Contraception after birth – postpartum contraceptive methods

Fertility can return far sooner after giving birth than you might think. Many women can conceive again as early as 4–6 weeks after delivery. The safest way to prevent an unplanned pregnancy is therefore to use an effective method of contraception from the very first time you have sex.

Statistics show that around 50% of couples resume their sex life before their first postnatal check-up. This makes well-considered family planning after birth all the more important, so that your body has enough time to recover from the previous pregnancy. Read on to find out which contraceptive options are available during the postnatal period and beyond, and how to find the one that's right for you.

What is postpartum contraception?

Postpartum contraception covers all contraceptive methods that can be used after birth to prevent another pregnancy.

Many women assume that fertility only returns once their periods start again. In reality, however, ovulation can occur considerably earlier, meaning pregnancy is possible even before your first period after birth. Your body does need time to recover, though, and pregnancies in quick succession can increase the risk of complications. For this reason, doctors generally recommend a gap of at least 12–18 months between two pregnancies.

Choosing a suitable method of contraception is therefore essential to avoid an unplanned pregnancy and to protect the health of both mother and baby.

When can contraception begin after birth?

Contraceptive protection is needed sooner after birth than you might expect. According to a cross-sectional study, only around 44% of women use some form of family planning during the postnatal period and the months that follow. The precise point at which you should start using contraception depends, however, on factors such as when you resume your sex life, when your fertility returns and how quickly your body recovers.

Fertility and ovulation after birth

Ovulation can occur very shortly after birth – even before your menstrual cycle resumes. According to certain statistics, around 60% of women ovulate before their first postnatal period, and some are fertile again as early as 4–6 weeks postpartum.

This means pregnancy is possible very early on, even if your periods haven't yet returned and you haven't needed to use any period care products. That's why it's important to use contraception in the very first weeks after birth, as soon as you resume your sex life.

Resuming your sex life after birth and starting contraception

As a general rule, it's recommended that you wait until your postnatal check-up before having sex. Your doctor can then confirm whether the healing process is progressing normally and whether it's safe for you to be intimate again.

Depending on these factors – namely how well your body has recovered and when you resume sexual intercourse – you and your doctor will also decide on the right time to start contraception. This may be earlier or later, depending on the type of birth (vaginal or caesarean), how your tissues are healing and your physical and emotional wellbeing.

If all is well, your doctor will talk you through the available options and help you choose the contraceptive method best suited to your individual needs.

 

Is breastfeeding a method of contraception after birth?

Breastfeeding can have a temporary contraceptive effect, but it isn't a reliable method in every situation. In studies on the return of fertility after birth involving 12 breastfeeding mothers who used no contraception whatsoever, eight pregnancies occurred – seven of them while the mothers were still breastfeeding.

The lactational amenorrhoea method as contraception after birth

Exclusive breastfeeding can temporarily suppress ovulation and thereby reduce the likelihood of pregnancy. For this reason, the lactational amenorrhoea method (LAM) is considered a natural form of contraception. Under ideal conditions its effectiveness can be around 98% – but only if certain criteria are met.

Under what conditions does breastfeeding offer contraceptive protection?

For the method to be as reliable as possible and protect you from another pregnancy, the following conditions should all be met at the same time:

• Your baby is under 6 months old
• You are breastfeeding exclusively or almost exclusively, with no long gaps between feeds
• Your periods have not yet returned

Under these conditions, hormone levels can suppress ovulation for a limited period.

Limitations of breastfeeding as a contraceptive method

The lactational amenorrhoea method is regarded as a temporary solution only, and it doesn't work equally reliably for every woman. Although it can be effective initially, it is limited and becomes less reliable as your baby grows and feeds less frequently. Once the intervals between feeds grow longer and you start introducing solid foods, its reliability as contraceptive protection declines.

Hormonal contraceptive methods after birth

Because they are highly reliable, hormonal methods are frequently used for contraception after birth. Your doctor will advise you on which option is suitable for you – depending on your medical history and whether or not you are breastfeeding, as certain contraceptive methods are not recommended while breastfeeding.

The contraceptive pill as a method of contraception after birth

The contraceptive pill is one of the best-known hormonal methods of preventing pregnancy and is available in two main forms.

There is the combined pill, which contains oestrogen and progesterone. It isn't recommended immediately after birth and particularly while breastfeeding, as oestrogen can affect milk production.

There is also the progestogen-only pill (mini-pill), which contains only progesterone and is often recommended during breastfeeding, as it doesn't significantly affect milk supply.

For the pill to be effective, you need to take it every day at roughly the same time.

The contraceptive patch as a hormonal method after birth

The contraceptive patch releases hormones through the skin, which enter the bloodstream and prevent ovulation. All you need to do is stick it to your skin and change it at set intervals.

Unlike the pill, the patch offers a more convenient alternative with no daily dose to remember, and you can use it once the waiting period recommended by your doctor during the postnatal period has passed.

The vaginal ring as a method of contraception after birth

The vaginal ring is a hormonal contraceptive method that can provide protection for several weeks. It's inserted into the vagina and releases hormones continuously. Whether and when you can use it – particularly in the period immediately after birth – depends on your doctor's advice.

Hormone injections as a method of contraception after birth

The three-monthly injection contains progestogen and provides long-term protection lasting several months. In certain situations you can also use it during the postnatal period – depending on your doctor's advice and your individual needs.
 

Long-acting reversible contraceptive methods after birth (LARC)

If you want to protect yourself against pregnancy without frequent application or a daily dose, while keeping the option of conceiving again in the future, there are methods that offer long-term protection and are fully reversible (LARC). They are among the most reliable options after birth.

The coil as a method of contraception after birth

The coil is a small, T-shaped intrauterine device that your doctor inserts through the cervix into the womb to prevent pregnancy. It's available as a hormonal coil or a copper coil, and offers contraceptive protection for between 3 and 10 years depending on how it works.

The contraceptive implant as a method after birth

The contraceptive implant is a long-acting hormonal method that is inserted under the skin of the upper arm. It continuously releases a set amount of progestogen and provides contraceptive protection for up to 3 years.

Among the implant's greatest advantages are its very high reliability and the fact that there's nothing to remember each day. Another important plus is that fertility returns quickly once it's removed.

Barrier methods of contraception after birth

Barrier methods prevent pregnancy by blocking contact between sperm and egg. They contain no hormones, which makes them suitable for the period after birth and safe to use while breastfeeding.

The condom as a method of contraception after birth

The condom is one of the most widely used barrier methods. It's rolled onto the penis before intercourse and protects against both pregnancy and sexually transmitted infections. A major advantage: condoms are easy to obtain and very inexpensive.

The female condom as a method of contraception after birth

The female condom is an alternative to the male condom and is used internally. You insert it into the vagina before intercourse, where it forms a barrier between sperm and cervix, thereby preventing another pregnancy.

The diaphragm as a method of contraception after birth

The diaphragm is a flexible membrane that covers the cervix. You need to insert it into the vagina before intercourse and use it together with a spermicide for reliable protection. Bear in mind that you may need to be refitted for a new size after giving birth.

The cervical cap as a method of contraception after birth

Another barrier method that should be used in combination with a spermicide is the cervical cap: a smaller silicone cap that covers the cervix and prevents sperm from entering the womb. It's important to position it correctly so that it works reliably.

Spermicides as a method of contraception after birth

Spermicides are substances that kill sperm or render them immobile. They're available as gels, foams or pessaries. You need to apply them before intercourse and should generally combine them with other barrier methods such as a diaphragm or cervical cap for reliable protection.
 

Permanent methods of contraception after birth

If you're certain you don't want any more children in the future, there are permanent contraceptive methods to consider after birth. They involve a medical procedure and are regarded as definitive contraception – a decision like this should therefore only be made after careful consideration, together with your doctor.

Tubal ligation as a permanent method of contraception after birth

Tubal ligation is a surgical procedure for women who have decided against further pregnancies. The fallopian tubes are blocked or cut. The method prevents sperm and egg from meeting and offers permanent protection against pregnancy without affecting your hormone balance or menstrual cycle.

Your partner's vasectomy as a permanent method of contraception

A vasectomy is a surgical procedure in men in which the vas deferens are cut so that sperm no longer enter the ejaculate. It's a safe and effective method that affects neither libido nor sexual function.

Emergency contraception after birth

Emergency contraception can be a quick solution for preventing pregnancy after unprotected sex or if the method you were using has failed. It's important to use it as soon as possible, though: the more time that passes after intercourse, the lower the effectiveness.

The morning-after pill as emergency contraception after birth

The morning-after pill is one of the most widely used emergency methods. You can take it after unprotected sex – the sooner, the more effective it is.

Always speak to your doctor beforehand, however, particularly if you're breastfeeding. That way you'll know which product is suitable so that your milk supply isn't affected.

The copper coil as emergency contraception after birth

The copper coil can also be used as emergency contraception. It should be fitted by a doctor within 5 days of intercourse to provide a high level of protection against pregnancy. You can then keep it in place as a long-term method of contraception.

Choosing the right method of contraception after birth

When it comes to choosing contraception after birth, there's no one-size-fits-all solution. What suits you may differ from what's ideal for other women, and it depends on factors relating to your health, lifestyle and future plans:

• Whether you're breastfeeding, as some hormonal methods can affect milk supply
• Your medical history, including any conditions or contraindications
• Your personal preferences (for example a daily dose, long-term protection, hormone-free contraception and so on)
• Whether you'd like another pregnancy in the short or long term

In short: the best contraceptive method is the one that protects you reliably while also allowing you to feel physically and emotionally well as your body continues to recover. Your postnatal gynaecological check-up is key to making the best possible decision.

Benefits of family planning after birth

According to available data, between 2005 and 2013 around 32–65% of women had no access to the family planning they needed in the period after giving birth. In response, the World Health Organization (WHO) published the digital tool Postpartum Family Planning Compendium to support informed decisions about contraception in the first 12 months after birth, and thus help avoid closely spaced and unplanned pregnancies.

Depending on your state of health, any treatments you're having and your lifestyle, careful family planning brings a number of important long-term benefits for you and your child:

• It gives your body time to recover fully from pregnancy and birth
• It reduces the risks associated with closely spaced pregnancies
• It supports responsible family planning
• It helps protect the health of both mother and baby

Frequently asked questions about contraception after birth

Sooner or later after giving birth, it's completely normal to have questions about fertility, resuming your sex life and the health of you and your baby. You can discuss all of these openly with your doctor at your first check-up – and together you'll also find the contraceptive method that's right for you. In the meantime, we answer the most common questions here to give you some useful information about contraception after birth.

Can I get pregnant while breastfeeding?

Yes, it's possible. Breastfeeding can delay ovulation, but it doesn't always offer complete protection – especially if you don't meet the conditions of the lactational amenorrhoea method. If you aren't breastfeeding exclusively, or the gaps between feeds grow longer, the risk of pregnancy increases.

Which contraceptive methods are safe while breastfeeding?

Condoms, the copper coil and progestogen-only products are generally considered safe while breastfeeding. Your doctor will advise you on the right choice for your individual needs.

When can a coil be fitted after birth?

A coil can be fitted immediately after birth or a few weeks later – depending on your doctor's advice and how your recovery is progressing.

Which contraceptive method is most effective after birth?

Long-acting reversible methods such as the coil or the contraceptive implant are among the most reliable, as they don't depend on daily use.

How soon after birth can ovulation occur?

Ovulation can occur very shortly after birth, sometimes as early as 4–6 weeks and occasionally before your first period. That's why pregnancy is possible even without any clear signs.

When can you resume your sex life after birth?

As a rule, you can resume your sex life after your postnatal check-up, once your doctor confirms that healing is complete and there are no further risks.

Can I take the pill while breastfeeding?

Yes, but not all products are suitable while breastfeeding. Progestogen-only pills are generally recommended, as they don't significantly affect milk production.

Is the morning-after pill safe after birth?

You can use the morning-after pill after birth, but you should seek medical advice first and choose a product that's compatible with breastfeeding.

What hormone-free contraceptive methods are available after birth?

Barrier methods such as condoms or the diaphragm, the copper coil and the lactational amenorrhoea method are hormone-free options that can reduce the risk of pregnancy during the postnatal period and beyond.

How long after giving birth is another pregnancy advisable?

Doctors generally recommend a gap of at least 12–18 months between two pregnancies, so that your body can recover fully and the risk of complications is reduced.

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