Not keen on having #2 just after delivery? Start thinking contraception!

By Annabel Meggeson 

With a new baby, sex could well be the last thing on your mind. But if you don’t want to add to your family right now, read on. 

Around 30 per cent of women find that the contraception they used before they got pregnant no longer suits them. Plus, certain types can interfere with breastfeeding.  Condoms suit women who are uncomfortable with putting any kind of hormones into their body.  General consensus is if you are exclusively breastfeeding, if it’s less than six months since you gave birth and you have no periods, you are very unlikely to get pregnant.

The thought of contraception may currently seem as relevant as a course of scuba diving lessons. But it’s worth considering now, because your libido may creep up on you without warning. Moreover, as many shocked parents with a short gap between children will testify, your fertility can come back equally unexpectedly. 

Some women ovulate within weeks of giving birth and, while breastfeeding can offer some protection from a new pregnancy, don’t be fooled into thinking it’ll keep you 100 per cent safe. 

So if, like most of us, you don’t want to get pregnant again the minute you’ve popped out your last baby, you need to start thinking about contraception pretty soon. “Talk to your gynae at your postnatal check-up - or book an appointment beforehand, if you think it’s necessary,” says family planning nurse 
Celia Murray. 

As for the method you use, it’s not just a simple case of picking up where you left off. “Around 30 per cent of women find that the contraception they used before they got pregnant no longer suits them,” says Murray. “Plus, certain types - notably the combined pill - can interfere with breastfeeding.”
So how do you know which type will suit you best? Here’s Mother & Baby’s up-to-date expert guide to help you decide. 

THE MIRENA COIL
What is it?
An IUS (intrauterine system) that releases a small amount of progestogen and prevents the womb lining building up so there’s nothing for fertilised cells to stick to. 

Why it’s good
“Your post-baby womb is better able to accommodate an IUS and having it inserted is less painful,” says Murray. As well as being at least 99 per cent effective, the Mirena is effective for five years. If you so choose, you can have it removed and your fertility will return straightaway. What’s more, it makes your periods very light and in some cases, they disappear altogether. Some women feel uncomfortable not being able to keep track of their periods, in which case a standard copper coil is another option. 

Mirena has minimal side effects, since it releases only small amounts of hormone. Early side effects include staining, abdominal pain and weight gain, explains M&B expert Dr Christopher Chong, a consultant obstetrician, gynaecologist and urogynaecologist at Gleneagles Hospital.
The Mirena IUS - priced between $550 and $700 - is available in some GP clinics and all O&G specialist clinics.

“Do it about eight weeks after delivery, once the womb has shrunk back to its normal size,” Dr Chong adds. 

THE COMBINED PILL
What is it?
A combined oestrogen and progesterone tablet that inhibits the development of ovarian follicles and ovulation. Brands include Microgynon 30, Cileste and Marvelon. 

Why it’s good
It’s convenient and effective. “The combined pill is a good option as it’s still fairly flexible,” Murray says. “You’ve got a 12-hour window in which to take it, and if you miss the odd one here and there, it doesn’t matter.” As there’s strong evidence to suggest oestrogen decreases milk supply, this type of pill can interfere with breastfeeding and your gynae will suggest an alternative until your baby is weaned. 

THE MINI-PILL
What is it?
A progesterone-only pill (POP) containing a hormone that mimics the effect of your body’s own progesterone. It prevents the womb lining thickening and increases the amount of mucus between the cervix and the uterus, making it harder for sperm to enter. 

Why it’s good
You can start taking it just 21 days after giving birth and it becomes effective straightaway. Plus, unlike with the combined pill, you can breastfeed because it doesn’t contain oestrogen. The risks associated with the oestrogen in the combined pill , such as blood clots, don’t occur with the POP, so it’s particularly good if you’re a smoker and over 35. 

“However, you have to take it at the same time every day. It doesn’t control your periods (so they won’t become lighter, more regular or less painful) and it’s not quite as effective as the combined pill,” Murray says. 

On the other hand, Dr Chong adds, “It also means fewer hormones in your body and therefore fewer potential side effects. Any contraceptive with medication can reduce breastmilk, but the mini-pill reduces this to a lower extent than the combined oral contraceptive pill.” 

DEPO-PROVERA
What is it?
A contraceptive injection that gradually releases into your bloodstream a hormone that suppresses ovulation. 

Why it’s good
“Like implants, contraceptive injections can be used while breastfeeding,” says family planning expert Dr Anne Szarewski. “They last 12 weeks ? ideal if you don’t want to take a daily pill, but are still working out what to do long-term.” Downsides include heavy bleeding at first, but it rarely has any other side effects. “It can take up to eight months for your fertility to return, so you need to factor that in to your family planning,” Dr Szarewski highlights. 

IMPLANON
What is it?
A contraceptive implant about the size of a hairpin that’s inserted under the skin in your upper arm. It slowly releases a progesterone-based hormone into your bloodstream that prevents ovulation, makes the uterus lining thinner, and thickens the mucus plug between the cervix and womb to help block the passage of sperm. 

Why it’s good
It’s long-lasting, convenient and effective. Implanon takes a few minutes to insert (you'll be given a local anaesthesia first) and lasts for three years. Apart from reduced periods, side effects are minimal. It’s great for women who want to resume a sex life soon after giving birth, as it doesn’t interfere with breastfeeding. You can have it inserted from 21 days after giving birth. 

CONDOMS
What are they?
One of the most popular form of contraception. 

Why they’re good
They’re nearly 100 per cent effective (when they don’t split) and have no side effects, unless you’re allergic to latex. “Condoms suit women who are uncomfortable with putting any kind of hormones into their body,” Dr Szarewski notes. 

On timing a second visit from the stork, Dr Chong concludes, “Spread out your pregnancies - at least a year apart - the first six months for breastfeeding, and the next six to build up your health.” 

Can you get pregnant while you’re breastfeeding? Dr Miles Levy, consultant endocrinologist at Leicester Royal, gives us the lowdown.  “The short answer is yes, although in some circumstances, breastfeeding can give almost total contraceptive protection. When you’re breastfeeding, a hormone called prolactin makes you produce milk. It also inhibits the release of the hormone GRH, which is responsible for ovulation and periods. The higher the levels of prolactin, the more GRH is suppressed and the less likely you are to ovulate.  General consensus is if you are exclusively breastfeeding, if it’s less than six months since you gave birth and you have no periods, you are very unlikely to get pregnant. But no one can guarantee you won’t conceive ? even expressing the odd feed instead of putting your baby to your breast will lower the levels of prolactin and increase GRH, meaning you could get pregnant.”  So, which contraception should you try? Trace our easy-to-follow path to find the best solution for you, though you should see your GP or gynae for advice.  You’re still happy taking the pill Yes  - You’re breastfeeding - Yes (Try the mini pill), - No (Try the combined pill)    No – It’s been more than six weeks since you gave birth - No (Try the contraceptive injections) - Yes - You have had problems with your uterus or ovaries (eg cysts) or  you have a vaginal infection - NO - You feel reassured being able to track your periods ¬ NO Try Mirena coil - YES - Try an IUD (ie. a copper coil)

If you have any comments or practical suggestions, write to us at editor@family.sg 

- Mother & Baby
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