Contraception after having a baby

After a birth, many women are not thinking about contraception. That is normal. But planning early helps you rest, recover and decide when, or if, you want another baby. This guide from Network One Health explains your options and when each one can start.

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The most important fact

You can get pregnant before your first period comes back. Your body can release an egg before you see any bleeding. So do not wait for your period to start contraception.

• If you are not fully breastfeeding, start a method by 4 weeks after the birth.
• Health guidelines suggest waiting at least 2 years after a birth before trying for another baby. This gives your body time to recover.

The easiest time to plan is before the birth, or before you leave the hospital.

Which methods can start when

Your clinician will check which methods suit you. The times below are general guides from the South African national guideline.

Methods that can start straight after the birth (breastfeeding or not):

• Contraceptive implant. A small rod placed under the skin of your arm. It can be put in before you go home. It does not affect breastfeeding.
• Progestogen-only pill (mini pill). A daily pill with one hormone. It can start immediately. It does not affect breastfeeding.
• Male and female condoms. You can use them any time. They also protect against sexually transmitted infections (STIs) and HIV.

IUD (copper or hormone IUD). An IUD is a small device placed inside the womb.

• It can be placed within 48 hours of the birth. The best time is straight after the placenta comes out.
• It can also be placed during a caesarean section.
• If it is not placed in the first 48 hours, wait until 4 weeks after the birth.
• A check-up about 6 weeks after placement makes sure it is in the right place.
• A copper IUD does not affect breastfeeding.

The injection (Depo-Provera or Nur-Isterate).

• If you are not breastfeeding, or only partly breastfeeding, it can start immediately.
• If you are fully breastfeeding, the usual start is 6 weeks after the birth. In South Africa it can be given earlier if no other method suits you. Your clinician will discuss this with you.

Combined pill, patch or ring. These contain two hormones, including oestrogen.

• If you are fully breastfeeding, wait until your baby is 6 months old. These methods may reduce your milk.
• If you are not breastfeeding, you can usually start at 3 weeks (21 days). If you have extra risk factors for blood clots, wait until 6 weeks.
• If you are partly breastfeeding, the usual start is 6 weeks.

Sterilisation (tubes tied). This is permanent. It can be done within 7 days of the birth, or any time after 6 weeks. It can also be done during a planned caesarean section. Take time to decide. Reversible methods are also very effective.

Breastfeeding as contraception (LAM)

Breastfeeding can delay your fertility. This is called the lactational amenorrhoea method, or LAM. “Amenorrhoea” means having no periods.

LAM only works if all three of these are true:

1. Your periods have not come back.
2. You are fully or nearly fully breastfeeding. This means breast milk for almost every feed, day and night.
3. Your baby is less than 6 months old.

As soon as one of these changes, you need another method. That includes when you start giving bottle feeds, or feed less often. Plan your next method before your baby turns 6 months.

LAM is not actively promoted in South Africa. If you choose it, talk it through with your clinician first.

After a miscarriage or abortion

Fertility can return very quickly. You can release an egg as early as 2 weeks after a miscarriage or abortion.

• Most methods can start immediately, on the same day.
• An IUD can be placed once any infection is ruled out or treated.
• Wait to have sex until the bleeding stops. This usually takes about 5 to 7 days.

You do not have to decide straight away. You can take condoms or pills home and start later. Be kind to yourself. Feelings of loss or relief are both normal.

Your six-week check

Your six-week check after the birth is about you. Contraception is part of that visit. Bring your questions. If you already started a method, we will check how it is going. If you have not, we can start one then.

Read more in our guide: The first six weeks after birth.

When to get help

After any birth, miscarriage or abortion, go to your nearest hospital straight away if you have:

• Heavy bleeding
• Fever
• Strong pain in your belly
• A smelly discharge

In an emergency, go to your nearest hospital emergency unit or call 10177.

What to expect at Network One Health

We talk through your plans and your health, then help you choose. There is no right answer for everyone. If a method does not suit you, changing is simple.

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Ready to talk? Ask us to call you or WhatsApp Noma on 065 072 5315 for bookings and questions.