Contrary to popular legend, breastfeeding women can become pregnant. However, other methods of birth control exist that present no or few problems for either the nursing mom or her baby.
The health benefits that breastfeeding offers newborns are widely known and well-documented by numerous studies, and the convenience and cost savings associated with breastfeeding are significant. While most women who choose to breastfeed do so until their baby gets their first teeth (age 4-6 months), some will continue for much longer, often into the child's second year.
Since most women resume sexual activity several weeks after delivery, the need for effective birth control is an important consideration. The ideal method is one that is completely safe for the newborn infant, free of side effects for the nursing mother, and highly effective in preventing pregnancy. While no current method fits that exact description, there are several good options available to the woman who chooses to breastfeed. These include hormonal contraceptives, barrier methods, the intrauterine device (IUD), and sterilization.
The common misconception is that exclusive breastfeeding itself prevents pregnancy. However, multiple studies have shown pregnancy rates similar to, or a little higher, than other birth control methods, but only for the first 6 months. After that the risk of pregnancy gets higher as you increase supplemental feedings.
Breastfeeding can be a natural way to reduce the rate of pregnancy after birth. It is known as the Lactation Amenorrhea Method (LAM). While you are nursing, hormones that cause ovulation are not produced. If ovulation does not occur, pregnancy cannot happen.
In order to use LAM effectively, you must:
While this may be effective, the pregnancy rate with LAM is 1-2%. You may want to consider other forms of birth control during this time.
After 6 months other forms of birth control are needed to prevent pregnancy. There are several options for you to consider.
The Pill and Mini-pill
The combination birth control pill, commonly referred to as the pill, combines estrogen and progesterone hormones. Progesterone-only birth control pills, also called the mini-pill, only contain progesterone. Hormone contraceptives may work by disrupting the hormone cycle that results in ovulation. Some pills thicken cervical mucus, which makes it more difficult for sperm to meet the egg. Other pills do both.
Mini-pills are a popular choice for many nursing and non-nursing women. Mini-pills are less effective than combination pills. However, it is often recommended over combination pills after delivering your baby because combination pills increase your risk of developing a blood clot. Also, despite insufficient evidence to prove it, many organizations are concerned that combined oral contraception may suppress milk production, so they do not recommend them in breastfeeding women. Most women will not menstruate as long as they remain on the mini-pill—a welcome side effect for some women.
When breastfeeding is discontinued, an easy transition can be made to a combination pill. It is essential that the mini-pill be taken everyday at the same time to be effective. Noncompliance can result in an unintended pregnancy.
This option is an injectable hormonal contraceptive, which is given every 3 months. Breastfeeding women should wait until 6 weeks after delivery before receiving their first injection. The progesterone-like hormone contained in Depo-provera will not harm the nursing infant and is almost 100% effective in preventing pregnancy. However, it may decrease milk production. Other side effects include irregular periods or absence of periods and weight gain.
Barrier methods of birth control include condoms (male and female), the diaphragm, and the cervical cap. All of these methods work by presenting a physical barrier that prevents the sperm from gaining access to the egg. Although side effects are minimal, the pregnancy rate is significantly higher when compared to hormonal methods. However, when combined with LAM, they may be very effective in the first 6 month.
None of the barrier methods interfere with breastfeeding in any way.
To improve their efficacy, condoms should be used in conjunction with a spermicidal gel. The chemicals in these gels do not enter the breast milk and therefore are harmless to a nursing infant. Failure to prevent pregnancy is usually due to improper use, failure to use at all, or breakage. Latex condoms may cause an allergic reaction in some women, but will not affect the nursing infant in any way.
It should be noted that using a male latex condom is the only birth control method that protects you from sexually transmitted diseases.
The diaphragm is a round, flexible, rubber, cup-shaped device that is inserted into the vagina before sex. When used with a spermicidal gel, its effectiveness at preventing pregnancy is similar to condoms. Diaphragms come in different sizes, so you need to see your healthcare provider to get a proper fit. You will also be instructed by your healthcare provider as to the proper way to insert and remove the diaphragm. The diaphragm should be left in place for up to 8 hours after intercourse to prevent pregnancy. Removal should be done within 24 hours. With proper care, a diaphragm will last for 2-3 years, but should be refitted if you gain or lose a substantial amount of weight during that time. You can be fitted for a diaphragm at your postpartum check-up—usually 4-6 weeks after delivery.
The less popular cervical cap fits more tightly against the cervix, is more rigid than a diaphragm, and can remain in place for longer periods of time.
Breastfeeding women sometimes develop atrophic vaginitis. This condition, a result of depressed estrogen levels, causes vaginal dryness, irritation, and painful intercourse. Insertion and removal of a diaphragm or cervical cap may be painful. If you suffer from this condition, a different method of contraception may be more acceptable.
The IUD is an effective and safe contraceptive method for breastfeeding women. Current IUDs either contain copper or are impregnated with a progesterone-like hormone. There are no adverse effects from the IUD or any of its chemical components on the nursing infant. Side effects for the mother may include expulsion, bleeding, pain, and an increased risk of infection.
For women who have completed their families, permanent sterilization is another method of birth control. A tubal ligation can be performed shortly after delivery while you are still in the hospital, or, if preferred, at a later date as an outpatient. In either case, no interruption in breastfeeding is necessary. Anesthetics used during the procedure may be present in the breast milk for a short period of time, but not in quantities high enough to cause any harmful effects on a nursing infant. Recovery from this minor surgery is rapid, and breastfeeding can resume as soon as you are awake and alert. After surgery, a wide variety of safe pain medications may be used.
For most new mothers, the thought of becoming pregnant again right away is frightening. Effective birth control is therefore of paramount importance. Breastfeeding mothers are often concerned about medications that might be transferred to their babies in their breast milk. Fortunately, there are several safe methods available for prevention of pregnancy in women who choose to breastfeed their infants. If you opt to go with LAM, adding another form of birth control, especially a barrier, can further decrease your chances of another pregnancy. Talk to your healthcare provider before your delivery about which method might be best for you.
Association of Reproduction Health Professionals
La Leche League International
The College of Canadian Family Physicians
Womens Health Matters
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Last reviewed May 2017 by Michael Woods, MD, FAAP