Contraception: what every new mum needs to know

When you've just had a baby, contraception may be the last thing on your mind. But it's something you need to think about, especially if you're not planning to get pregnant anytime soon. We look into your contraceptive choices, now you're a mum.

After giving birth, you're exhausted, emotional – not to mention sore and uncomfortable! And then your midwife reminds you about contraception. And so does your GP at your six-week postnatal check.

So why, when sex is the last thing on your mind, is everyone so concerned about contraception?

'For lots of people, sex is the last thing they feel like doing in the weeks after giving birth, but others are ready to have sex quite soon,' says Natika H Halil, chief executive of the Family Planning Association (FPA).

'Many unplanned pregnancies happen in the first few months after childbirth, so even if you’re not interested in sex at the moment, it's better to be prepared if you want to avoid another pregnancy. If possible, think about what contraception you'll use before the birth so that you’re ready and don’t have to worry about it afterwards,' she says.

Need more info? Check out our guide to the contraceptive choices on offer, including which ones are suitable for breastfeeding mums and which ones are ideal if you're not planning another pregnancy soon.

Here's what every new mum needs to know about post-baby contraception ...

What are my contraceptive choices now I'm a mum?

The FPA says that these methods can be used or started any time after the birth:

• Male or female condoms.
• Contraceptive implant.
• Progestogen-only pill.
• Contraceptive injection. (When using the injection within six weeks of giving birth you may be more likely to have heavy and irregular bleeding.
• Natural family planning. (It may be more difficult to identify the signs and symptoms of fertility immediately after giving birth or when you’re breastfeeding.)

From three weeks after the birth, if you’re not breastfeeding and have no other medical risks, or from six weeks if you are
breastfeeding or have certain conditions or risks, you can use:

• the combined pill
• the contraceptive patch
• the contraceptive vaginal ring

From four weeks after the birth you can use:

• an intrauterine device (IUD)
• an intrauterine system (IUS).

The IUD and IUS can also be inserted within 48 hours after vaginal or caesarean birth.

From six weeks after the birth you can use:

a diaphragm or a cap. You must check that it fits correctly.

How do I know which contraception is right for me?

As well as personal preference, your choice of contraception also depends on these three factors:

• your medical history
• any problems you had in your pregnancy
• if you’re breastfeeding.

You can talk through your choices with your midwife or GP in your post-baby check ups. Or, at a later date with your GP or contraceptive clinic.

I don't want another baby yet – what are the most effective contraception choices?

Long-acting reversible contraceptives (LARC) are the most effective methods at preventing pregnancy.

'This is because you don’t need to remember to take or use them,' says the FPA.

Here are your long-term options:

• Contraceptive implant – lasts for up to three years.
• IUD – lasts for five to 10 years, depending on type.
• IUS – lasts for three to five years, depending on type.

'Don’t think that these methods aren’t for you if you’re planning another pregnancy sooner than that – it’s completely fine to get one and have it taken it out whenever you’re ready to try for another baby,' says Natika.

The contraceptive injection is also long-acting and reversible. The most common brands (Depo-Provera or Sayana Press) last for 13 weeks.

'If used perfectly they’re over 99% effective, but they become less effective if you forget or miss an injection. You need to be able to go back for your next injection at the right time, which isn’t always convenient for busy mums,' says Natika.

'The way the injection is typically used means around six in 100 injection users become pregnant in a year. Some clinics and GPs might be able to give you a supply of the injection to inject yourself at home. It’s worth asking about this if the injection’s your preferred choice,' she says.

These contraceptive methods are also effective, as long as you remember to take or use them:

• Combined pill
• Contraceptive patch
• Contraceptive vaginal ring
• Progestogen-only pill
• Male or female condoms
• Diaphragm or cap with spermicide
• Natural family planning.

When do I need to start using contraception after having a baby?

According to the FPA, you need to start using contraception from three weeks (21 days) after the birth.

'People don’t always realise you can get pregnant before your periods come back because you release an egg around two weeks before your period. So if you wait until you have a period before you start contraception then it could be too late,' says Natika.

Will breastfeeding stop me getting pregnant again?

Many new mums think that breastfeeding their baby acts as an effective contraception. But this isn't actually the case.

The FPA says that breastfeeding can be 'up to 98% effective in preventing pregnancy for up to six months after birth.'

However, for it to even be this effective, you must be exclusively breastfeeding (not mixed feeding) and not had a period since giving birth.

Just be aware that the risk of getting pregnant again increases if:

• you start breastfeeding less often
• there are long intervals between feeds – both day and night
• you stop night feeds
• you use supplement feeding
• your periods return.

If you do choose to rely on breastfeeding as a form of contraception, you should find an alternative form once your baby is six months – even if you're still breastfeeding.

Will contraception affect breastfeeding?

If you want to go back on the pill and are breastfeeding, advice is to delay starting the pill. This isn't because it will harm your baby as there is no evidence to suggest this. Instead it is because the hormones in the pill can affect your milk production.

The FPA advises waiting six weeks before starting the pill but the NHS advises waiting until you are no longer breastfeeding (or at least waiting until your baby is six months).

This advice applies to starting the combined pill, vaginal ring and contraceptive patch.

What's an IUD and how does it work?

An IUD is a small t-shaped plastic and copper device that is inserted into your womb. It's small enough to fit in the palm of your hand and the arms that make the 't' shape allow it to sit in the opening to your womb, with threads that hang down.

An IUD stands for intrauterine device. You may have heard of the coil, which is another name for it.

There are two types of IUD; the Mirena coil and the copper coil. Although they work in slightly different ways, in a nutshell, an IUD will stop the sperm and egg from surviving in the womb or fallopian tubes. It may also prevent a fertilised egg from implanting in the womb.

If you decide to have an IUD, you'll need to have it fitted by a trained nurse or GP. It takes around 15–20 minutes to do and is about as uncomfortable as a smear test.

The good thing about an IUD is that once it's in you can forget about it for at least five years. Depending on the type you have fitted, an IUD can stay in place for between five and 10 years. You can also have it fitted if you're still breastfeeding.

And when you are ready to start trying for another baby, just book to have it removed and your normal fertility should return. 

I had the baby! Can my partner take responsibility for contraception now?

Sadly, there are still only two contraceptive methods for men – using a condom or getting a vasectomy. In the heat of the moment, it can be easy to not bother with a condom and a vasectomy may not appeal to your other half yet, if at all.

'Some couples might choose to rely on withdrawal but this can be notoriously difficult to get right so your risk of pregnancy is quite high. Around 22 women out of 100 relying on withdrawal will get pregnant in a year,' says Natika.

The good news is that a lot methods of contraception for women are safe to use soon after giving birth, even if you’re breastfeeding. Many methods can be started either straight away or within days (IUD and IUS) if not weeks of the birth (the pill or contraceptive patch).

You can always discuss contraception options for you and your partner with your GP.

I've had unprotected sex and don't want to get pregnant yet – what should I do?

Without contraception, the only reliable way to avoid getting pregnant is not to have sex. If you do have unprotected sex or your contraception fails then try not to panic.

Emergency contraceptive pills are safe to use from 21 days after giving birth, explains the FPA.

There are two types of pill:

• A pill with the hormone levonorgestrel can be used up to three days (72 hours) after unprotected sex and is safe to use when you’re breastfeeding. It’s more effective the earlier it’s taken.
• A pill with ulipristal acetate [medication used for emergency contraception] can be used up to five days (120 hours) after unprotected sex, but if you’re breastfeeding you’ll need to express and discard your milk for a week after taking it.

A less well-known method of emergency contraception is the IUD (copper coil). Your local contraception or sexual health clinic may be able to fit this for you.

Let them know it’s for emergency contraception so they can see you quickly. It can be fitted up to five days after unprotected sex or five days after the earliest time you could’ve released an egg.

Although it’s not as convenient to get hold of as a pill, it’s the most effective way to prevent an unwanted pregnancy and you can keep it as your usual method afterwards if you want to.