WHAT YOU’LL LEARN

• The Best Time to Plan for Birth Control After Childbirth 
• Does Breastfeeding Act as Birth Control? 
• Choosing Between Hormonal and Non-Hormonal Birth Control 
• Permanent Birth Control Options After Childbirth
• The Importance of Patient Autonomy

When moms are expecting a baby, birth control options after childbirth might be the last thing on their minds. They are focused on their pregnancy, their health, and preparation for the baby. 

But before they know it, they find themselves facing contraception decisions—and battling myths, internet misinformation, and unanswered questions in the process. 

The earlier we consider options for contraception after childbirth, the better. This allows us to prevent unexpected pregnancies, protect our health, and understand what options are available to us, both in the short-term and the long-term. 

There are many options for birth control after childbirth—from short-term contraception to long-term or permanent options. Determining the right choice is hard—we have to weigh out factors like whether we want more children, whether or not we’re breastfeeding, and how our body responds to hormones. 

This week on The Momwell Podcast, I’m joined by OB-GYN Dr. Fran Haydanek, founder of Paging Dr. Fran, to discuss how moms can make informed decisions about birth control after childbirth. 

The Best Time to Plan for Birth Control After Childbirth

Moms are often surprised when their OB-GYN brings up birth control during pregnancy. But Dr. Fran said that it’s the best time to reflect on your options. 

The postpartum period is complex and often overwhelming—and researching or making decisions with a newborn might be difficult. But if we plan ahead and consider our options, we can reduce the mental labor around making the decision in postpartum. 

The earlier we consider options for contraception after childbirth, the better. 

Dr. Fran pointed out that birth control after childbirth is important. Your body needs time to recover before becoming pregnant again—and you need time to make choices about pregnancy spacing or whether or not you want more children. 

Discussing birth control options early also gives you plenty of time to consider your lifestyle, your feeding plans, and your sensitivity to hormones—all of which can affect the decision that works for you. 

Does Breastfeeding Act as Birth Control? 

Many moms believe that breastfeeding acts as birth control, leading them to think they don’t need to worry about contraception. 

Dr. Fran said that there is a lot of misinformation around this idea. Lactational amenorrhea is when you don’t get your period while breastfeeding. This happens for some moms and not for others. 

If you do experience lactational amenorrhea, it does decrease your chances of getting pregnant—the rate is less than 2%. But this only applies if four factors are true:

• You haven’t gotten your period yet
• You are directly breastfeeding
• Your baby is exclusively breastfeeding, with no formula or supplementary foods
• You are within six months postpartum

Even if your period hasn’t returned yet and the other pieces are not true, the protection from breastfeeding is no longer in place. 

Dr. Fran also pointed out that you ovulate before you get your period back, so you could end up pregnant again without even realizing ovulation has re-started. Overall, if you do not want to become pregnant again, it’s safer to use other methods rather than relying on breastfeeding. 

Nursing moms might worry that birth control will decrease their milk supply—but there are many options that won’t affect supply. 

Best Options for Birth Control After Childbirth

There’s no one-size-fits-all when it comes to birth control, especially after childbirth. Your postpartum body is adjusting and coping with changes in hormones. What worked for you before having a baby might not work after. It might take some trial and error to find the right fit. 

It might take some trial and error to find the right fit. 

The best option for you depends on what you need from your birth control, whether or not you’re breastfeeding, your tolerance level for the risk of getting pregnant, your hormone sensitivity, whether you want more children, and how long you want to wait before becoming pregnant again if you do. 

Dr. Fran said that there are three main categories for birth control options after childbirth: non-hormonal, combined hormone, and progestin only.

Non-Hormonal Options

Not all birth control options use hormones. The copper IUD (ParaGard) is hormone-free. This can be a good option for moms who have experienced hormone sensitivity in the past and want a long-term solution for family planning. Non-hormonal options also include barrier methods like condoms.

Combined Hormone Options

Combined hormone options use estrogen and progestin (a synthetic form of progesterone). These hormones both occur naturally in your body and impact your reproductive system. Combined options include birth control pills and the NuvaRing. 

Dr. Fran said that estrogen could potentially decrease milk supply. Because of this, combined hormone options are probably a better choice for moms who aren’t breastfeeding or for those with an oversupply. 

Progestin-Only Options

Progestin-only options are often recommended postpartum for moms who are breastfeeding. These include the mini-pill, the Depo shot, the arm implant (Nexplanon), and hormonal IUDs. 

It’s important to note that the mini-pill is only effective if taken at the same time every day—with combined hormone pills there is a larger margin of error. If you think that you will have trouble remembering to take a pill, one of the other progestin-only options or combined hormone options might be a better fit. 

Choosing Between Hormonal and Non-Hormonal Birth Control 

Some people turn to non-hormonal options for birth control out of fear of putting something into their bodies. Dr. Fran pointed out that the copper IUD is a great non-hormonal option, but that hormonal birth control is often misunderstood. 

Not all hormonal options work the same way, and hormonal choices can offer benefits that non-hormonal options don’t, depending on your preferences. 

She said that birth control pills are a systemic form of birth control. They impact our menstrual cycles and stop ovulation, which can help with things like PMDD. But hormonal IUDs work differently. They target the uterus locally, thinning your endometrial lining and impacting cervical mucus. For the most part, they don’t stop ovulation—meaning you will still have a “natural” cycle with hormonal ebbs and flows. 

Dr. Fran also pointed out that 60-70% of people get lighter or no periods while on hormonal IUDs—which can be a pro or a con. Many moms are happy to have lighter periods or avoid them altogether. For other moms, this could feel scary—they might feel scared about a pregnancy without a monthly period. 

The copper IUD is also not without side effects. Dr. Fran said that it creates an inflammatory response inside the uterus to prevent pregnancy. This response often also leads to longer or heavier periods. For some moms, this is not an issue—but for others, it might be. 

Ultimately, the choice depends on you—and you can always change and try something else. 

Short-Term vs. Long-Term Birth Control Options

One of the factors that will probably impact your decision on birth control is the length of time you want between pregnancies. 

Dr. Fran shared that doctors typically recommend waiting between 12-18 months after having a baby before becoming pregnant again—though she pointed out that the “safe zone” is a bit of a gray area. 

If you want to have your children close together, options like the shot, the NuvaRing, or pills are probably best. These are more temporary, short-term solutions that can be stopped whenever you’re ready. But if you want some time between pregnancies, a longer-term option might be a better fit.

The arm implant and IUDs are “set it and forget it” choices that don’t require you to remember to take a pill, but that also don’t require you to commit to something permanent. 

Arm implants last three years. Hormonal IUDs offer protection for eight years. And the copper IUD lasts for ten years. These are all choices for long-term protection—and they can also be removed at any time. 

Dr. Fran also pointed out that there’s a lot of buzz about IUDs and pain management. She said that when IUDs first came out, they were primarily offered to people who already had babies—and their bodies often didn’t experience major insertion pain. 

Today, we know that IUD insertions can cause a lot of pain and discomfort for some people, especially those who haven’t had biological children before. But for a long time, pain management wasn’t offered or even considered. 

Don’t be afraid to ask for pain management and advocate for yourself. 

Now there are options for pain management—over the counter pain relievers, paracervical blocks (cervical numbing injections), nitrous oxide, or even anti-anxiety medication for those who are worried about the pain. Your provider might offer some or all of these options—just don’t be afraid to ask and advocate for yourself. 

Permanent Birth Control Options After Childbirth

If you're sure you're done having children, permanent options like tubal ligation (also known as sterilization or getting your “tubes tied”) or a vasectomy for your partner are available. 

If you’re sure you’re done having children, there are permanent options. 

A vasectomy is less invasive and has a quicker recovery time. It is an outpatient procedure, hits less major tissue, and comes with less complications. It is also potentially reversible. Dr. Fran said that for couples who want a permanent birth control option and are in stable relationships, this is her go-to recommendation. 

Tubal ligation is a more invasive procedure but also offers a permanent solution. If you’re already having a C-section, a tubal ligation can be done at the same time, making it more convenient. 

Dr. Fran said that tubal ligations have changed over time—but with modern procedures, your fallopian tubes are removed. That means that it is final and irreversible. She said that you should only do this if you are absolutely certain that you do not want any more children and that you will never change your mind. 

The Importance of Patient Autonomy

Doctors might be hesitant to perform sterilizations out of fear that patients will come to regret it or might change their mind later down the line. Dr. Fran pointed out that this doesn’t come from a malicious place—most of these doctors genuinely want to help their patients avoid regret. 

But it has led to a situation where many doctors will outright refuse to respect their patient’s wishes, or will follow arbitrary “rules” like “We only perform tubal ligations if someone has two or more children” or “We only perform them after a certain age.”

This has led to public outcry and a push for more and the rights for people to decide whether or not they want children, and how many they want to have. Many people point out that men are able to receive vasectomies without the same level of scrutiny. 

Patients deserve to make informed birth control decisions. 

Dr. Fran believes that patients deserve to make informed birth control decisions. Doctors should educate patients on all available options and iterate that tubal ligations are irreversible. They should also share that there is a small percentage of people with tubal ligations that do end up regretting their choice. 

But once they have done their due diligence and informed their patients, doctors should respect patient autonomy. They shouldn’t refuse sterilization or try to make decisions for their patients. 

More and more doctors are embracing patient-centered care and informed decision-making. Dr. Fran’s website provides a list of doctors who are willing to perform sterilizations. 

If your provider isn’t willing to listen to your needs or respect your choices, you should feel empowered to seek another. It’s important to make informed decisions, but you deserve bodily autonomy.

‍If you’re feeling overwhelmed by your choices or frustrated by the treatment from you provider, working with a mom therapist can help you navigate these decisions and advocate for yourself. Book a FREE 15 minute consult today.