhea can last for a long time, a few months or even more than a year .

In breastfeeding , a woman ‘s fertility can be more or less reduced and therefore relying only on breastfeeding to avoid unwanted pregnancies is not a safe method .

Before menstruating again, a woman ovulates and can therefore become pregnant even before the first period ( foreman ).  In non-breastfeeding women, ovulation can occur about a month after delivery; on the other hand, in those who are breastfeeding it can occur as early as three months after giving birth.

If the couple does not want to have a new close pregnancy (especially if the woman has undergone a caesarean section) they should adopt a valid contraceptive method with help in choosing from the gynecologist or obstetrician of reference.

She should begin to evaluate the issue already in pregnancy to make a careful and thoughtful choice that listens to the needs of the couple.

Barrier methods

Among these we find the male condom, the female condom and the diaphragm. While the first two can be used from the resumption of sexual activity and have no contraindications, for the diaphragm it is necessary to wait at least 6 weeks after delivery.

The effectiveness of the diaphragm (which must be used in the correct way to give good effectiveness) increases with the use of spermicidal creams and ovules.

Hormonal methods

Among these we find oral contraceptives, the patch and the ring.

The estrogen-progestogen pill is rarely prescribed as it may decrease milk production in breastfeeding women. It can be recommended only 6 months after delivery (unless there are conditions that contraindicate its use) also due to the risks of venous thromboembolism which are present not only during pregnancy but also in the first 3 weeks after delivery and which decrease as the weeks go by.

The progestin pill, unlike the previous one, has the advantage of not increasing the risk of thrombosis and does not affect milk production . For this reason it is the most common hormonal contraceptive method among breastfeeding women (who have no contraindications to its use).

In breastfeeding women it is always preferable to wait at least 6 weeks after giving birth because studies on rats have shown that progesterone affects brain development.

Subcutaneous implant

In Italy there is etonogestrel (recommended only after 6 weeks of childbirth).

For etonogestrel, there are no studies that demonstrate a negative effect on the quantity and quality of milk, nor on the development of the newborn.

levonorgestrel intrauterine system

They are recommended after 4 weeks of delivery.

Copper spiral

The WHO recommends insertion 4-6 weeks after delivery or even better, after the resumption of menstruation (after the department head ).

LAM: lactation amenorrhea method

According to those who defined it, this method offers 98% effectiveness but only if these conditions are met:

• The first 6 months have not passed since the birth
• Menstruation has not returned (still amenorrhea)
• Breastfeeding is still exclusive (no use of artificial milk or herbal teas, etc…) with intervals between feedings never exceeding six hours at night and four hours during the day

If breastfeeding is no longer exclusive and more hours pass between feedings, even one episode of prolonged sleep during the night is enough, contraceptive safety is lost.

Natural methods

The Billings Method and that of the basal temperature are useful with a stabilized menstrual cycle but must be taught by qualified personnel who can be contacted from the official website .

The Ogino Knaus has big limitations and it is preferable to recommend it only when trying to get pregnant.

Summing up

• Barrier methods are the primary choice within 6 weeks of delivery.
• The hormonal progestogen methods are recommended for breastfeeding women no earlier than 6 weeks after delivery, the estrogen-progestogen methods 6 months after delivery
• The alternative is represented by the LAM method

Insights

If you are interested in learning more about the subject, you can refer, as a starting point, to the  Interdisciplinary Technical Operational Table on the Promotion of Breastfeeding of the Ministry of Health .

Warnings

Always refer to your gynecologist or midwife to choose the contraceptive method best suited to your condition .