Sex Objects

Your birth-control choices after having a baby

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With its attendant sleep deprivation and nearly constant physical demands, life with a newborn has likely left you feeling less than amorous, with sex a distant memory. But rest assured that your thoughts will eventually turn to re-establishing physical intimacy with your partner. And when that happens, you’ll need to think about something you haven’t had to in a while: birth control (unless, of course, you want to conceive again immediately). Wives’ tales notwithstanding, ovulation can occur as early as four weeks after delivery. So as soon as you start having sex again—which is not advised until at least six weeks postpartum, or until your doctor gives you the go-ahead—you’ll need to use some form of protection.

Fortunately, there are more reversible methods of birth control available today than ever before. Indeed, the contraception landscape has changed considerably, with several new, convenient methods available, from patches applied weekly, to vaginal rings inserted monthly, to progestin shots given every 12 weeks—and even the return of a safer, improved IUD. Here’s a look at your options.

Male Condom How it works: Prevents sperm from entering the vagina and uterus and fertilizing the egg. Should be used in conjunction with spermicide for maximum effectiveness. Effectiveness: 86% to 98%. Pros: Safe to use while breastfeeding; available over the counter; also prevents transmission of sexually transmitted diseases (STDs). Cons: Lack of spontaneity; possibility of breakage; can cause reduced sensation.

Female Condom How it works: Used in conjunction with spermicide and inserted before intercourse, the female condom is a polyurethane sheath with two soft rings at each end. One ring fits over the cervix; the other remains outside the vagina. Prevents sperm from entering the vagina and uterus and fertilizing the egg. Effectiveness: 79% to 95%. Pros: Safe to use while breastfeeding; available over the counter; also prevents transmission of STDs. Cons: Relatively low effectiveness rate; can slip during use; lack of spontaneity; can be difficult to insert; shouldn’t be used by people with allergies to spermicide.

Diaphragm How it works: Used in conjunction with spermicide and inserted before intercourse, the diaphragm blocks sperm from entering the uterus and fertilizing the egg. A clinician must initially fit the diaphragm to you and recheck its fit after you have a baby. Effectiveness: 80% to 94%. Pros: Safe to use while breastfeeding; protects against gonorrhea and chlamydia and possibly other STDs as well. Cons: Relatively low effectiveness rate; lack of spontaneity; shouldn’t be used by people with allergies to latex or spermicide.

IUD How it works: This small, plastic T-shaped device is inserted into the uterus by a clinician and contains hormones or copper to prevent fertilization. The brand Mirena contains a hormone called levonorgestrel and can be left in place for five years; ParaGard is made of copper and can be left in place for 10 years. Whichever type you choose, it is typically inserted six weeks postpartum, although your doctor or clinician may agree to insert it immediately after you deliver. Effectiveness: 97% to 99%. Pros: Safe to use while breastfeeding; high effectiveness rate; convenience; spontaneity. Cons: Possibility of increased cramping and heavier periods; increased risk of uterine infection for first four weeks after the IUD is inserted.

Cervical Cap How it works: The cap is a thimble-shaped latex device that is coated with spermicide and inserted into the vagina before intercourse. It blocks sperm from entering the uterus and fertilizing the egg. A clinician must initially fit the cap to you and recheck its fit after you have a baby. Effectiveness: 60% to 80%. Pros: Safe to use while breastfeeding; protects against gonorrhea and chlamydia and possibly other STDs as well. Cons: Low effectiveness rate; available in only four sizes; can be difficult to insert; lack of spontaneity; shouldn’t be used by people with allergies to latex or spermicide.

Combined-Hormone Pill How it works: A pill containing both estrogen and progestin is taken daily. Suppresses ovulation; also thickens the cervical mucus, thereby blocking sperm and preventing fertilization in case ovulation does occur. Effectiveness: 95% to 99%. Pros: High effectiveness rate; convenience; spontaneity. Cons: Must not be used if you are over the age of 35 and smoke, as these factors can significantly increase your risk of heart attack, blood clots and stroke. Also, estrogen can reduce milk supply, so if you’re breastfeeding, your clinician will need to determine whether the combined-hormone pill is an option for you.

Mini-Pill How it works: A pill containing progestin is taken daily. Thickens the cervical mucus, thereby blocking sperm and preventing fertilization; also may prevent ovulation. Effectiveness: 95% to 99%. Pros: Safe to use while breastfeeding; high effectiveness rate; convenience; spontaneity. Cons: Must be taken at the same time each day for maximum effectiveness.

Depo-Provera How it works: A clinician gives you a high-dose progestin shot every 12 weeks. Suppresses ovulation; also thickens the cervical mucus, thereby blocking sperm and preventing fertilization in case ovulation does occur. Effectiveness: 99%. Pros: Safe to use while breastfeeding; high effectiveness rate; convenience; spontaneity. Cons: May cause altered periods and sex drive, appetite changes and weight gain; increased risk of ectopic pregnancy if pregnancy occurs; it may take longer to get pregnant once shots are stopped.

NuvaRing How it works: You insert a small, flexible ring into your vagina once a month, where it remains for three weeks; you then remove it on the fourth week. Contains estrogen and progestin to suppress ovulation; also thickens the cervical mucus, thereby blocking sperm and preventing fertilization in case ovulation does occur. Effectiveness: 95% to 99%. Pros: High effectiveness rate; convenience; spontaneity. Cons: Possible increase in vaginal discharge; estrogen can reduce milk supply, so if you’re nursing, your clinician will need to determine whether NuvaRing is an option for you.

Ortho Evra (The Patch) How it works: You apply this thin, plastic patch to your buttock, stomach, upper arm or torso. A new patch must be applied once a week for three weeks; no patch is worn for the fourth week. Contains estrogen and progestin to prevent ovulation; also thickens the cervical mucus, thereby blocking sperm and preventing fertilization in case ovulation does occur. Effectiveness: 95% to 99%. Pros: High effectiveness rate; convenience; spontaneity. Cons: Possibility of irritation at application site; estrogen can reduce milk supply, so if you’re nursing, your clinician will need to determine whether Ortho Evra is an option for you.

Lunelle How it works: A clinician administers an estrogen/progestin shot monthly. Suppresses ovulation; also thickens the cervical mucus, thereby blocking sperm and preventing fertilization in case ovulation does occur. Effectiveness: 99%. Pros: High effectiveness rate; convenience; spontaneity. Cons: You must get a shot every month; estrogen can reduce milk supply, so if you’re nursing, your clinician will need to determine whether Lunelle is an option for you.

NOTE: Prefilled syringes of Lunelle were temporarily and voluntarily recalled in October 2002 over concerns that the syringes contained insufficient hormone levels. Lunelle that is packaged in vials was not affected by this recall. For more information, visit www.lunelle.com.

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