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If you are breastfeeding and do not want to become pregnant, you should consider using some form of birth control unless you meet all of the strict criteria for lactational amenorrhea. With so many contraceptive options out there, it is important to know which are considered safe for nursing mothers and which ones you may want to avoid.

Estrogen-containing birth control

This includes the combination birth control pill (they have both estrogen and progesterone), the vaginal ring, and the patch. The estrogen in these formulations has been shown in some studies to decrease milk production, which most breastfeeding mothers want to avoid! However, the truth is that no good randomized control trials exist to definitively prove this. Even though we have insufficient data, there are some practical steps to take if you want to consider this kind of birth control:

  1. Wait until at least 6 weeks after delivery to start this kind of birth control.
  2. If you want to be even more cautious, wait a full 6 months after delivery or until you have weaned to initiate this method (this is the World Health Organization’s recommendation).
  3. Only start using an estrogen-containing method once breastfeeding is well established and your baby is gaining adequate weight.
  4. If you notice a sudden decrease in your milk supply after starting one of these methods, talk to your doctor or lactation consultant right away. Remember, other things may also be the culprit (such as returning to work at the same time you started a new birth control), but certainly an evaluation is warranted! 

Progesterone-only birth control

The progesterone-only pill (AKA the “mini-pill”), the progesterone IUD, the implant, and the Depoprovera injection all fall into this category. These methods (as well as non-hormonal ones) are generally what are recommended for breastfeeding mothers, since they do not contain estrogen and do not interfere with milk supply. Some studies have even shown an increase in milk supply with the Depoprovera injection!

When it comes to starting this method, there is no data that shows starting these methods at any time negatively affects milk supply, but some organizations such as the World Health Organization recommend waiting until 6 weeks postpartum. If you want to use one of these methods, you can discuss when to start them with your doctor or midwife and make a plan that works for you. Keep in mind that the mini-pill requires you to not miss any pills and to take it within the same 3-hour window every day, which may be hard for some new moms to remember. And if at any time you notice any milk supply issues, be sure to seek care.

Non-hormonal methods

Any method that doesn’t contain hormones qualifies here: the copper IUD, barrier methods (condoms, diaphragms, and cervical caps), and the fertility awareness method. None of these have any effect on milk supply since they lack hormones, and as such are good choices for nursing moms. It is important to keep in mind, however, that efficacy rates vary drastically in this category, from 99.2 percent effective at preventing pregnancy with the copper IUD to only 82 percent effectiveness with condoms.

Takeaways

  • It’s important to use some form of birth control if you don’t want to get pregnant and don’t meet the criteria for lactational amenorrhea.
  • Birth control that contains estrogen may decrease milk supply, but good studies are lacking.
  • Non-hormonal methods and progesterone-only birth control are generally recommended for breastfeeding women.

References

  1. J. Riordan and K. Wambach. Breastfeeding and Human Lactation, 4th edition.
  2. RA Lawrence and RM Lawrence. Breastfeeding: A Guide for the Medical Profession. 7th edition.
  3. Centers for Disease Control and Prevention. Contraception.
  4. Truitt ST., Fraser AB., Gallo MF, Lopez LM, Grimes DA, Schulz KF. Combined hormonal versus nonhormonal versus progestin-only contraception in lactation. Cochrane Database of Systematic Reviews 2003, Issue 2.
  5. American College of OB/GYN. ACOG Clinical Review special report from ACOG: Breastfeeding: maternal and infant aspects. ACOG Clinical Review 2007: 12 (supplement).

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