If you are meticulously preparing for your pregnancy, don’t wait until your first postpartum checkup to think about what you do after giving birth. Postpartum family planning involves the use of contraceptives during the first 12 months after giving birth to prevent unintended pregnancies that occur closely together.
For Angela Ryan, a lack of postpartum family planning resulted in multiple life-altering outcomes. Ryan, an attorney and now a reproductive justice advocate in Bryn Mawr, Pennsylvania, struggled to get pregnant and ultimately pursued in vitro fertilization to conceive. She delivered a healthy baby after three rounds of IVF but knew she and her husband wanted more children. Her OB-GYN reassured her that given her reproductive history, Ryan did not need to worry about postpartum family planning.
However, Ryan delivered her second child just one year and one month after delivering her oldest. After her second baby, Ryan had the same conversation with a different OB-GYN, who gave her the same advice to forgo contraceptives. Shortly after that, Ryan gave birth to twins and had four kids under the age of two-and-a-half years old.
“What I keep coming back to is this: Our ability to family plan was never really ours,” Ryan says. “It was slowly eroded by poor advice from multiple physicians that pushed us to have pregnancies we were not physically, emotionally or financially prepared for.”
For Ryan, each birth became more stressful and more high risk, reaffirming the need for proactive postpartum family planning.
Read on for more information on postpartum family planning, including timing and which contraceptive options you might consider.
[READ Pregnancy Checklist]
What Is Postpartum Family Planning?
Postpartum family planning refers to the use of contraceptive methods, such as birth control, after childbirth to prevent unintended pregnancies shortly after giving birth and optimize your and your baby’s well-being.
Spacing out your pregnancies can prevent complications, such as:
— Preterm labor or delivery
— Anemia
— Postpartum hemorrhage
— Emergency C-section
— Placental abruption
— Uterine rupture
— Postpartum depression and anxiety
— Financial stress
— Strained family relationships
— Low infant birthweight
If you aren’t breastfeeding, ovulation can return within a few weeks after giving birth. This makes it possible to get pregnant shortly after childbirth.
Spacing between pregnancies impacts future pregnancies as well as the health of both mother and baby, says Dr. Sadia Haider, chair of obstetrics and gynecology at Rush University System for Health in Chicago.
Experts recommend waiting 12 to 18 months before having another baby, according to the American College of Obstetrics and Gynecology (ACOG).
What happens to your body after childbirth
To better illustrate the window for family planning, let’s break down what physical changes you can expect your body to go through after giving birth and when to consider contraceptives:
| Timeline | Key changes | Notes |
| 0-6 weeks |
— The uterus contracts. — Lochia, or bleeding, tapers. — A cesarean or perineal incision heals. — Hormones fluctuate. — Sleep deprivation occurs. |
During the immediate postpartum period, vaginal intercourse is not recommended while active healing takes place.
The first postpartum check-up is typically 10-14 days after a C-section and 6 weeks after a vaginal delivery. |
| 6-12 weeks |
— Hormones start to stabilize. — Menstruation may return. — Energy starts to increase. |
After medical clearance, vaginal intercourse may be safe.
Contraceptive options expand after 6 weeks, and fertility may return before your first postpartum menstrual cycle. |
| 3-6 months |
— Weight may start to stabilize. — Exclusively breastfeeding may suppress ovulation. |
Fertility may return as supplementation or pumping reduces exclusive breastfeeding. |
| 6-12 months |
— Menstrual cycle normalizes. — Hormones begin to return to prepregnancy cycles. — Sleep deprivation is often less severe. |
The full range of contraceptives is available. You should discuss pregnancy spacing with your medical provider. |
[READ: Delivery and Labor: What to Expect at the Hospital]
How to Find the Right Postpartum Contraceptive Method for You
Postpartum contraception isn’t a one-size-fits-all approach.
“I don’t routinely recommend any one method for postpartum contraception. The decision to use any method really depends on many patient factors,” says Dr. Amy Nelson, an OB-GYN and clinical associate professor at VCU Health, a university-based health system in Richmond, Virginia. Nelson is also a board-certified complex family planning OB-GYN.
According to various sources, contraceptive methods include:
| Method | Timing | Breastfeeding compatibility | Effectiveness |
| Natural family planning, or fertility awareness | Anytime | Yes | 77% |
| Barrier methods (condoms, spermicide, cervical cap, diaphragm) | Anytime | Yes | 78% to 87% |
| Patch | At least 3 weeks postpartum; 6 weeks postpartum if you’re exclusively breastfeeding | May reduce milk supply | 93% |
| Vaginal ring | At least 4 weeks postpartum | Yes | 93% |
| Copper intrauterine device (IUD) | Anytime after delivery | Yes | >99% |
| Progestin-only IUD | Anytime after delivery | Yes | >99% |
| Implant | Anytime after delivery; 4 weeks postpartum if you’re breastfeeding | Yes | >99% |
| Injection | Anytime after delivery | Yes | 96% |
| Progestin-only pill | Anytime after delivery | Yes | 93% |
| Combined progestin and estrogen pill | At least 6 weeks postpartum; 6 weeks postpartum if you’re exclusively breastfeeding | May reduce milk supply | 93% |
| Tubal ligation, or getting your tubes tied | Anytime after delivery | Yes | >99% |
Factors to consider
While all contraceptive methods are effective to varying degrees, the right one for you depends on multiple factors, including:
— Breastfeeding or baby formula. Consider whether you plan to breastfeed (and for how long) or supplement with pumping or formula.
— Medical history. Your personal medical history, including previous labor, delivery and postpartum complications, as well as any history of blood clots are important factors to consider.
— Family planning. The type of contraceptive will also depend on your current preferences for how many children you want and how you want to space them out.
— Possible side effects. Talk to your doctor about any concerns you have with the side effects of contraceptive methods.
“When breastfeeding, we don’t recommend starting any method with estrogen until at least 6 weeks postpartum, as estrogen can interfere with early breastfeeding,” Nelson adds. “Once the milk supply is well established, then we can certainly add estrogen if they prefer.”
Nelson adds that providers don’t recommend estrogen-containing methods immediately postpartum because of the risks for developing blood clots. Certain types of clots, called deep vein thrombosis, can travel to the lungs and become a life-threatening condition called a pulmonary embolism. For this reason, in the immediate postpartum period, providers recommend nonestrogen methods, such as progestin-only IUDs, injections and pills, as well as the copper IUD.
Now that research has shown that IUDs can be safely placed immediately postpartum, Haider feels this has revolutionized postpartum family planning.
“It’s much easier for patients, and it has improved the rates of postpartum contraception,” she says.
There is slightly more risk of the IUD expelling on its own than if it were inserted at 6 weeks or after, but it can still be beneficial for some patients because they have contraception in place as needed.
[READ: Baby Blues vs. Postpartum Depression: What’s the Difference?]
When to Start Postpartum Family Planning
The best time to start postpartum family planning is during your pregnancy.
“I typically begin the conversation at about 20 weeks’ gestation,” says Dr. Sarah Tout, an OB-GYN and assistant professor with the department of obstetrics and gynecology and the department of reproductive biology at Case Western Reserve University School of Medicine in Cleveland. “When I first bring it up, most patients tell me that they haven’t given it much thought. My role is to provide information in an unbiased and evidence-based fashion to support my patients’ decision-making.”
Why should postpartum family planning start so early?
“It’s hard to return for postpartum care,” Haider says. “A high proportion of patients miss their 6-week visit, even up to 50%, which is typically when contraceptive needs are addressed.”
What You Should Know About Postpartum Contraception Counseling
Postpartum contraception counseling is your time to make sure you understand all of the postpartum family planning options available to you and how to effectively use them.
Once you and your provider have decided on a postpartum family planning method, Nelson recommends trying it for about 3 to 6 months to see how your body adjusts. With hormonal contraceptives, side effects usually improve over time and are usually gone by 6 months. Overall side effects occur in about 10% of contraceptive users, Nelson adds.
Side effects may include:
— Irregular bleeding
— Cramping
— Nausea
— Decreased libido
Frequently Asked Questions
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What Is Postpartum Family Planning? originally appeared on usnews.com