Choosing your Birth Control – Part 1

As doulas we are here to support you and provide the education you need in order to feel like you are making the best decision for your family. Considering all your options when it comes to preventing pregnancy can feel like a monumental task even on the best of days, but when you are exhausted while caring for your children, uncertainty can often prevail. The stress can also alter your emotions and influence the ability to properly weigh out all the options available. This is why we encourage our clients to have a conversation with their medical care provider well before the birth of your baby if at all possible.

We are beginning a blog series on the many birth control options. We will discuss the benefits and risks of each method in order to help you make the decision that is best for your family planning needs.


Which option is best for you will depend on a few different factors.

  • When do you want to start taking birth control?

  • Will you be breastfeeding?

  • Which method is best for your current circumstances?

When considering your options for birth control after having a baby, one of the first factors to consider is when can you start. Some methods will require that you wait a few weeks to begin, while others will be available for use immediately after birth.

Parents who wish to breastfeed must be aware that some methods of birth control are not recommended to begin until the milk supply is well established.

If you have used birth control in the past, what has worked before may not be the best option at this time. Discussing your options with your healthcare provider will be an important part of the decision-making process. By taking your current circumstances into account, you and your provider can make the best decision for you.

How hormonal birth control works

Methods that contain both progestin and estrogen work to prevent ovulation. Birth control pills, the patch, and the vaginal ring are the three most common. All three provide a continuous stream of the hormones for approximately 21 days. The final 7 days they are physically removed, or sugar pills are taken to allow for uterine shedding to occur. Then, the hormonal combination is reintroduced via a new patch, ring or pills.

The Pros …

In addition to the potential prevention of pregnancy, these methods may make your periods shorter and lighter. In some cases, they may also help to lower the chances of period related migraines, reduce unwanted hair growth, improve acne, and reduce the intensity of menstrual cramps.

The Cons …

Combined hormonal methods may include risk of lowered milk supply and a small increased risk of heart attack or stroke. Additionally, they can increase the risk of blood clots, specifically deep vein thrombosis, or DVT. Due to these factors, it is recommended that combined hormonal birth control methods not be started until at least 3 weeks post birth and in some cases, not until 4-6 weeks post birth. By this time the milk supply should be well established and any potential impact on supply should be minimal.
It should be noted that
individuals who are over 35 years old and smoke are discouraged from their use. If you have a history of heart attack, stroke, migraine headaches, or deep vein thrombosis your provider may recommend that you avoid this method of birth control.

The “mini pill”

A progestin-only pill, this is often the most prescribed (and preferred) for parents that choose to breastfeed. The mini pill works by preventing fertilization of the egg by the sperm. It must be taken at the exact same time every day. If the pill is taken more than three hours later than the usual time, a backup method must be used for the following 2 days. The progestin-only pill is not recommended if you have a personal or family history of breast cancer.

The Implant

This is a thin and flexible rod that is inserted under the skin of the upper arm. Much like the patch or the vaginal ring, the implant delivers a continuous dose of the hormone progestin to your body and prevents ovulation and the sperm from reaching the egg by thickening the cervical mucus. This can be placed immediately after birth before hospital discharge or at the postpartum visit. It is also considered an effective long-term birth control option and is effective for three years. After three years the old implant is removed and a new implant is inserted.

One may experience intermittent bleeding, and for some individuals their periods may become lighter or heavier, last longer, become more infrequent, or experience bleeding in between periods, known as breakthrough bleeding. For some individuals, side effects may include acne, mood changes, depression, and headaches.

The “shot”

The birth control injection is a progestin-only form of birth control that is given once every three months by your healthcare provider. The injection works by preventing ovulation and is typically given in the upper arm or butt cheek.

One of the benefits of the injection is that it can be given immediately after birth, before hospital discharge. The birth control injection may also reduce the severity of menstrual cramps and result in lighter or no periods.

Possible risks of the injection may include bone loss, breakthrough bleeding, weight gain, and tenderness of the breasts.

There is a chance that the birth control injection may reduce breastmilk supply, so it is recommended that those who intend to breastfeed wait until 4-6 weeks post birth to receive the injection.

Stay tuned for Part 2….

Our next part in this series will focus on barrier methods such as condoms and cervical caps. We hope that you’ll follow along with us to gain some insight as you make the best decisions regarding family planning.

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