An Overview of Birth Control While Breastfeeding

If you recently gave birth, are currently breastfeeding or chest feeding, and are not yet ready for another baby, you may wonder which birth control option is right for you. 

This article will discuss the safety of breastfeeding while using birth control, potential benefits and risks, contraceptive options for breastfeeding parents, and the importance of timing when beginning birth control postpartum.

Is Birth Control While Breastfeeding Safe?

Overall, birth control is safe while breastfeeding and won't impact the health of you or your baby. Many contraceptives can be started immediately after giving birth, including intrauterine devices (IUDs), arm implants, birth control shots, and progestin-only pills. 

For the first three weeks after giving birth, you should not use a method that has the hormone estrogen, like the pill, patch, or ring. After six weeks, you can start any of these medications—sometimes at three weeks if you have no risk factors and are not breastfeeding.

While it's a good idea to discuss your birth control options with your doctor prior to giving birth, you will have time to decide which type is right for you postpartum: Most doctors recommend that new parents avoid sex for six weeks while recovering from labor and delivery.

Benefits of Contraception

It’s best to wait at least 18 months between giving birth and getting pregnant again. This means your baby will be at least 1 and a half years old before you get pregnant with another baby. This gives your body time to recover fully from your last pregnancy before it’s ready for your next pregnancy.

Getting pregnant again before 18 months increases your risk of certain health problems for your baby, including:

• Premature birth: This means your baby is born too soon, before 37 weeks of pregnancy. Premature babies are more likely to have health problems and have to stay in the hospital longer than babies born on time. The shorter the time between pregnancies, the higher your risk for premature birth.
• Low birthweight: This is when your baby is born weighing less than 5 pounds, 8 ounces. 
• Small for gestational age (SGA): This means your baby is smaller than normal based on the number of weeks in the womb.  

Babies with these health conditions are more likely to have long-term health problems or even die compared with babies without the conditions. 

The time between giving birth and getting pregnant again is called birth spacing, pregnancy spacing, and interpregnancy interval (also called IPI). It should be noted that birth spacing of more than five years is associated with its own risks, such as an increased chance of preeclampsia, a serious pregnancy complication defined by high blood pressure and signs of damage to another organ system, usually the liver or kidneys.

Risks of Birth Control While Breastfeeding

One of the biggest drawbacks of using birth control while breastfeeding is lowered milk supply, but this is usually relevant only when hormonal methods containing estrogen are used.

Estrogen may decrease milk supply and cause you to stop breastfeeding earlier than nonhormonal or progestin-only contraceptive methods.

Reduced milk supply can cause a number of issues for your newborn, including:

• Weight loss
• Dehydration
• Decreased bowel movements
• Fewer wet diapers

Given the risks associated with estrogen contraceptives, progestin-only birth control options are preferred. Hormonal birth control that contains estrogen can include the pill, NuvaRing, and a skin patch.

Finally, during the postpartum period, people who have just given birth are at higher risk of developing blood clots deep in the body. This is known as deep vein thrombosis (DVT). Combined hormonal options of birth control, which contain both estrogen and progesterone, raise this risk further.

Types of Contraception

Intrauterine Devices (IUDs)

Intrauterine devices (IUDs) are the most effective form of birth control. They can be hormonal or nonhormonal. Both require a prescription.

IUDs are plastic, T-shaped devices inserted into the uterus to prevent fertilization. One hormonal version of an IUD is Mirena, which contains progestin. It provides eight years of protection. It works locally, releasing a tiny amount of hormones directly into the uterus. It doesn't affect the quality or quantity of breast milk. Other hormonal IUDs include Skyla, Liletta, and Kyleena.

Nonhormonal IUDs approved by the Food and Drug Administration (FDA) include the brands Miudella and Paragard. They are made of copper and do not affect the quality or quantity of breast milk. Copper IUDs are safe and effective for 10 years, depending on the brand. Your risk of infection is slightly greater with an IUD.

Minipill

The minipill is a progestin-only option for birth control. It's highly effective, but must be taken daily, and at the same time, for it to work. It has a slightly higher failure rate for contraception compared with the regular pill, but because people who are breastfeeding aren't as fertile, it is usually not an issue.

Birth Control Pills

There are two types of birth control pills: combination and progestin-only pills. Combination pills are daily pills that contain both estrogen and progestin, and they are the most common type of birth control pills. However, they are not generally recommended until about six weeks postpartum because they contain estrogen, which can lower milk supply.

Arm Implants

Nexplanon is an arm implant that is a form of birth control that contains progesterone only. It is convenient because, once inserted, you do not have to do anything else to prevent pregnancy. It is good for three years.

You may be able to get an implant or IUD in the hospital or at your postpartum checkup.

Depo-Provera Shot

The Depo-Provera injection prevents ovulation, and a new shot is needed every three months in either the arm or the buttocks. You can get your first shot immediately after childbirth.

Nonhormonal Birth Control

Besides certain types of IUD, other nonhormonal birth control methods include:

• Condoms
• Internal condoms, which go inside the vagina for pregnancy prevention or into the vagina or anus for protection from sexually transmitted infections
• Diaphragm, a shallow cup-shaped device made of soft silicone that you bend in half and insert inside your vagina to cover your cervix after inserting spermicide
• Cervical cap, a little cup made of silicone that you insert into your vagina to cover the cervix after inserting spermicide
• Birth control sponge, which is inserted deep inside your vagina before sex and covers your cervix and contains spermicide to help prevent pregnancy

It's important to note that these options are much less effective than hormonal birth control. The typical failure rates are 13% for external condoms, 21% for internal condoms, and 17% for a diaphragm or cervical cap.

If you used a diaphragm or cervical cap in the past, wait until your postpartum checkup to begin using that method again. Most doctors recommend that you don’t put anything in your vagina until that checkup. You may also need a new size.

When to Begin Taking Birth Control Postpartum

When you begin birth control depends on the method chosen. In general, you will want to start using birth control a few weeks after giving birth.

Timing matters when it comes to inserting an IUD since the chance of the implant being expelled is dependent on how soon after birth it is inserted. For some, the best option is to get the IUD immediately after delivery, which poses a 10% risk of expulsion, or to wait about four to six weeks postpartum, when the risk drops to less than 4% overall.

You can have an implant inserted immediately after a vaginal birth or a cesarean section, and you can get birth control injections immediately after giving birth as well.

Combination birth control pills should be introduced later on, when milk supply is well established, at around four to six weeks.

The cervical cap, diaphragm, and sponge can typically be used starting at six weeks postpartum.

Summary

Birth control is safe to use while you are breastfeeding. However, not all types of birth control can be used immediately after giving birth.

Progestin-only hormonal options are usually preferred. IUDs are the most effective. Anyone concerned about birth control postpartum while breastfeeding should consult their doctor about their specific situation.

A Word From Verywell

Birth control plays an integral part in family planning. Knowing your contraceptive options while breastfeeding gives you the power to make the right choice for yourself and your family. Taking time between pregnancies is important for maternal and child health.

There are plenty of contraception options for breastfeeding parents, including both hormonal and nonhormonal ones. Talk to your doctor about what method of birth control is right for you, being open and honest about your concerns.