Birth Control Pills
Oral contraceptives are made of estrogen and progesterone. The Pill is taken daily to prevent ovulation. It is important that birth control pills be taken every day, preferably at the same time each day. The fourth week of the pack consists of inactive, placebo pills. It is during this week that a woman will experience bleeding similar to a normal menstrual period. When birth control pills are used correctly, they are more than 99% effective. This is the most popular method of contraception in our country. Birth control pills do not protect against sexually transmitted infections. Common side effects are nausea, headache, and irregular spotting. These side effects, if they occur, often resolve after the first few months of use.
Combination estrogen and progesterone birth control pills are not recommended for a nursing mom. However, there is a progesterone-only birth control pill which is safe for nursing. It is also known as the minipill. The minipill also prevents ovulation. The minipill is about 95% effective. Since combination birth control pills are more effective than the minipill, once a nursing mom has decided to wean, we prefer that she switch to combination birth control pills.
Intrauterine Devices
There were some IUDs on the market in the past which were associated with complications. The new IUDs do not increase your risk of pelvic inflammatory disease. They are designed for women who have had at least one baby and are in a mutually faithful, monogamous relationship.
The advantage of the IUD is that you don't have to think about it every day the way you do with the birth control pill or with barrier methods. Patient satisfaction with IUDs is among the highest of any reversible method. This is because it does not require daily attention and has a high degree of effectiveness as well as convenience.
Diaphragm
A diaphragm is a soft rubber, latex, or silicone cup that is filled with contraceptive jelly or cream and inserted into the vagina to cover the cervix. It provides a physical barrier to semen and holds the contraceptive jelly which kills the sperm before they can enter the uterus and fertilize an egg. The diaphragm should remain in place for six hours after intercourse, and should be removed as soon as possible thereafter. Diaphragms should be replaced every two years. Use of the diaphragm may increase a woman's risk of urinary tract infections. The diaphragm is about 80% effective.
Condoms
The male condom is worn on the penis. It collects semen and prevents sperm from entering the uterus. It is 88% effective. The female condom is a lubricated plastic sheath with the rings on each end. The ring on one end is open and remains outside the vagina, covering part of the labia. The ring on the other end is closed with the plastic and looks like a diaphragm. It is placed in the vagina so that it covers the cervix, preventing sperm from entering the uterus. The sheath between the two rings forms a pouch to line the entire vaginal area.
The use of the male condom and the female condom can help prevent the transmission of sexually transmitted diseases. Both are available without a prescription. The female condom can be inserted up to eight hours before intercourse.
Tubal Ligation
Tubal ligation is performed with an instrument called a laparoscope as an outpatient surgery. The surgery takes about a half an hour. Recovery is within a few days. There is about a 1 in 300 failure rate. It is considered permanent. You should not consider tubal ligation unless you are sure that you do not want to have anymore children. It is very difficult to have the tubes put back together. Tubal reversal is not always effective. It is often not covered by insurance. Vasectomy is done by a urologist as an office procedure. Female sterilization is immediately effective. Vasectomy is only effective after multiple ejaculations when the existing sperm are cleared out of the vas deferens.
Postpartum Contraception
We recommend an IUD and the "minipill" for post partum contraception. Breast feeding is not a reliable birth control option. Although nursing can in some cases delay or even prevent the return of your period, it does not necessarily prevent you from becoming pregnant.
Whether or not this is your first baby, it is not too soon to consider when or if you would like your next, and what you are going to do about family planning. Going through another pregnancy may be the last thing on your mind at this time, but it is best to think it over now so that you are prepared for the future.
Other options for postpartum birth control include combined oral contraceptives for women who are not breast feeding, the diaphragm, condoms, and sterilization.