2018 Update: We still think this is a great discussion of birth control after having a baby — but you may also want to check out our more recent roundup of the best birth control options in 2018, over at Corporette.
Choosing birth control before you were a mom was complicated enough . . . but we thought we’d talk about birth control considerations after having a baby. We haven’t talked a lot about birth control here (although a few years ago we had a post over at Corporette about IUDs), so we thought it’d be a great topic to discuss today. What did you consider when choosing birth control after having a baby? Were you concerned about breastfeeding, hoping to get pregnant again soon, or worried about other issues? Are you using the same type that you did before getting pregnant, or did you switch to something else?
What were (or are) your deciding factors? The efficacy of the method? The potential side effects? The length of time that it stays effective? Whether it’s hormonal vs. non-hormonal? Whether or not you’re planning to have another baby soon?
Here are some pros and cons that moms find themselves considering when deciding on birth control after having a baby:
- Breastfeeding: If you breastfeed your baby at least every four hours during the daytime and at least every six hours at night (and you don’t supplement with formula), your body won’t ovulate. (But talk to your doctor and lactation consultant about this — there are a lot of caveats, as described in this Self article.) However, when your baby turns six months old, you’ll start ovulating again. (Psst: here’s our last discussion on crazy hormones while weaning from breastfeeding.)
- Birth control pill: If you’re still breastfeeding/pumping, your doctor will probably tell you to avoid the combination pill because it contains estrogen, instead recommending the progestin-only “mini pill” (which isn’t quite as effective). Last December brought news of a new study (NYT) that confirmed previous studies’ findings that the pill increases breast cancer risk — but that was followed up with articles reminding women that it reduces the risk of other types of cancer (NYT).
- IUD: You may not want to use this method (either the copper IUD or hormonal IUD) if you’re thinking of having a baby within the next few years (although it’s easy to remove, and you can get pregnant right away). Doctors usually recommend waiting six weeks after giving birth to get one. (Here’s an old guest post on Corporette detailing one woman’s experience with an IUD.)
- Permanent birth control:
Essure involves a non-surgical procedure that blocks the fallopian tubes, and it’s 99% effective — but so many women have had problems that it now has an FDA “Black Box” warning. (Of course, many more have had no issues at all.)[Update: Essure will no longer be sold in the U.S. after 2018.] The old standby, tubal ligation, is more than 99% effective as well. Of course, the least painful, safest option for a mom is to have her partner get a vasectomy — and it’s much more effective than a tubal ligation. However (perhaps not surprisingly), the vasectomy rate in the U.S. is about half of the rate of tubal ligations.
- None, because babies: Some moms simply take a break from birth control because the only things they’re currently doing in bed are breastfeeding, sleeping, and wishing they were sleeping.
(Not to mention the many other sorts of birth control, including natural family planning, etc. — Planned Parenthood’s website is a great place to research any of them.)
If you’re trying to avoid pregnancy right now, which birth control method are you using? Are you happy with it? What have you used in the past that you’ve had good or bad experiences with, either before or after you became a mom? Have you conceived a “surprise” baby when you were on the pill or using another type of birth control? What’s your advice for other moms on what to consider when choosing birth control after having a baby?
Picture via Stencil.
I was on the pill or the ring, skipping the placebo week, for almost two decades before going off it to TTC. (I had painful periods so I went on the pill at age 14.)
In between kids, we just used condoms.
Then at my 6 week check up after the last kid, I asked about IUDs and had the Mirena inserted shortly thereafter. Later that year, we realized we were at the family OOP maximum for insurance thanks to birth and complications, so my husband went in and got a vasectomy on Dec 20th or so. I’m leaving my IUD in until it expires, then I’ll probably explore other options, although I desperately want to avoid getting a monthly period so may just stay with an IUD until I have to start thinking about menopause.
Is there even a non-hormonal option that stops your period? Or is it pretty much pill vs IUD vs period? And I’m worried how I’ll even know menopause is starting or is something I have to worry about, if I’m basically ignoring my uterus for all but my yearly checkup.
I think the only non-hormonal way to avoid a period is a partial hysterectomy (removal of the uterus, leaving the ovaries). That seems a little extreme, and I don’t think the doctors will even do this as an elective. I have a copper IUD because the Mirena is less effective than the copper one, and we already have one surprise post-vasectomy baby and I don’t need any more! I do envy the no periods thing the mirena offers tho.
I have clotting factors and migraines that preclude all forms of hormonal BC. As a result, I ended up abstaining entirely until I was 28 because I didn’t want to risk getting pregnant without a degree and then once I was out of college I just wasn’t in a serious relationship until 28. I tried to get an IUD but apparently my cervix has a crazy hard left turn we discovered trying to insert it so that is off the table, and since I had a scheduled c-section (see clotting factors), it is unlikely my cervix has changed at all. My husband and I used condoms and a sponge (my acne meds strongly recommended two forms of BC). Once I went off the acne meds it was just condoms. Once we started trying, took 2 months to get pregnant, and post baby (5 months) we haven’t bothered because colic + teething + sleep regressions = two very sleepy parents. We will go back to condoms once we get more sleep, but want to space the babies about 2 years apart, so query whether we will need to for very long. Whenever we decide we are having our last kid, I will probably get my tubes tied during the c-section just like my mother did. TBD whether that will be 2 or 3.
2 Cents says
Thanks for sharing! I have clotting issues from birth control too, so after this baby, will be trying to figure out what to do. Probably condoms, since that’s what we used before we were actively TTC.
Same reason for condoms for me. High stroke risk.
Mrs. Jones says
My doc refuses to prescribe the pill to anyone over 40. After son was born, I had an IUD until my husband got a vasectomy. I highly recommend the latter. :)
I was on the pill from 18 to somewhere in my early 30s and now at 36 I don’t think I would be comfortable taking it again. I think once I have this baby, our method of BC will have to be a vasectomy. Between that and getting my tubes tied, it seems like a no brainer.
Having read about the side effects of other “permanent” BC, I cannot understand how anyone would be willing to risk it. Teeth falling out seems like a pretty high risk to me, even if it’s not the result for a majority.
For BC over 35, is the concern stroke?
I think when the FDA made the recommendation, the concern was mainly heart disease. Generally the concerns for women 40+ are stroke, blood clots, heart attacks, hypertension, etc. I have read that this is not really considered an issue now unless you smoke or have a history of these things. Personally, I just don’t want to be on the pill anymore. I feel like I’ve dealt with BC up to now, and now it’s my turn to do nothing.
FWIW, I nursed for 2+ years with both my first two kids, and I didn’t start ovulating until at least 16 weeks with both. Nursing baby 3 now and no ovulation yet at 6 months even with her STTN (10-12 hours) since 2 months old!
Did tubal ligation during c-section for baby 3. Husband flat out refused a vasectomy. Sigh.
Agreed. I went back to work at four months but kept nursing/pumping and didn’t get my period back until 12 months.
Can’t multitask today – that should say 16 MONTHS, not weeks.
I had an IUD after my first because we wanted to wait 2-3 years between kids. However, I had a rare experience of excess inflammation in my uterus and as a result had a cancer scare when I had abnormal cells in paps and other tests. Thankfully we took out the IUD and all was resolved. It then took me longer to get pregnant with my second, but I think that was due to other hormonal factors and not from the IUD. After my second child my husband got a vasectomy – we thought about waiting to see if we wanted to have another but my age plus the factors of having trouble getting pregnant before and the added expense of another child helped us to see that our family was complete.
And also should have mentioned that I nursed my first for 12 months and did not ovulate until two months after I weaned him. Nursing baby two now and at 10 months I’m still not ovulating (he’s also sleeping long stretches when he doesn’t have the dreaded daycare cold!).
I used a copper IUD initially post-partum, which caused long and bloody periods but was otherwise fine. When my son was 5, I got fed up with the blood and decided to try the pill again, but it was really upsetting my stomach (which in hindsight I think it did pre-baby too, but I never made that connection – I was diagnosed with irritable bowel syndrome back then). So I decided to try a hormonal IUD, which somehow came out of my body without me noticing it in the first week or two after insertion. Luckily I figured this out before I had a chance to accidentally get pregnant. Then instead of trying that again I got the implant. It has the same efficacy and side effect profile as a hormonal IUD, lasts as long, was less painful to have inserted, and cannot fall out. It will be slightly harder to get removed though.
The implant was inserted on the very day the news story broke about how all forms of hormonal BC increase breast cancer risk, which I am not feeling great about, but otherwise so far it has been a good option for me, and one I think more women should be aware of.
How reversible is a vasectomy? We’re 90% sure we’re done after I deliver #2 in a couple of months. But I’m not sure if I’m ready to really say, “this is it.” I just don’t know how I’ll feel in a couple of years, assuming I still have childbearing years ahead of me.
It’s considered “permanent” so while you can reverse it, the odds of sperm count returning to pre-vasectomy levels are fair at best. If you’re not sure you’re done, use a more temporary method like IUD until you’re sure.
I know it’s still hormonal but I did Nexplanon for three years and found it just right for me. Easy pain free insertion (I had a C-section so was afraid of the pain with an IUD). Nothing to remember.
I don’t tolerate hormonal BC well, so we used condoms between kids. DH had a vasectomy after our youngest was born, and let me tell you, it has been the most freeing thing ever.
Most of my friends got IUDs but they scare the heck out of me. Just knowing that I’d need yet another procedure if it didn’t agree with my body was a huge deterrent. (I’ve more surgical procedures in that region of my body than I care to think about!)
These are all fascinating and are introducing me to lots of options I hadn’t previously considered. I was on the pill until age 35, when we started trying for #1. Started trying for (or at least, not avoiding) #2 when #1 was a year old, and used condoms until then. I am now due in a couple of weeks and have no idea what we’ll do afterwards.
My OBGYN asked me what we were doing for BC at my first appointment after the baby. I was like, girl, I don’t even know what I’m doing in terms of eating/sleeping/showering. She was super no-nonsense and made me prioritize it, which in retrospect I am really grateful for.
Pretty Primadonna says
Six weeks postpartum, I got the Mirena installed. I had it for a little over a year then had it removed. It made me tired and fat. I am back on The Pill and doing horribly with taking it, which is so interesting because I had been on hormonal BC pills for years before getting pregnant. I wish the Mirena had worked for me. It was so easy.
I have migraines and hormonal birth control cut the frequency in half. (From 1 every six-nine months to 1 every year-18 months. Also had a couple of aura-only/pain free migraines while on the pill.)
I had two migraines in the first six weeks after giving birth. None on the mini-pill (which I took for two years — longer than my daughter nursed).
I’ll take hormonal pills as long as they’ll give’em to me.
Between 1st and 2nd kids, I used the breastfeeding method. Fortunately it worked out. We were fine having kids close together but in the end, I didn’t start ovulating again until my 1st had forgotten my b**bs even existed (haha, but really – I didn’t get my period until 4 months after I weaned her). I got my first PP period when older daughter was about 14 months old, and got pregnant with #2 when oldest was 18 months. After #2 the dr convinced me to try Mirena, which I HATED. Spotting + discomfort for both my husband and me during gardening. I went back to Ortho Tri Cyclen which worked well for me before kids and also works fine now. I have another medicine that I take daily so I don’t have trouble remember to take the pill.
layered bob says
I am on my third copper IUD; I had one before kids and then placed again six weeks after each kid. I love it. Periods are long and heavy but it doesn’t interfere with nursing, doesn’t seriously raise my risks of anything and doesn’t require any action. Plan to do copper IUDs in between and after kids until we’re very certain we’re done; then DH will get snipped.
I was on the pill until we started TTC when I was 27. That took over a year. Then I got the Mirena 8 weeks after giving birth to my son. I was really scared of the insertion pain, but maybe because I got it so soon after giving birth (or because I was still mildly traumatized from the pain of giving birth), I honestly barely felt a thing! I’ve had no complications.
Important side note though – because it took so long for us to conceive, and then I was pregnant after, my DH and I completely and totally forgot about birth control the first time we had sex after I gave birth! Thankfully nothing happened, but I had a mild panic attack right at the mere thought that I could be pregnant again so soon!
Mirena was terrible for me, but was easy enough to get out and replace it. I LOVE love love Paragard – had it before TTC, have it now. I haven’t experienced the higher flow a lot of people have, also no increase in cramps. It has been awesome! My feeling with IUD is that if one doesn’t work for you, it’s not a big hassle to try another. YMMV, I guess. I wish I had gone with an IUD 20 years ago.
I am sensitive to all types of hormonal BC, and was hoping Mirena would have a small enough amount that I could tolerate it, but – nope. Highly recommend Paragard (copper) for those with similar issues. As an aside, my husband is more comfortable with the Paragard, too – something is different about the strings.
I’m on my third Mirena – the first for four years before TTC #1 (pregnant first cycle after removal), the second from 10 weeks postpartum to 12 months postpartum when we TTC #2 (pregnant first cycle after removal), and now the third that was inserted 10 weeks after delivering baby #2. Given how quickly we were able to conceive both times, I’m incredibly confident in the Mirena’s birth control capabilities! I had no adverse effects at any point with Mirena and will likely stick with one until I’m sure that I’m sure we are done having kids.
CPA Lady says
One thing that surprised me was that having a kid changed my hormones, so things that I used to tolerate well no longer were worth the awful side effects. It was very surprising and confusing after being on BC with no issue for a decade, to all of a sudden be at a loss about what I could take. In the end DH got a snip and as of a month ago, I’m not longer on BC. Yay! I think!
the pill- slight nausea, no big deal
the shot – totally great, no period
implanon – totally great, no period
implanon – nonstop bleeding for months and months
the shot – became an enraged harpy
the patch – extreme breast tenderness and morning-sickness level nausea
Yeah… body chemistry is weird.
I want to put in a plug for FAM/NFP, which I am currently using (and is not to be confused with the old “rhythm method”). With perfect use the efficacy rate is in the high 90s; with typical use, it’s in the 80s, which is comparable with many forms of contraception. It takes a little bit of daily effort/action, especially postpartum, but it has zero side effects, and it’s been fascinating to understand and track my fertility. So, if you’re feeling a little bit crunchy, I recommend it.
And that’s how I had a surprise pregnancy this summer. So….ymmv.
Pre-child, I took the pill and didn’t seem to have many side effects. When I went back on it post-baby, I didn’t tolerate it nearly as well, it gave me horrible mood swings, and decided to go off of it. Got a Mirena after that. I’m due to replace it this year, but I’m not sure I want to. The first few years with it, my cycle was light to non- existent and now it lasts for a week. I’ve had a much harder time losing weight too. I’m moodier too. I don’t know if these age related or IUD related, but taking out the IUD may provide some answers Our family is complete and DH has said he’s fine with getting the snip. Having him actually get that scheduled may take some time. At the same time, I feel kinda bad asking him to take a permanent step if I decide to go back to an IUD for cycle control or something.
I had a very bad reaction to hormonal birth control when I first went on it right after becoming sexually active, so condoms were my only method of birth control from age 20 to age 34 – never had an accident. Once we started trying, I became pregnant immediately at age 34 so clearly no fertility issues and the condoms were doing their job for many years. The long term plan is for husband to get snipped but we’re using condoms until we’re 100% sure we’re one and done (95% sure now). My husband and I both kind of like using condoms – he lasts longer and there’s no mess – and they’ve been very reliable for us so I’ve never really considered an IUD or trying hormonal BC again.
Prebaby – I used the ring, which was amazing. I loved it. I had tried various pills but they all made me nuts.
Postbaby – I was advised against the ring because I was breastfeeding, and all my health care providers and my friends raved about the IUD. I got it but I’m not a huge fan. My husband can feel the string, my periods are unpredictable and although they are much lighter, they last WAY longer than they used to be (from 5 days to 10+ days). Plus I’ve been advised against using the DivaCup with the IUD because apparently the suction can dislodge it, so that just makes the whole experience less pleasant. I was also pretty uncomfortable for the first few weeks after it was inserted (though the actual insertion was nothing at all). After the next baby, I’m not sure what I’ll do.
Chi Squared says
I had a tubal ligation during c-section. I was almost 41, and had 2 complicated pregnancies. Clearly the right decision for me.
Abstinence so far. 100% effective, but often dissatisfying.
But now I’m starting to think about dating again (how’s that for noncommital?) and wondering what I should use. I am more concerned about STDs from new partners, so I guess condoms are the way to go. But I’d like a less in-the-moment option just in case; I really don’t want to be a single working mom of an infant ever again. Hormonal BC completely changed my taste in men (I went from liking normal, geeky, smart guys to wanting to take care of whiny emo guys and hey voila, ex husband!), so I’d like to avoid that until/unless I find a long-term partner.
I’m thinking of an IUD but I don’t really understand the “strings” issue. Are they really strings or stiffer than strings? And do I need to do anything with them? Will *I* feel them all the time? Because that’s a no for me.
Like a string. I couldn’t feel it in me unless I went looking for it (which my OB said I didn’t have to do, but I did every once in awhile to be sure).
They’re more like fishing line at first, but I have never felt them from the inside, if that makes sense. If you can feel them it is because your GYN didn’t trim them short enough and they can be trimmed at a follow up appointment. They soften and curl up over time so they lay flush with your skin. My DH has never felt them (>5 years and 3 IUDs), but I can find them with my fingers if I want some reassurance. You don’t need to do anything with the strings, it is just nice to have confirmation of protection.
anon mom of one says
Ugh, birth control. Fun times. I am almost 40 and have been on the pill since I was 17… Eek. So the news of the new study kind of freaked me out. My ob/gyn says it’s fine for me to stay on the pill, however (when I asked before that big study). I wish I had known I was going to have a C-section when I had my son years ago, because I would have asked them to do a tubal ligation as well, grrr. I was so out of it at the time that I didn’t think about it in the moment, and maybe they wouldn’t have anyway. I’m not crazy about the IUD option (my ob/gyn says they’re a great option for me though), and my reasons for staying on the pill for now is that my periods are totally scheduled, I don’t have side effects on the one I use, and … I love what it does for my skin. Yes, that’s a shallow reason. I’m not sure if my husband would agree to a vasectomy or not, but maybe he would if I remind him about my two-day labor… two-day back labor.
Since my very first period, my cramps were out-of-control bad so I tried progesterone pills to mellow it out, ortho-tri to regulate my cycle, etc. since I was 13 years old. By the time I was 16 I realized that severe depression is a very real risk for me on heavy hormonal bc pills and I stopped using it. I tried other pills (huge pigment spots on my face, not a good look) and even the depo shot (bled daily for 3 months, no thank you). I used condoms/abstinence the rest of the time in college and then got a copper IUD pre-kids from planned parenthood while I was in grad school. That worked really well until TTC, likely caused a uterine polyp that interfered with #1, used no bc in between #1 and #2 since we were told we were borderline infertile, planned to go on BC again after #2 but before my cycle started (14 months pp, while I was still bf #2) I ended up with #3. Hubby got snipped after #3 and we used nothing for a year. Then, a week after #3’s first birthday I got pregnant with surprise!#4. Sigh. She’s 7 months now and I’m starting to daytime wean because I’m so tired of pumping. Still no period evident, which I’m happy about. I didn’t start ovulating until almost 12 months pp with the other kids either.
I have a copper IUD again, and since I’m 40 it should last until menopause. Because there’s no way I need #5. Moral of the story: if the vasectomy happens, continue to get him tested until it comes back “zero live sperm” from a FERTILITY LAB. The urologist did a quick check in his office, said there were zero, accused me of whoring around (not in so many words) and then we got a second opinion. A count of 2 million is technically infertile, but not infertile enough.