5 Questions to Ask Yourself Before Choosing Your Post-Baby Birth Control

After spending time “trying,” then having a bump, then being too sleep-deprived to care about sex, you may be a tad fuzzy on the new contraception rules. Here’s what you missed. 

Husband and Wife Riding Bicycle Thayer Allyson Gowdy
After I had my second daughter, I was relieved not to be dealing with a bump anymore. But there was one thing I was dreading about not being knocked-up: having to think about birth control again. I had been trying to conceive a baby or pregnant for almost four straight years, and as I dipped my toe into the contraception pool, I discovered a lot had changed.

There is no one-size-fits-all-moms option, says Eve Espey, M.D., chair of the department of obstetrics and gynecology at The University of New Mexico School of Medicine in Albuquerque and president of the Society of Family Planning. The best method is the one you are going to like (or at least not hate) and use correctly, she says. You also need to keep in mind that breastfeeding is not birth control, Dr. Espey warns. While nursing can delay ovulation and make conception less likely, that really only applies to women who exclusively breastfeed without supplementing with any formula and who don’t (or rarely) pump and feed the expressed breast milk in a bottle. What should you choose? Answer these five questions to find your new go-to method.

1. Did you like the Pill before?

There’s no reason you can’t go back to it eventually, even if you’re breastfeeding. The mini pill, which contains only progestin (a synthetic version of the hormone progesterone), is usually recommended due to worries that the estrogen in combined pills can diminish milk supply. That thinking is starting to change, however. Some research shows that milk production is not affected significantly in nursing women who are healthy and well-nourished, so talk with your ob-gyn about which one is right for you, Dr. Espey says. Nursing or not, all moms need to wait to start combined estrogen-progestin birth control until at least four weeks after delivery, when elevated blood clot risk during pregnancy returns to a normal level. (Keep in mind that ob-gyns advise no intercourse until six weeks after delivery anyway!) If you suffer from difficult periods, menstrual migraines, or, hey, just don’t want to be bothered, consider continuous-dose pills that give you four or fewer periods a year, suggests Draion Burch, D.O., clinical assistant professor of obstetrics and gynecology at the University of Pittsburgh.

Finally, while taking the Pill daily might have suited your pre-baby life, if it seems too stressful to remember to do that now, there are two other combined hormonal options that you don’t have to deal with as frequently: You change the Ortho Evra patch weekly and the NuvaRing once a month. However, you may struggle to find a spot for the patch on your arm, stomach, back, or hips if you don’t want it to show (especially during swimsuit season), and you have to get used to inserting the ring into your vagina and removing it. 

2. Is immediate important?

Although many women won’t be having sex until at least six weeks postpartum, those who do can still get pregnant. “And believe me, we see it!” says Dr. Espey. One increasingly popular and immediate option is the implant Nexplanon or Implanon. It’s a tiny plastic rod that a doctor inserts just beneath the skin on the inner side of your upper arm. Like the mini pill, it contains progestin alone. One important note: Billing and insurance rules in some states won’t allow for immediate postdelivery insertion, so you may need a separate appointment.

Another progestin-only option that can be given right after delivery is the Depo-Provera shot, which protects you for three months. 

3. Are hormones a no-no?

If you smoke, have risk factors for blood clots or stroke, or have another medical condition that makes a combined estrogen-progestin birth control method too risky, there is a super-effective, reversible contraception option for you that is nonhormonal: the Paragard copperreleasing intrauterine device (IUD), which lasts for up to 10 years. The copper IUD, which creates an environment that’s toxic to sperm, is as effective as sterilization, but can make cramps and bleeding worse. (The cramps and bleeding should subside over time.) However, there are also the Mirena IUD and the Skyla mini IUD, both of which slowly deliver small amounts of progestin directly into the lining of your uterus. Unlike the Paragard, they usually make periods lighter and cramps less severe. They’re also safer for smokers or women with blood clot or breast cancer concerns compared to taking the regular Pill.

“My patients really like the IUD,” says Dr. Burch. “You don’t have to think about birth control again; the doctor puts it in, and boom—you’re free to go.” When you’re ready for another baby, you usually only need a trip to the doctor’s office for removal. In some cases, however, an IUD may require surgical removal if it gets too firmly lodged in place. 

4. Is a pregnancy "oops" okay?

If some part of you would be secretly happy if you turned up pregnant again sooner than you planned, you can go for the cheapest and simplest birth control option: withdrawal. It doesn’t work great, but surprisingly, it’s still about 73 percent effective at side-stepping conception. A bit more reliable are condoms at 82 percent, which many couples use if they want to have another baby soon. 

5. Are you done having kids?

Well, then, you know what to do. There’s vasectomy (for him) or tubal ligation (for you). Both procedures are considered permanent, though a vasectomy can possibly be reversed with surgery. If you’re having a scheduled C-section, you can plan in advance for your ob-gyn to perform a tubal immediately after your baby is delivered. It only adds about 10 minutes to your time in the operating room. (If you deliver vaginally, you can usually have a tube-tying procedure the day after the birth, adds Dr. Espey.)

Whatever option you settle on, follow through. As a new mom, it’s not easy to handle all the hassles that you managed pre-baby. Adds Dr. Burch: “See your doctor to stay up to date with your birth control method.”