For most of a woman's life, she is trying to avoid getting pregnant, and pretty soon after delivery, she is probably going to return to doing exactly that.
At the very least, an obstetrician has probably told you that waiting a year between pregnancies is highly recommended for your health. Also, the prospect of having more than two creatures that need their diapers changed in the house at one time is daunting. And you don’t need to fear that you will change your mind. Plenty of people know for an absolute fact how many children they want, and they never waver on that point even when they change their mind about everything else.
Consider that of all the women who get sterilized after they turn 30, only 6% ever come to regret the decision. Even for those who are under 30, only 20% change their minds, and sterilization is permanent. We women really do know what we can handle and want in our lives - we just need to know how to achieve those goals.
And actually achieving the goal changes how you maintain it. Pregnancy and giving birth changes your hormones, your living situation, and your physical condition, all of which makes your old birth-control plan obsolete. You will have to re-jigger your practices, but, fortunately, this list has the information you need to successfully manage the transition.
15 No Period? No Relaxation.
Do yourself a favor and don’t try to track your period as a means for preventing pregnancy. Ovulation, the actual egg dropping, can happen in as little as 25 days after a woman gives birth, but there won’t be any period for at least 2 weeks after (completely hidden) ovulation. What this means is that you can get pregnant again within weeks of giving birth without having even one period, or realizing that you were back to your monthly cycle.
Besides which, you have just had a massive hormone dump. Your body will be struggling to get back to a routine, with other factors delaying or speeding up the return of ovulation. This can make predicting your fertility like predicting the weather - not something you want to bet on. If you want a break between pregnancies, you will have to put your plan in place immediately.
14 Baby-Feeding And The Estrogen Dump
You might have heard that women won’t (or are less likely to) get pregnant while breastfeeding. The rumor is true - kind of. Your levels of estrogen drop significantly, which stops you from ovulating if you drop it far enough. However, another hormone, progesterone, is at play here, and if you naturally have low levels of it, you will start menstruating sooner. Also, you will have to adhere to a particular breastfeeding routine for it to work as an even remotely reliable way to prevent pregnancy.
If you want breastfeeding to work double-duty, as both a source of nutrition and contraceptive, you will have to be feeding every 4 hours during the day, every 6 hours at night, and providing 90-95% of the baby’s food by breastfeeding. You will also have to plan on following this routine for at least 6 months. Otherwise, the change in your hormones that that breastfeeding provides will only reduce your chances at pregnant, not eliminate it.
13 Your Pill Will Be Off The Table For A While
Many types of birth control are, at it's base, estrogen in a bottle. Everybody’s favorite pill, the patch, and the ring all use estrogen to control your menstrual cycle. Unfortunately, estrogen also increases your risks for blood clots in the first 4 weeks after you give birth, so you will won’t be able to go back to those methods for at least a month.
And if you are breastfeeding? You won’t be able to go back to the pill, patch or ring until your milk supply is well-established. Estrogen reduces how much milk you make, and it will harm the quality of your milk. This adds at least another 2 weeks until you can think of going back to your estrogen-using birth control methods. Since you can start ovulating within a month, you may want to talk about a stop-gap measure in the meantime.
12 Your Method Will Have To Be Specially Tailored
Diaphragms are an interesting case. As a type of barrier that is inserted in a woman before sex, it has to fit in the right space in order to work, and that means fitting your particular shape. If this was your method of birth control before you decided to have a kid, then you might be tempted to reach for the old diaphragm. However, the space where the diaphragm is supposed to go may have been stretched and changed size from giving birth.
Don’t worry if you still want to use a diaphragm as your preferred birth control method. You can go to your doctor 6 weeks after you give birth and ask to be fitted for a new diaphragm. The doctor should be able to get you the right size.
11 Getting Tied Gets Easy
Tubal ligation is a popular form of sterilization. Roughly 600,000 undergo the surgery every year in the US, and it makes sense for many women who have decided that they have maxed out on kids for their lifetime. If you tell your doctor that you are interested in the procedure, they can arrange to perform it a day or 2 after you give birth, while you are still in the hospital. Your uterus will still be enlarged and raised out of your pelvis for the first several days, making getting to your tubes through the stomach easier. If you have a cesarean section, the obstetrician can perform the surgery at the same time as the delivery.
Not all aspects are easier. The fallopian tubes can be more prone to bleeding for a few days after giving birth, and many parents want to wait and see how the kid they just gave birth to does before cutting off the chance of ever having any others. Ultimately, you and your medical team will have to decide on the best time to perform the surgery if you want to have it.
10 When Does Mother Nature’s Gift Arrive?
You will have a ton of things to think about when you first take baby home, from how to keep the cat away from the baby’s bed to fending off the grandparents, and so running out to get pads will be the last thing on your mind. However, you may have to make a run to the convenience store for sanitary napkins shortly after you come home. If you aren’t breastfeeding, or aren’t breastfeeding much, your menstrual cycle can return any time between the 25th and 72nd day after giving birth, with the average start being 45 days postpartum. So you will start needing those pads between day 39 and day 86.
Of course, if you are breastfeeding, your period will start later. It can be delayed by months or years, depending on how regularly you breastfeed and how much progesterone you have in you.
9 1-2-3, IUD
Tubal ligation isn’t the only option right after you give birth. There are less permanent options that can be slipped in the day after you give birth. The intrauterine device is inserted by a healthcare provider, and can be put in right after delivery. They are the size of a quarter so they slip into place easily. The IUDs are safe for nursing moms because they are made of either copper or come with progestin, which won’t interfere with lactation. The copper IUD starts to work immediately and the progestin IUDs start working in a week. There is the risk that the IUD will fall out if they are inserted right after having a baby, but it can just be inserted again to do its job for years on end.
8 The Pill For Breastfeeders
The problem with the traditional pill for women who just gave birth is the estrogen. It can cause blood clots and it will interfere with the production of milk. I know, it’s a bummer: oral contraceptives are convenient to use and transport.
Fortunately, there is a substitute that you can use. Called the mini-pill, it lacks the estrogen, so it is safe to use right after you give birth. You can take it if you are breastfeeding full-time as well, since progestin doesn’t change the milk. There is a caveat that if you are exclusively breastfeeding, you might want to wait 6 weeks before you start the mini-pill, just to make sure that the milk is established. Otherwise, it is just like the classic pill except there isn’t a week of placebo pills that don’t have any hormones in them. The mini-pill gives a daily dose of progestin every day.
7 It Depends On Your Hospital’s Policies
While tubal ligations and hysterectomies are a popular way to control family size, not all hospitals are 100% on board with them. Hospitals that are owned by the Catholic Church might follow directives that limit sterilization procedures to times when it would cure or alleviate some kind of pathology. There was a recent case of a woman who threatened to sue her hospital in Redding, California for telling her doctor she couldn’t get a tubal ligation, and they changed their mind.
Even if there aren’t bigger directives, hospitals often have a waiting list that you have to get on in order to get the operation, since there are situations where it’s considered an elective surgery. There are a lot of people, though, who would argue that a sterilization after a birth is more of an emergency operation because, while 25% of women who did not ask for sterilization got pregnant again within a year, 50% of women who did ask for sterilization got pregnant within a year.
6 Consent Is The Operative Word
Nor are all states going to make your way to sterilization easier. If you are on state aid, there might be consent decrees you have to fill out. At the federal level, you are required to wait 30 days after signing the consent decree to have the procedure performed on the off-chance you change your mind. This can be reduced to 72-hours if it’s being done because of premature delivery or abdominal pain.
And it should be added that the only person that needs to consent to the procedure is you. There are some old doctors who have tried to claim that you need to have a certain number of children or permission from your husband, but they are misinformed. Your family size is your choice.
Sterilization for people on public aid has a shady past. For the first four decades of the 20th century, many states had laws that allowed states to have people with handicaps to be forcibly sterilized. They are largely not used now, but they probably inspired the requirement for consent decrees in some states to make sure that people who have their tubes tied really want their tubes tied.
5 Post-Partum Nookie Has A New Obstacle
The tissue around where the baby comes out, called the perineum, takes a beating during birth. I mean, the kid’s head is a couple of times bigger than the opening in question, so the tissues around it must stretch significantly. This would cause the perineum to tear. If that sounds painful, it's because it is. It also causes incontinence, diarrhea and painful intercourse. That will definitely put a damper on any attempt to have more kids.
There was a time when it was routine for obstetricians to cut the perineum in order to avoid bigger tears, but they are leaning more towards only doing so in an emergency now. If your perineum does tear less than 2 cm during delivery, you can mostly treat it by trying to keep the area dry and clean, and letting it rest. It might need to be stitched up if it is more than 2 cm.
4 Perhaps Hubby Would Like To Get The Snip
Probably the biggest change in birth control after you give birth is that the choice to not do it again becomes more viable. If you and the spouse are positive that one little bundle of joy is plenty and that your home has reached carrying capacity, there are 3 options. Getting your tubes tied is pretty popular and effective, but it can be expensive. There are cases of ectopic pregnancies with these, too.
There are also hysteroscopic sterilizations, called Essure, where metal implants are placed in the fallopian tubes. Scar tissue forms over the implants and essentially blocks the passage. There have been no reports of pregnancies after this type of procedure, but there have been reports of injuries.
And then there is the sterilization process that doesn’t involve you at all. Vasectomies are cheaper than tubal ligations, and a recent study showed that they their failure rate is about 1 in 100, around the same as tubal ligations. Of course, the obstacle here is convincing the husband.
3 Hormones Vs Barriers
If you are thinking about changing your type of birth control after you give birth, you will definitely want to pick one with a good track record. After all, you already have one kid; you will probably want a year at least to enjoy him or her. With this in mind, you might want to pick one of the hormonal choices such as the mini-pill, the patch or the shot. This may seem counter-intuitive, since they normally require doing something regularly. You take the mini-pill every single day, the patch has to be applied once a week for 3 weeks, etc. But the numbers are that hormonal methods of birth control are 99% effective, whereas barrier methods are 85% effective.
This may have something to with the potential for barriers to rip or used incorrectly, or just the hassle of interrupting the mood. Whichever the case, you will definitely want to take effectiveness into account.
2 Some Things Stay The Same
Condoms have been around ever since their introduction as sheepskin condoms available in Babylonian times. Don’t want to think too hard about how those fit. Anyway, as a method for preventing pregnancy, condoms are pretty darn effective. Their usefulness won’t change after baby is born. After all, while the spouse may have put on some weight while he was sympathy-eating with you, the rest of him is the same shape it was when you and he were trying to conceive.
The best part about them is that they can always act as a back-up plan. Have to wait for a pill to kick in or to start getting some treatment? Condoms can be used until you can get your preferred method in place. There is the matter of keeping them out of baby’s reach once the baby is mobile, though. A closed drawer generally works.
1 Not Everything Gets Stretched Out Of Shape
There are several barrier/hormone methods that you put in you that don’t need to change. The cervical cap, sometimes called FemCap, doesn’t need fitting to work as it goes over your cervix and you have to wait 10 weeks to use it. By the time you get the prescription, your cervix is back to its old form and waiting for use. Once you can start using estrogen again, the ring will slide right back into place and not require any further fuss.
Eventually, the baby will be weaned and sleeping through the night. You’ll be able to get a babysitter and start thinking about whether there will be another kid. Granted, children will make conceiving again a little more complicated, but you’ll find a way. In the meantime, birth control is your friend.
Sources: parents.com, bedsider.org, huffingtonpost.com, glowm.com