Methods of postpartum (postnatal)contraception
What methods of contraception are recommended for a breast feeding woman?
There are several alternatives and we shall discuss them shortly. In summary, there are:
Both male and female barrier methods
Oral progestogen preparations
Injectable progestogen preparations
Spermicidal preparations and, finally
Natural family planning.
Which are the barrier methods?
The most widely used is the male condom. For a fully breast-feeding woman, properly used condoms should be sufficient in the first six months.
The female barrier methods include the diaphragm, the cervical cap and vaginal sheath (female condom). These, properly used, are equally effective for those who are fully breast-feeding. They are usually readily available from family planning clinics. However, it is important to remember that a diaphragm cannot be fitted until at least four weeks after delivery. The same applies to the cervical cap. With both of these, a spermicidal cream should be used as well.
What about the progestogen-only pill?
This is the most popular form of postnatal contraception among women who are breast-feeding. It is popularly known as the "mini-pill" or P.O.P.
It has the advantage of not affecting milk production in any way. However, it calls for an element of discipline because, to work effectively, the pill has to be taken at regular times each day.
There may be irregular menstruation with its use. Overall, it is very effective when used appropriately.
What can be said about the injection form of contraception?
Depo-Provera® is the grand old duke of injectable progestogens. It is administered every twelve weeks and is an extremely effective contraceptive. However, like its oral cousin, the mini-pill, it can cause irregular vaginal bleeding, especially in the first three months. Thereafter, the tendency is to have no period at all. It does not interfere with milk production and is regarded to be safe for breast-feeding.
It is important to ensure that the injections are given on a strictly regular basis, for maximum effectiveness.
Noristerat® is another injectable contraceptive. This one has to be repeated every 8 weeks.
What about the implant Implanon® or Nexplanon®?
The progestogen contraceptive can also be administered in the form of an implant. A small flexible rod containing the hormone (Etonogestrel) is implanted under the skin and is effective for three years. This is therefore suitable for those requiring long term convenient contraception. It is very effective. However, for a woman who is clinically obese, it may not last the prescribed 3 years and may have to be changed a few months earlier. Your doctor should be able to give you personalized guidance on this. Over the last few years Implanon has been phased out and replaced with Nexplanon. The active hormone is the same. The advantage of the new preparation is in the ease of insertion and removal.