Postpartum Birth Control
Frequently Asked Questions: Contraception
If you are not using a birth control method, it is possible to get pregnant very soon after having a baby. Using a birth control method in the weeks after you have a baby (the postpartum period) helps you avoid an unintended pregnancy.
When choosing a birth control method to use after you have a baby, think about the following:
- Timing—Some birth control methods can be started right after childbirth. With other methods, you need to wait a few weeks to start.
- Breastfeeding—All methods are safe to use while breastfeeding. But there are a few methods that are not recommended during the first weeks of breastfeeding because there is a very small risk that they can affect your milk supply.
- Effectiveness—The method you used before pregnancy may not be the best choice to use after pregnancy. For example, the sponge and cervical cap are much less effective in women who have given birth.
The intrauterine device (IUD) is a small, T-shaped device that your obstetrician–gynecologist (ob-gyn) or other health care professional inserts into your uterus. IUDs can be inserted right after a vaginal or cesarean birth or at your first postpartum health care visit.
The hormonal IUD releases a small amount of progestin into the uterus and is approved for up to 3 to 6 years of use, depending on the type you get. The copper IUD releases a small amount of copper into the uterus and is approved for up to 10 years of use. Both work mainly by stopping the egg and sperm from joining (fertilization).
IUDs do not interfere with sex or daily activities. Once inserted, you do not have to do anything else to prevent pregnancy. The hormonal IUD may decrease menstrual pain and heavy menstrual bleeding.
- The IUD may come out of the uterus. This happens in about 5 percent of users in the first year of using the IUD. Serious complications from using an IUD, such as infection or injury, are rare.
- The hormonal IUD may cause spotting and irregular bleeding in the first 3 to 6 months of use. Other side effects include headaches, nausea, depression, and breast tenderness.
- The copper IUD may increase menstrual pain and bleeding or cause bleeding between periods, mainly in the first few months of use. This usually decreases within 1 year of use.
The birth control implant is a single flexible rod about the size of a matchstick that your ob-gyn or other health care professional inserts under the skin in your upper arm. You can have the implant inserted immediately after a vaginal or cesarean birth. It releases progestin into the body and is approved for up to 3 years of use.
The implant does not interfere with sex or daily activities. Once it is inserted, you do not have to do anything else to prevent pregnancy. Almost all women are able to use the implant.
The implant may cause unpredictable bleeding. Your periods may be heavier, lighter, or longer. Some users experience infrequent periods or bleeding in between periods. Other common side effects include mood changes, headaches, acne, and depression.
The birth control injection contains a type of progestin called depot medroxyprogesterone acetate (DMPA). It works by preventing ovulation. Your ob-gyn or other health care professional will give you a shot of DMPA in your arm or buttock every 3 months. You can get your first shot right after a vaginal or cesarean birth.
An injection does not interfere with sex. Almost all women are able to use the injection.
- Bone loss may occur with use of the injection. When injections are stopped, some, if not all, of the bone that was lost is gained back.
- An injection should not be used if you have multiple risk factors for cardiovascular disease.
- An injection may cause irregular bleeding, headaches, or slight weight gain.
Birth control pills, the vaginal ring, and the patch are birth control methods that contain estrogen and progestin. They work mainly by preventing ovulation. Depending on the method, you need to remember to do one of the following: take a pill each day, insert a vaginal ring every 21 days, or apply a skin patch every week for 3 weeks.
These methods do not interfere with sex. They may make your period more regular, lighter, and shorter. These methods may also reduce cramps, improve acne, reduce menstrual migraine frequency, and reduce unwanted hair growth.
- During the postpartum period, women have a higher risk of developing blood clots in veins located deep in the body. This condition is called deep vein thrombosis (DVT). Combined hormonal methods increase the risk of DVT even further. If you have no additional risk factors for DVT, you can start using these methods 3 weeks after childbirth.
- There is a very small risk that the estrogen in these methods can affect your milk supply if you are breastfeeding. You should avoid these methods for the first 4 to 6 weeks after childbirth, until breastfeeding is established.
- Combined hormonal methods have been linked to a small risk of stroke and heart attacks. They are not recommended if you are older than 35 years and smoke; have high blood pressure or a history of stroke, heart attack, or DVT; have a history of migraine headaches with aura; have certain medical conditions; or have breast cancer or a history of breast cancer.
- Side effects may include breakthrough bleeding, headaches, breast tenderness, and nausea.
Progestin-only birth control pills contain just progestin. They work mainly by preventing fertilization of the egg by the sperm. They must be taken at the exact same time each day. If you miss a pill by more than 3 hours, you will need to use a back-up method for the next 48 hours.
Progestin-only pills do not interfere with sex. They may reduce menstrual bleeding or stop your period altogether.
Side effects include headaches, nausea, and breast tenderness. Progestin-only pills should not be used if you have breast cancer or a history of breast cancer. They are not recommended if you have certain medical conditions.
Barrier methods include spermicide, male and female condoms, the diaphragm, the cervical cap, and the sponge. Barrier methods work by preventing the man’s sperm from reaching the woman’s egg. The cervical cap, diaphragm, and sponge can be used starting 6 weeks after childbirth, when the uterus and cervix have returned to normal size. If you used a diaphragm or cervical cap before childbirth, you should be refitted after childbirth.
Condoms are the only birth control method that protect against sexually transmitted infections (STIs). Condoms, spermicide, and the sponge can be bought over the counter. Barrier methods have no effect on a woman’s natural hormones.
Spermicides can cause vaginal burning and irritation. Some people are allergic to spermicide and may have a reaction. Frequent use of spermicides (such as every day) can increase the risk of getting human immunodeficiency virus (HIV) from an infected partner.
Lactational amenorrhea method (LAM) is a temporary method of birth control based on the natural way the body prevents ovulation when a woman is breastfeeding. It requires exclusive, frequent breastfeeding. The time between feedings should not be longer than 4 hours during the day or 6 hours at night. LAM may not be practical for many women.
It is a natural form of birth control. It does not cost anything.
There are no health risks or side effects to using LAM. This method can be used for only 6 months after childbirth or until your period returns. It is unclear whether pumping breast milk decreases the effectiveness of LAM.
Sterilization is permanent birth control. In women, sterilization is performed by closing off or removing the fallopian tubes. It can be performed soon after delivery while you are still in the hospital, several weeks after you have your baby, or several months after childbirth. For men, vasectomy is an option. It takes about 2 to 4 months for the semen to become totally free of sperm after a vasectomy. A couple must use another method of birth control or avoid sexual intercourse until a sperm count confirms that no sperm are present.
Sterilization is permanent. Once you have it done, you do not need to use any other birth control method.
There is a small risk of infection and bleeding with female and male sterilization. You should be sure that you no longer want to become pregnant again in the future. If you change your mind later, attempts to reverse are not guaranteed to work.
Aura: A sensation or feeling experienced just before the onset of certain disorders like migraine attacks or epileptic seizures. These senations may be flashing lights, a particular smell, dizziness, or seeing spots.
Bone Loss: The gradual loss of calcium and protein from bone, making it brittle and more likely to break.
Breakthrough Bleeding: Vaginal bleeding that happens in between regular periods.
Cardiovascular Disease: Disease of the heart and blood vessels.
Cervix: The lower, narrow end of the uterus at the top of the vagina.
Cesarean Birth: Birth of a fetus from the uterus through an incision (cut) made in the woman's abdomen.
Deep Vein Thrombosis (DVT): A condition in which a blood clot forms in veins in the leg or other areas of the body.
Depression: Feelings of sadness for periods of at least 2 weeks.
Egg: The female reproductive cell made in and released from ovaries. Also called the ovum.
Estrogen: A female hormone produced in the ovaries.
Fallopian Tubes: Tubes through which an egg travels from the ovary to the uterus.
Fertilization: A multistep process that joins the egg and the sperm.
High Blood Pressure: Blood pressure above the normal level. Also called hypertension.
Hormones: Substances made in the body that control the function of cells or organs.
Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system. If left untreated, HIV can cause acquired immunodeficiency syndrome (AIDS).
Lactational Amenorrhea Method (LAM): A temporary method of birth control that is based on the natural way the body prevents ovulation when a woman is breastfeeding.
Obstetrician–Gynecologist (Ob-Gyn): A doctor with special training and education in women’s health.
Ovulation: The time when an ovary releases an egg.
Postpartum: Related to the weeks following the birth of a child.
Progestin: A synthetic form of progesterone that is similar to the hormone made naturally by the body.
Sexual Intercourse: The act of the penis of the male entering the vagina of the female. Also called "having sex" or "making love."
Sexually Transmitted Infection (STIs): Infections that are spread by sexual contact. Infections include chlamydia, gonorrhea, human papillomavirus (HPV), herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]).
Sperm: A cell made in the male testicles that can fertilize a female egg.
Spermicide: Chemicals (creams, gels, foams) that inactivate sperm.
Uterus: A muscular organ in the female pelvis. During pregnancy, this organ holds and nourishes the fetus. Also called the womb.
Vasectomy: A permanent birth control method for men. In this procedure, a portion of the tube that carries sperm is removed.
If you have further questions, contact your obstetrician–gynecologist.
FAQ194. Copyright May 2020 by the American College of Obstetricians and Gynecologists
This information is designed as an educational aid to patients and sets forth current information and opinions related to women’s health. It is not intended as a statement of the standard of care, nor does it comprise all proper treatments or methods of care. It is not a substitute for a treating clinician’s independent professional judgment. Read ACOG’s complete disclaimer.