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Birth Control and Breastfeeding

Can I get pregnant if I’m breastfeeding? Which methods of birth control will affect my milk supply? Learn more about your birth control options and which methods are safe for breastfeeding mothers.

 

What birth control methods are safe for breastfeeding?

Many birth control methods are available that are reliable and do not affect breastfeeding. It is important to look carefully at which method is right for you and your partner. The following chart is a list of birth control methods and their effect on breastfeeding. This is followed by a description of each method. For more information, talk to your healthcare provider about your specific situation.

How soon after my baby is born can I have sex?

Only you will know when you are ready to have sex again after the birth of your baby. Generally, you can have sex again when you have stopped bleeding and have recovered from your birth. Talk to your healthcare provider. Make sure you and your partner are both ready and you have chosen a type of birth control.

 

 

Birth Control Methods and Ratings

Method

Effect on Breastfeeding

Lactational Amenorrhea Method

Positive Effect

Barrier Methods

None

Intrauterine Methods:

 
IUD None
IUS No adverse effects on breastmilk supply if breastmilk supply is well established

Hormonal Methods Containing Progestin:

 
Progestin-only minipill
No adverse effects on breastmilk supply if breastmilk supply is well established
Progestin injectable

Hormonal Methods Containing Estrogen:

 
Oral contraceptive pill

Studies have shown that estrogen may reduce breastmilk supply

The Patch
Estrogen and Progestin vaginal ring

Natural Family Planning

None (wait until period returns)

Lactational Amenorrhea Method (LAM)

LAM is a short-term (first six months after delivery) birth control method that is 98% reliable if used perfectly. The key is to breastfeed often, both day and night. This delays the return of your period and suppresses your fertility.

The three key questions for LAM to be a safe birth control method are:

(you must answer “no” to all three questions)

  1. Has your period returned? (a period is two days of bleeding in a row, that occurs 8 weeks after the date of delivery).
  2. Are you giving your baby other drinks from a bottle or feeding solids, so that there are long periods without breastfeeding? (longer than four hours in the day and six hours at night).
  3. Is your baby more than six months old?

If you answer “no” to all three questions, you have less than a 2% chance of becoming pregnant.

If you answer “yes” to any one question, you should use another birth control method to protect yourself from pregnancy. 2

Barrier Methods

Condoms (male and female) act as a barrier so that sperm do not enter the uterus and fertilize an egg. They can be made of latex, or polyurethane. Condoms are widely available, inexpensive and you do not need a prescription. They also provide protection from sexually transmitted diseases.

Condoms are most reliable if used with spermicides (jellies or foams that disable sperm). Spermicides need to be inserted into the vagina ahead of time (time depends on product).

Intrauterine Methods

Intrauterine Device (IUD)

  • Small plastic T-shaped device that contains copper
  • Inserted into uterus by health care provider at six weeks after delivery
  • Causes changes in the uterus so that sperm cannot fertilize an egg
  • Can stay in place for up to ten years

Intrauterine System (IUS)

  • Small plastic T-shaped device that slowly releases progestin into uterus
  • Inserted into uterus by health care provider at six weeks after delivery
  • Works by thickening cervical mucus making it difficult for sperm to reach egg; causes changes in the lining of the uterus that helps prevent implantation; may prevent ovary from releasing an egg in some women
  • Can stay in place up to five years
  • Has been shown to possibly reduce milk supply in some mothers due to presence of progestin

Possible issues with IUD/IUS

  • Irregular bleeding or spotting in the first few months after insertion
  • Increased bleeding or cramping (IUD)
  • Reduced bleeding and in some cases, no periods (IUS)
  • Expulsion (IUD/IUS falls out)
  • Perforation (rare) (making a small hole in the uterus)

Hormonal Methods

Hormonal methods are not the first choice for breastfeeding mothers. Taking hormones can cause a decrease in milk supply. Also, newborns may have difficulty removing the hormones from their system. These methods are only available with a prescription from your health care provider.

Progestin-Only Methods

How they work

  • Prevent ovary from releasing an egg
  • Thicken cervical mucus which slows movement of sperm through cervix
  • Change lining of uterus, making implantation difficult
  • Can be started six weeks after delivery. If used earlier, may affect establishment of milk supply

Progestin-Only Minipill

  • Needs to be taken at the same time every day
  • Less effective if taken late or missed a pill

Progestin-Only Injectable

  • Injected every three months, not reversible
  • May decrease bone-mineral density

Methods Containing Estrogen

Estrogen-containing birth control methods are not recommended until six months after delivery due to the estrogen reducing a mom’s ability to produce enough breast milk. At six months, the baby is starting on solids and this can help him deal with the drop in milk supply. Estrogen pills are not recommended for mothers with blood-clotting problems, certain cancers, or severe migraines. These methods cannot be used by women who are over 35 years and who smoke due to increased risk of blood clots.

How they work

  • Prevent ovary from releasing an egg
  • Thicken cervical mucus which slows the movement of sperm
  • Changes the lining of the uterus making implantation difficult

Oral Contraceptive Pill

  • Combination estrogen and progestin pill
  • Dosage varies depending on brand
  • Taken daily for 21 days, off for 7 days (which is when period occurs)
  • Needs to be taken at same time every day

The Patch

  • A patch that releases hormone through the skin
  • A new patch is applied once a week for three weeks, then one week without a patch (which is when period occurs)

Estrogen and Progestin Releasing Vaginal Ring

  • Flexible ring, inserted by the mother into the vagina for three weeks, then removed for one week (which is when period occurs)
  • Releases a continuous dose of hormones for three weeks while it is in the vagina

Other Natural Methods

Natural family planning teaches a mother to look for signs of ovulation (when an egg is released) by observing changes in her body. The sympto-thermal method means a mother checks her body temperature and cervical mucus to figure out when she is ovulating. The calendar method means a mother tracks the days of her menstrual cycle to identify her time of fertility (when she can get pregnant). The goal of natural family planning is to learn when you are ovulating and avoid sex during those fertile times. Teaching sessions on natural family planning are available at London Natural Family Planning. For more information, you can contact them by email at billings@londonnfp.com.

It is harder to read fertility signs during breastfeeding. These methods may be easier to use and more reliable after your periods have returned and are regular. The calendar method alone has little value before first ovulation

 

 
Date of creation: June 4, 2013
Last modified on: October 1, 2021
 

References

1The Society of Obstetricians and Gynecologists of Canada (2021) It's a Plan.Helping you make decisions about contraception. Retrieved from
http://www.sexualityandu.ca
2Mohrbacher, Nancy (2010) Breastfeeding Answers Made Simple: A Guide for Helping Mothers, Amarillo, Texas, Hale Publishing
3Canadian Paediatric Society's Nutrition and Gastroenterology Committee (CPS), Dietitians of Canada (DC), Breastfeeding Committee for Canada (BCC), Public Health Agency of Canada (PHAC), and Health Canada (HC). (2015-08-18). Nutrition for Healthy Term Infants: Recommendations from Birth to Six Months. Retrieved from
http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/recom/index-eng.php