Choosing the Right Postpartum Birth Control Option for You

Carrying a pregnancy, delivering a baby, and caretaking an infant is a lot of physical work. To help the body heal, current recommendations suggest that women should avoid back-to-back pregnancies starting shorter than 6 months, and waiting a minimum of 18 months. This is widely accepted to maximize health benefits for moms and babies.

About one third of births have short interpregnancy intervals under the recommended 18 months. It is important to note that it is possible to get pregnant while breastfeeding, even without the presence of a regular period. Fortunately, there are numerous methods of birth control that are well-suited for post-partum use.

Finding the Right Post-partum Birth Control Option

Choosing a birth control method is a personal and private decision, especially during pregnancy and after giving birth, when there is so much to think about. There is no “one size fits all” birth control method for everyone.  This article includes information about the journey to learn and to decide about postpartum birth control.

When considering method options, intimate partners, social support persons, and health care providers should aim to be supportive in contraception decision-making. This decision is entirely yours and should never feel “rushed” or “pressured”.

Birth control methods can be an ongoing conversation  including everyone directly affected by or advising on the choice. It’s helpful for everyone involved to learn about method options and considering reproductive goals to determine the right path forward. That said, your comfort, safety, and health are the primary drivers of that conversation.

Birth control choices can also be situational, which is why putting some thought into reproductive goals can help in decision-making.

Some things to consider when choosing birth control are:

• Whether and when to get pregnant again (aka: family planning goals) 
• Whether or not you want to breastfeed your baby, and for how long
• How birth control might impact your body
• Birth control methods used in the past, and how it worked
• Personal preferences and lifestyle, like “will you remember to take a pill each day?” or “how do you feel about having a method placed internally by your provider?” 
• Thoughts and beliefs about different methods
• Effectiveness of the method (how good a method is at preventing pregnancy)

Finding Information About Post-partum Birth Control

There are great online resources that a patient can review before their next appointment to discuss favored options with their provider.

• All about postpartum birth control from the American College of Obstetrics and Gynecologists
• A comprehensive guide to sexual and reproductive health from Bedsider.org 
• A guide to postpartum birth control options from PICCK.org

Discussing Options with Your Partner and Provider

Involving your sexual partner in discussions about postpartum birth control can be helpful too, especially because some methods will require partner agreement, like using condoms and/or getting a vasectomy. The full range of postpartum birth control methods includes:

• Sterilization or “getting your tubes tied”
• Intrauterine device (IUD) - a long-acting method that is placed and removed by a provider 
• Implants - a long-acting method that is placed and removed by a provider 
• The Depo shot 
• Birth control pills, a ring, or a patch
• Barrier methods - condoms, spermicide, diaphragm, cervical cap, and sponge
• Partner vasectomy

Doctors and other health care professionals, like midwives, nurses, lactation consultants, and doulas, are tasked with giving mothers the correct information about all the different birth control options. Providers should answer all questions and support each mothers’ decision.   When having conversations with a provider, a few questions you might ask are: 

• What is the risk of pregnancy after I give birth?
• Will this method impact my ability to breastfeed my baby?
• Are there any side effects?
• How frequently do I need to take or receive the treatment?
• Can I schedule a procedure to get my tubes tied while I am at the hospital?
• Will it hurt to place an IUD or implant?
• Can I receive an IUD or implant while in the hospital? Or do I have to go to a clinic? 
• How often does an IUD or implant need to be changed?
• Will this birth control cost me money?
• Where can I get free condoms?
• Where can my partner access a vasectomy procedure? What will it cost? 
• What if I become pregnant while actively using this method?

Access to postpartum birth control might be very easy or require additional steps. Health insurance plans, including Medicaid and private plans, should cover postpartum birth control. Immediate postpartum contraception should be provided in the hospital, but sometimes this option might not be available due to a lack of trained providers.

If you’re pursuing a sterilization procedure, there might be a long wait for the procedure, or health insurance companies (especially with Medicaid) might need to approve the procedure first. Also, local clinics should provide birth control, but sometimes different methods must be ordered ahead of time (like the IUD or implant).

Aside from birth control, having a baby is a major event, and many mothers may not want to have sex shortly after giving birth. It is normal and okay to not want or have sex for a while after giving birth. There are other ways to be intimate with a partner that do not risk pregnancy. You have a right to discuss this with your sexual partner and/or health care provider. Whatever birth control you choose, you should not be rushed or pressured to have sex.

The bottom line is: YOU have the power to care for your reproductive health, to honor your feelings, and to decide what birth control is best for you, if any. Your provider’s job is to support you to make the best decision for YOU, and your intimate partner has a responsibility to respect YOU.

More Information

• About pregnancy intervals from the American College of Obstetrics and Gynecology
• More about pregnancy intervals from a scientific perspective

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