How to prevent pregnancy while breastfeeding

You may have heard that breastfeeding alone is a good form of birth control. This is only partially true.

Breastfeeding reduces your chances of becoming pregnant only if you are exclusively breastfeeding. And this method is only reliable for six months after the delivery of your baby. For it to work, you must feed your baby at least every four hours during the day, every six hours at night, and offer no supplement. This means that your baby eats nothing besides your milk.

You will ovulate first, and then if you don’t get pregnant you have your first period about two weeks later. You probably will not know if you ovulate, so there is the danger of getting pregnant when breastfeeding. This method isn’t effective if your period has already returned.

If you’re concerned about preventing pregnancy while breastfeeding, it’s a good idea to speak to your doctor about your options. You may want to avoid birth control that contains the hormone estrogen. Estrogen has been linked to lowered milk supply in breastfeeding mothers.

That said, there are still plenty of options available for both preventing pregnancy and protecting you against sexually transmitted infections (STIs). Keep reading to learn more.

Option #1: IUD

Intrauterine devices (IUDs) are more than 99 percent effective, making them the most effective birth control on the market. IUDs are a form of long-acting reversible contraception (LARC). There are two different types of IUDs available, hormonal and non-hormonal. Both are available by prescription only.

Hormonal IUDs contain progestin, which is a synthetic form of the hormone progesterone. The hormone thickens your cervical mucus to prevent sperm from reaching your uterus.

Options include:

  • Mirena: provides up to 5 years of protection
  • Skyla: provides up to 3 years of protection
  • Liletta: provides up to 3 years of protection
  • Kyleena: provides up to 5 years of protection

A healthcare provider inserts a plastic T-shaped device into your uterus to prevent fertilization. Because a foreign object is inserted, your risk of infection is greater. An IUD is not a good choice for women who have multiple sexual partners.

Hormonal IUDs may also make your periods lighter. Some women may stop experiencing periods entirely.

Paragard is the only non-hormonal IUD available. Paragard uses a small amount of copper to interfere with sperm movement. This can prevent egg fertilization and implantation. Paragard provides up to 10 years of protection. However, this IUD may not be for you if you normally have a heavy period or experience strong cramping. Many women who use the copper IUD report longer, heavier periods.

You can have an IUD placed immediately after delivery, but it’s a good idea to ask your doctor whether this is your best option. Many doctors want to wait until you heal and stop immediate postpartum bleeding in two to six weeks. Otherwise, the IUD may become dislodged if placed too soon and your risk of infection is greater.

Side effects include cramping after insertion, irregular or heavy bleeding, and spotting between periods. These side effects usually ease within the first six months of insertion.

If you decide you would like to get pregnant again, you can have your IUD removed and start trying right away.

Learn more about IUDs »

Option #2: Mini-pill

Traditional birth control pills contain a mixture of the hormones estrogen and progestin. Some women may experience a reduced milk supply, and consequently a shorter duration of breastfeeding, when using combination pills. It’s thought that estrogen may be at the root of this.

If you’d like to use an oral contraceptive, the mini-pill is an option. This pill contains progestin only, so it’s considered to be safer for breastfeeding mothers. The pill is typically only available by prescription, but may be found over the counter (OTC) in some states.

Because each pill in a 28-pill pack contains progestin, you likely won’t have a monthly period. You may experience spotting or irregular bleeding while your body adjusts.

Like with many other progestin-containing contraceptives, you can start taking the mini-pill between six and eight weeks after you deliver your baby. It’s between 87 and 99.7 percent effective at preventing pregnancy.

You may have the best success with this birth control method if you remember to take the pill every day and at the same time each day to keep your hormone levels steady.

While on the mini-pill, you may experience anything from headaches and irregular bleeding to a reduced sex drive and ovarian cysts.

If you decide you want to get pregnant again after taking the pill, speak with your doctor. For some women, fertility may return immediately after stopping the pill or it may take a few months to return.

Many moms notice their milk supply decreases with any hormonal birth control. To overcome that, breastfeed more often and pump after feeding for the first few weeks on the mini-pill. If your breastmilk supply continues to drop, call a lactation consultant for advice on increasing your supply again.

Learn more about oral contraception »

Option #3: Barrier methods

As the name implies, a barrier method blocks sperm from entering the uterus and fertilizing the egg. There are a variety of options available and all are OTC.

The best part? You can start using barrier methods as soon as you’re cleared for sexual intercourse after the birth of your baby. These methods don’t contain any hormones that may disrupt your milk supply.

Condoms

Condoms work by blocking the sperm from getting into the vagina.

They come in a variety of options, including:

  • male and female
  • latex and non-latex
  • non-lubricated and lubricated
  • spermicidal

Condoms are also the only form of birth control that help protect against STIs.

When used “perfectly,” condoms are about 98 percent effective. This means using a condom every time, from start to finish. In other words, there isn’t any genital contact before a condom is put on. Perfect use also assumes that the condom doesn’t break or slip off during intercourse.

With “typical” use, that number lowers to about 82 percent effective. This accounts for all of the mishaps that may occur during intercourse.

For added protection, use condoms with other birth control methods, like a spermicide, the mini-pill, or natural family planning.

Learn more about how to use condoms safely »

Sponge, cap, or diaphragm

Other barrier methods include:

Sponge: This is a piece of polyurethane foam that you insert into your vagina. The sponge blocks sperm from entering your uterus. It’s about 88 percent effective with typical use, however it may be less effective for women who have given birth.

The contraceptive sponge contains spermicide so it not only blocks sperm with a barrier, but contains chemicals that immobilize and kill sperm. Keep the sponge in place for at least 6 hours after intercourse, and never leave it in more than 24 hours.

Cervical cap: A cap can be placed in the vagina up to six hours before intercourse. The only brand available in the United States is called the FemCap. It’s 71 to 86 percent effective.

A cap is available by prescription only as your healthcare provider will need to fit you for the correct size. If you used one before you got pregnant, you will need to be refitted. This is because your cervix will change with pregnancy and delivery.

The FemCap will need to be used with a spermicide to get that effectiveness. This means that you might have up to a 30 percent chance of getting pregnant. If this risk is too high, then consider another method of birth control.

Learn more about the cervical cap »

Diaphragm: This is a small silicone cup that you can insert into your vagina up to two hours before intercourse. It fits over your cervix to prevent sperm from reaching your uterus.

A healthcare provider will need to fit you for a diaphragm, and refit after childbirth as the cervix changes and it may no longer fit. This method is about 60 percent effective for women who have already given birth.

You should always use spermicide with the diaphragm.

Option #4: Implant

The contraceptive implant Nexplanon is the only other LARC available. It’s also over 99 percent effective and is only available by prescription.

This small, rod-shaped device is about the size of a matchstick. Your doctor will insert the implant underneath the skin on your upper arm. Once in place, the implant may help prevent pregnancy for up to four years.

The implant contains the hormone progestin. This hormone helps prevent your ovaries from releasing eggs. It also helps to thicken your cervical mucus, preventing sperm from reaching the egg.

You can have the implant placed immediately after delivery. You may also have it removed if you choose to get pregnant again.

Although complications with Nexplanon are rare, you should tell your doctor if you have:

  • arm pain that won’t go away
  • signs of infection, such as fever or chills
  • unusually heavy vaginal bleeding

Learn more about the implant »

Option #5: Depo-Provera shot

The Depo-Provera shot is a long-lasting form of prescription birth control. It uses the hormone progestin to prevent pregnancy. The shot provides three months of protection at a time, so if you don’t keep your quarterly follow-up appointments, you won’t be protected.

The shot is about 97 percent effective. Women who receive their injections on time every 12 weeks have a higher level of efficacy than women who miss a shot or are off schedule.

Side effects include abdominal pain to headaches to weight gain. Some women also experience bone density loss while using this method of birth control.

If you’re looking to have more children in the future, it’s important to note it may take 10 months or longer for your fertility to return after discontinuing use.

Option #6: Natural family planning

The natural family planning (NFP) method is also called the fertility awareness method. It is hormone-free, but it requires some attention to detail.

There are several different ways to approach NFP, but it comes down to paying close attention to your body’s signals.

For example, you’ll want to pay attention to your body’s natural rhythm and how long your cycle is. For many women, this length is between 26 and 32 days. Beyond that, you’ll want to observe the cervical mucus coming out of your vagina.

You may also want to take your basal body temperature each morning using a special thermometer. This can help you look for spikes or dips in temperature, which help indicate ovulation.

However, it can be difficult to predict when your fertility returns after birth. Most women who have given birth don’t experience a period before they begin ovulating again. The first few menstrual cycles you experience may be irregular and different from what you are used to.

If this is your method of choice, you must decide to become educated and diligent about monitoring mucous, the calendar, symptoms, and temperatures. The effectiveness of natural planning methods is around 76 percent or lower if you’re not practicing the method consistently.

This is not a good choice for women who have always had irregular periods. Also, your cycle may be somewhat unpredictable while breastfeeding. For this reason, you may want to consider using a backup method, like condoms, a cervical cap, or a diaphragm.

Learn more about NFP »

Option #7: Sterilization

If you don’t want to have another child, sterilization may be a good option for you. Female sterilization is known by many names, including tubal sterilization, tubal ligation, or “getting your tubes tied.” This is a permanent form of birth control where the fallopian tubes are cut or blocked to prevent pregnancy.

Tubal ligation doesn’t affect your menstrual cycle. Some women choose to have this procedure completed after vaginal childbirth or during a cesarean section. The risks with this procedure are the same as for any other major abdominal surgery, including reaction to anesthesia, infection, and pelvic or abdominal pain.

Your doctor or a lactation consultant is your best resource for determining when you can safely return to nursing after surgery and taking medications, like painkillers.

Nonsurgical sterilization is also possible, although it may take up to three months to be effective. Tubal ligation is effective immediately.

Although reversing tubal ligation may be possible, the odds are very low. You should only explore sterilization if you are completely sure that you don’t want to give birth again.

Learn more about female sterilization »

What about the morning-after pill?

If you find yourself in a situation where you think your birth control has failed, it’s safe to use the morning-after pill while breastfeeding. This pill should only be used as a last resort and not as a regular form of birth control. It is available OTC or at a reduced cost by prescription.

There are two types of the morning-after pill: one that contains a combination of estrogen and progestin and another that is progestin-only.

The progestin-only pills are 88 percent effective, but don’t work as well as the combination pills, which are 75 percent effective.

Some options for progestin-only pills include:

  • Plan B One-Step
  • Take Action
  • Next Choice One Dose
  • My Way

The combination pill is about 75 percent effective.

Although progestin-only pills are preferred, taking a combination pill shouldn’t have a long-term effect on your milk supply. You may experience a temporary dip, but it should return to normal.

Learn more about emergency contraception »

The bottom line

Your fertility may return at any time after your deliver your baby, regardless of whether you’re breastfeeding. Breastfeeding alone only slightly reduces the chance of pregnancy for the first six months and only if feeding exclusively at least every four to six hours.

There are many options for birth control that you can discuss with your doctor. Choosing which one is right for you is a personal decision. Generally, breastfeeding mothers should avoid birth control that contains estrogen, as it may impact your milk supply.

If you have more questions about your fertility while breastfeeding and safe birth control methods, consider making an appointment with your doctor or a lactation consultant. Maintaining breastfeeding is important and you want to make a birth control choice that does not interfere.