Postnatal contraception *
It's Best to Plan for it Now!
Available Contraceptive Methods that are Compatible with Breastfeeding
In addition to the joy and pleasure that a new baby brings, there will be many big changes to your habits and lifestyle. It's really important to talk with your partner about your expectations and desires for resuming lovemaking after delivery. You need to think about which contraceptive method will work best for you. The best way to do this is to speak to your doctor before your baby is born.
Here are contraceptive methods that you may use after delivery:
INTRAUTERINE DEVICE OR IUD
An IUD is a small plastic T-shaped device that is placed in the uterus by a physician to prevent pregnancy. Three types are available in Canada: the Nova-T, the Flexi-T, and the Mirena. With the Nova-T and the Flexi-T, the vertical part of the T is covered in copper, which is why it is called a copper IUD. With the Mirena, the vertical part is covered by a small tube that contains progesterone (a hormone) that is slowly released into the uterus.
How it Works
The IUD destroys sperm or prevents them from entering the uterus. It also changes the endometrium (inner lining of the uterus) making it impossible for a fertilized egg to become implanted.
Effectiveness
This is a very effective method of contraception. These three IUDs may be left in place for a period of five years. The Nova-T and the Flexi-T offer approximately 98.6% protection, whereas, the Mirena is almost as effective as sterilization (99.8%).
Advantages
•No effect on lactation (milk production)
•Highly effective
•Does not change your natural cycle
•With the Mirena, 20% of women stop menstruating after one year
•With the Mirena, periods are shorter and lighter and cramps are reduced
Disadvantages
•It has to be inserted by a physician
•Follow-up and counselling are necessary to determine whether the IUD has been expelled
•It is preferable for the woman to be in a stable relationship, which reduces her risk of contracting a sexually-transmitted infection
•With the Nova-T and the Flexi-T, menstrual periods are one to two days longer on average; periods are generally heavier and menstrual cramps may worsen
•With the Mirena, there is a possibility of breakthrough bleeding during the first three or four months, which generally stops after that
•With the Mirena, some women may initially experience headaches, breast tenderness and in rare cases, nausea
THE MINI-PILL
The mini-pill is a contraceptive pill that contains only progesterone (the other pills contain estrogen and progesterone).
How it Works
The mini-pill works by altering the inner lining of the uterus (endometrium), making it unable to receive a fertilized ovum (egg). It also acts on the cervix by making the cervical mucous less easy to penetrate by the sperm.
It is close to 99% effective if taken very regularly.
Advantages
•No effect on lactation
•No side effects reported in nursing infants
•May be started immediately after childbirth
Disadvantages
•Must be taken at a regular time because a delay of 3 hours can reduce its effectiveness.
•You may experience irregular periods. Forty percent (40%) of women will have irregular periods; close to 20% will experience spotting (a small amount of bleeding and 3% will experience amenorrhea(absence of menstrual periods. Irregular periods are less likely in women who are nursing.
DEPO-PROVERA
Depo-Provera is an injectable contraceptive derived from a natural hormone, progesterone. Depo-Provera has been officially approved for contraceptive use in Canada since 1997.
How it Works
Injecting the product into a muscle causes a rapid increase in progesterone levels in the blood. This concentration in the blood is enough to provide contraception for 3 months.
The compound acts in different ways:•It prevents ovulation
•It makes the lining of the uterus unable to receive a fertilized egg
•It alters the cervical mucous
Effectiveness
It is 99.8% effective, which is comparable to tubal ligation. In order to be effective, the injection must be administered regularly every 11 to 13 weeks.
Advantages
•Can be injected within days of childbirth
•Has no effect on lactation (and may even increase milk production)
•No side effects reported in nursing infants
•A long-acting method that does not require you to take contraception every week
Disadvantages
•May cause menstrual problems which normally disappear after a few months(irregular breakthrough bleeding that is rarely heavy). This is the most common side effect.
•Weight gain is another frequent side effect resulting from an increase in appetite. On the other hand, 20% of users lose weight.
•It can cause the same side effects as taking the pill(see “The Pill”).
•Fertility is generally restored 6 to 9 months after the last injection; however, it can take up to 18 months.
THE PILL (Combined Oral Contraceptives)
The pill contains synthetic hormones similar to the natural hormones that are produced by the female body,i.e., estrogen and progesterone.
How it Works
Basically, the pill works by preventing ovulation. It also thickens the cervical mucous, making it less permeable for sperm and changes the inner lining of the uterus(endometrium), preventing implantation of a fertilized egg.
Effectiveness
It is 99.5% effective. However, if not used as directed, effectiveness can diminish very quickly.
Advantages
•Very effective and easily reversible
•Regular menstrual cycles
•No side effects reported in nursing infants
Disadvantages
•May reduce the quantity and quality of breast milk in women who are nursing
•Must be taken every day
•May cause side effects such as nausea, breast tenderness and swelling, headache and breakthrough bleeding
THE MAMA METHOD
(Combining Nursing and Amenorrhea)
The MAMA method provides effective contraception for up to 6 months after childbirth provided you are nursing full-time and that you meet all of the following conditions:
•Breastfeeding on demand, day and night; every 4 hours in the day and every 6 hours at night
•Exclusive breastfeeding, with the baby receiving no solids or liquids other than breast milk taken directly from the breast
•No menstrual periods
•This method can only be practised for the first 6 months after childbirth.
How it Works
Prolactin, the hormone that is released in sufficient quantities in the body of a woman who is nursing an infant full-time, considerably decreases the release of the hormones that are necessary in order for ovulation to resume.
Effectiveness
It is 98% effective if all of the conditions are met.
Advantages
•No impact on breastfeeding
•Natural contraception.
Disadvantages
•You must meet all of the conditions rigorously.
•You must use another method of contraception if any one of the conditions is not met.
BARRIER METHODS
The effectiveness of barrier methods varies and depends mainly on consistent correct use every time you have sex, regardless of the time of the month, including menstruation. To increase effectiveness, we recommend adding a spermicide when using the female condom and always using a spermicide with the diaphragm, cervical cap, and Lea Contraceptive™. Please note that only condoms protect against sexually-transmitted infections (STIs).
Advantages
•No effect on breastfeeding.
•May be used in combination with the MAMA Method.
•Spermicides and lubricated condoms reduce vaginal dryness, especially in women who are breastfeeding.
Disadvantages
•Less effective than the other methods (failure rate of 3% to 28%), except for condoms.
•You need to wait at least 6 weeks after childbirth before using a diaphragm, cervical cap or the Sponge.
Condoms
A condom is a sheath of polyurethane, latex or natural skin that you unroll over an erect penis. It prevents the sperm and bacteria from coming into contact with the other person's sex organs. Natural skin condoms are less effective.
Cost: between 75 cents and $5 each.
Effectiveness: can be 99% effective if used every time you have sex, regardless of the time of the month and if it is put on before any contact between the penis and the vulva or vagina.
The Female Condom (Reality™)
The female condom comes in only one style and one size. It is made of thin, flexible polyurethane, with a flexible ring at each end: the inner ring is used to insert the condom and keep it in place. Reality™ also protects against STIs and HIV. Because it covers most of the vulva,it is theoretically more effective than the male condom against condyloma and herpes.
Cost:approximately $13.49/box of 3
Effectiveness: 80% to 99%
The Diaphragm™
The diaphragm is a dome of thin rubber mounted on a flexible ring adapted to the size of the vagina. It must be used with spermicidal jelly or foam. Women who choose this method must be seen by a doctor who will determine the right size (55 mm to 90 mm in diameter) and who will teach the woman how to insert it. A change in weight of more than 3 kg, or another delivery, may change the vaginal size and, therefore, may require being refitted for a diaphragm. A verification of proper diaphragm fit should be done annually. In order to prevent toxic shock syndrome and foul odours, it is advisable to keep the diaphragm in place the shortest time possible (while respecting the minimum 6 hour delay after a sexual relation) and not to use the diaphragm during menstruation. To preserve the diaphragm properly it is recommended to wash it, coat it with sodium bicarbonate (baking soda) and to store it in a dark, cool place. The most commonly used rubber diaphragm is the COIL SPRING and the silicone brand is ARCING.
Cost:approximately $80 to $100 + the cost of spermicide
Effectiveness: 80% to 94%
The Cervical Cap™
There is one brand of cervical cap: “FemCap”. FemCap is dome-shaped and is made of silicone. It comes in three sizes: 22, 24, and 26 mm. Approximately 75% of women will fit one of the three sizes. Use of the cervical cap requires teaching by a doctor or other professional at a Women's Health Center. Using the cervical cap is not recommended in the first 6 weeks after childbirth, nor during vaginal bleeding including menstruation. Certain sexual positions can cause the cap to loosen making it ineffective. To avoid unpleasant odours, it is important to wash and dry the cervical cap between each use and to keep it in place for as short a time as possible, all the while respecting the minimal 8 hour delay after the sexual relation. You will need to be refitted for the Cap after childbirth.
Cost: approximately $46 + cost of spermicide
Effectiveness: 80% to 94%
The Contraceptive Sponge™
There are two brands: Protectaid and TODAY. They are manufactured with a gentle, flexible foam. Protectaid is designed with slots to make it easier to insert and remove from the vagina, whereas TODAY comes with a small loop to make it easier to remove. They are come with a spermicidal gel that disperses very well, is not irritating, and is well tolerated. It only offers single-use protection.
Cost: approximately $10/box of 4
Effectiveness: 70% to 94%