Life with a newborn has likely left you feeling less than amorous, with sex a distant memory between nighttime feedings and exhaustion. Eventually, however, your thoughts will turn to re-establishing physical intimacy with your partner. And when that happens, you'll need to think about something you haven't had to in a while: birth control.
Wives' tales notwithstanding, ovulation can occur as early as four weeks after delivery. So as soon as you start having sex again—which is not advised until at least six weeks postpartum, or until your doctor gives you the go-ahead—you'll need to use some form of protection.
If you're breastfeeding, you should steer clear of all forms of birth control that contain estrogen, as it can reduce your milk supply. These include the combined-hormone pill, NuvaRing (a flexible ring that you insert into your vagina and keep there for three weeks) and Ortho Evra (the patch). If you prefer a hormone-based method, your better bets are progestin-only birth-control pills or Depo-Provera (shots given every 12 weeks), as they contain no estrogen.
This method has an effectiveness rate of up to 98 percent as long as you meet three criteria: You arenursing at least six times a day on both breasts, including at night (and that means no pacifiers, formula or bottles of pumped milk); you have not resumed menstruating; and you are no more than six months postpartum.
If you don't meet these guidelines, you will need an additional form of birth control that does not contain estrogen.
How it works: This small, plastic T-shaped device is inserted into the uterus by a clinician and contains hormones or copper to prevent fertilization. The brand Mirena contains a hormone called levonorgestrel and can be left in place for five years; ParaGard is made of copper and can be left in place for 10 years. Whichever type you choose, it is typically inserted six weeks postpartum, although your doctor or clinician may agree to insert it immediately after you deliver. Effectiveness: 97% to 99%. Pros: Safe to use while breastfeeding; high effectiveness rate; convenience; spontaneity. Cons: Possibility of increased cramping and heavier periods; increased risk of uterine infection for first four weeks after the IUD is inserted.
How it works: A clinician gives you a high-dose progestin shot every 12 weeks. Suppresses ovulation; also thickens the cervical mucus, thereby blocking sperm and preventing fertilization in case ovulation does occur. Effectiveness: 99%. Pros: Safe to use while breastfeeding; high effectiveness rate; convenience; spontaneity. Cons: May cause altered periods and sex drive, appetite changes and weight gain; increased risk of ectopic pregnancy if pregnancy occurs; it may take longer to get pregnant once shots are stopped.
How it works: Prevents sperm from entering the vagina and uterus and fertilizing the egg. Should be used in conjunction with spermicide for maximum effectiveness. Effectiveness: 86% to 98%. Pros: Safe to use while breastfeeding; available over the counter; also prevents transmission of sexually transmitted diseases (STDs). Cons: Lack of spontaneity; possibility of breakage; can cause reduced sensation.
How it works: A pill containing both estrogen and progestin is taken daily. Suppresses ovulation; also thickens the cervical mucus, thereby blocking sperm and preventing fertilization in case ovulation does occur. Effectiveness:95% to 99%. Pros: High effectiveness rate; convenience; spontaneity. Cons: Must not be used if you are over the age of 35 and smoke, as these factors can significantly increase your risk of heart attack, blood clots and stroke. Also, estrogen can reduce milk supply, so if you're breastfeeding, your clinician will need to determine whether the combined-hormone pill is an option for you.
How it works: You insert a small, flexible ring into your vagina once a month, where it remains for three weeks; you then remove it on the fourth week. Contains estrogen and progestin to suppress ovulation; also thickens the cervical mucus, thereby blocking sperm and preventing fertilization in case ovulation does occur. Effectiveness: 95% to 99%. Pros: High effectiveness rate; convenience; spontaneity. Cons: Possible increase in vaginal discharge; estrogen can reduce milk supply, so if you're nursing, your clinician will need to determine whether NuvaRing is an option for you.