Birth Control Guide for New Mothers

At my six week postpartum check up, the first thing my doctor asked me was, "What kind of birth control do you want to use?" I walked out of his office with an armload of brochures about every form of birth control I could imagine. I had information on everything from condoms and spermicide to getting my tubes tied. I was overwhelmed, but once I sorted out all the information, I was able to make an informed decision. If you're a new mom considering birth control options, here's everything I learned from my doctor, all laid out in one spot to make it easy for you to chose what's best for you and your family.

Natural family planning: Many people look at those words and just assume that anyone using this method will become pregnant because they aren't using any physical form of birth control. But if you actually correctly chart your basal body temperature, check your cervical position and mucus, you can know what days you need to avoid sex in order to avoid getting pregnant. One downside to this method is that if you are nursing, you may not have a monthly cycle to chart. You won't be ovulating, which means you won't get pregnant, but it will be difficult to know when you will begin ovulating again. Often, breastfeeding is enough to suppress ovulation for a while, but it's not a guarantee. If your baby sleeps for more than five or six hours at night, your cycle could start at any time. The scary part is that you will likely ovulate before your period comes and that means if you have unprotected sex during that time, you could get pregnant without ever having a period. However, if your period has already returned, natural family planning is a viable option for birth control.

Barrier methods: This includes male and female condoms, diaphragms, and spermicides. These can be between 75-85% effective if used correctly. If you combine spermicide with a condom, you can increase this percentage, but it's still a risk that you could get pregnant. Other cons are that you can't be as spontaneous with your partner - you will need to "pause" your lovemaking to put on the condom or make sure you have the diaphragm in place before having sex. The pros are that since none of these are permanent, you won't have to worry about them affecting your ability to have children in the future. Also, since your hormones won't be affected, they are totally safe for breastfeeding and won't cause any annoying side effects like the pill can. Cost of these varies on how often you will need them.

Hormonal contraceptives: This category includes the pill, the patch, vaginal rings, and injections. Breastfeeding mothers will want to avoid hormonal contraceptives except for the progesterone only pill, also known as the mini-pill. If you take a normal pill or other hormonal contraceptive, it can adversely affect your nursing supply. The mini-pill doesn't change your supply at all, but I found that it made me feel like I was experiencing PMS all the time and couldn't tolerate that, so I stopped taking it. Also, you need to remember to take it at the exact same time every day or it may not work. Most women know about the regular pill - it can have annoying side effects such as bloating, weight gain and of course having to remember to take it every day. The ring (such as the Nuva ring) is inserted vaginally and remains there for three weeks, on the fourth week, you remove it and have a period. It releases the same hormones as the pill, but you only have to think about it when you need to put it in and take it out. The patch is applied to your skin - you can put it anywhere - and you replace it once a week and leave it off for one week while you have a period. Hormonal contraceptives are 90-98% effective. However, they have several annoying side effects that may make taking them much less tolerable than you might desire. On the other hand, they don't interfere with spontaneity, and you don't have to think about the ring or the patch all that often. Some insurance companies are now covering these forms of birth control, but most won't. Cost starts at around $30 a month.

IUD: There are two types of IUDs (intrauterine device), copper and hormonal. An IUD is inserted by a doctor into your uterus and remains there until the doctor removes it. Both are long-term contraceptives, but the copper IUD can remain in place longer. These are best for women who may want children in the future but not for at least a few years. The copper IUD has no hormones and is a good choice for a woman who is breastfeeding since it will not interfere with her supply. It can remain in your uterus for up to ten years, but can be removed at any time if you should chose to have more children. Since there are no hormones, your fertility should return immediately. With the copper IUD, some women experience increased bleeding and rarely infection. According to my reproductive gynecologist, a copper IUD is not the best choice for a woman who has Endometriosis because of the possibility of increased bleeding. The hormonal IUD (Mirena) actually reduces your bleeding and some women actually stop having a period altogether. It is only left in place for five years, but can be removed before that should you decide to get pregnant. Both are over 99% effective. The cost of the copper IUD is between $200 and $300, but if you use it for at least two years, it's much cheaper than paying for the pill over that same amount of time. The hormonal IUD is between $300 and $400. If you think you are done having children, but aren't 100% sure, an IUD is a great option. You don't have to think about it at all (other than once a month when you check for the threads to make sure it's still in the correct place) and it's long term, but not permanent.

Sterilization: Included in this category is a newer form of sterilization called Essure. Tiny metal coils are placed into your fallopian tubes. Over time, the coils cause scar tissue to build up and block your tubes so that when you ovulate, the egg can't make it to your uterus, thus preventing pregnancy. Cost for this procedure is between $1,300 and $3,000. You could also get your tubes tied - a tubal ligation. This is done through surgery, which itself has risks. Cost for this surgery is between $2,500 and $4,000. Of course, your husband can choose to get a vasectomy which is a much more minor procedure. This is often done in-office with a local anesthetic. Within a few months, your husband's sperm count will be zero. Cost of this procedure is between $250 and $1,000. All three of these procedures are over 99% effective, but since they are permanent, you should wait until you are certain you don't want any more children. While both a tubal ligation and vasectomy can be reversed, there are no guarantees that you will ever be able to get pregnant again. Anyone who chooses one of these methods should treat it as thought they will never be able to conceive again.

Whatever method of birth control you chose, make sure you and your husband are in agreement about what you would like to do. Also, talk to your doctor about any questions or concerns you might have about any of these forms of birth control. The best time to make the decision about birth control is before your new baby arrives so that when you are taking care of your newborn, you won't have to worry about your decision. However, if you already have your baby and are trying to decide what you should do, I hope this article has helped you to understand your options a little better.