Post birth contraception

We offer a wide choice of contraceptive options after the birth of your baby. A space of one year or more between birth and your next pregnancy is recommended, as evidence suggests it improves health outcomes for you and your children. Most importantly, it empowers you to take control of your own fertility and decide when you are ready to have your next child. We recognise that becoming a new parent is an exciting and extremely busy time in your life and would like to help by providing contraception before your discharge home. The following information provides you with an outline of the options available, all are safe to use while you are breastfeeding and will not affect your milk supply. 

Remember that these methods will not protect you from sexually transmitted infections. You should always consider using condoms to help protect against sexually transmitted infections. 

Intrauterine contraception (IUC) 

This is a device or coil which is inserted into your uterine cavity after your baby is born. IUC is a form of long-acting reversible contraception. There two types—hormonal and non-hormonal—and have a failure rate of less than 0.6%. We are able to offer IUC at elective caesarean section and hope to be able to offer it after vaginal birth in the future. 

The hormone releasing IUC contains progestogen which is similar to the natural progesterone produced by your ovaries and works for 5 years. It works by thinning the lining of the uterus so that a fertilised egg is very unlikely to implant and it also thickens cervical mucus making it difficult for sperm to enter the uterus. 

The non-hormonal IUC prevents fertilisation as the copper on the device is toxic to sperm and works for 5–10 years depending on the type. 

Advantages of IUC

  • It works instantly if inserted at birth. Both devices are more than 99% effective, with fewer than 1 woman in 100 becoming pregnant in a year  
  • Fertility returns to normal as soon as the IUC is removed 
  • It is not affected by other medicines 
  • Hormonal IUCs can make periods lighter or sometimes stop 

Disadvantages of IUC 

  • Non-hormonal (copper) IUC may make periods heavier, longer or more painful—this may settle after a few months 
  • Some women with hormonal IUC report having acne, headaches, and breast tenderness  
  • Some women develop small fluid-filled cysts on their ovaries which may cause pain but are not dangerous and do not usually need treatment 
  • The IUC does not increase your risk of infection, but if you do acquire an infection with the IUC in place, it could lead to a pelvic infection if not treated 

Risks of IUC 

  • There is a small chance of having an infection during the first 20 days after IUC insertion 
  • The IUC can be pushed out of your womb (expelled) or it can move (displacement)—this is not common and occurs in approx 5% of women 
  • If you do become pregnant while using an IUC the likelihood of it being ectopic is greater than if a pregnancy were to occur without an IUC—however, overall, the risk of ectopic pregnancy is small because they are so effective at preventing a pregnancy 

How will IUC affect my periods? 

With the hormonal IUC it is common to have extra bleeding or spotting during the first six months. Periods become shorter and lighter and may stop altogether, this is not harmful. 

With the non-hormonal (copper) IUC, irregular bleeding is common during the first six months. In some women periods become heavier, longer, and sometimes more painful. There are medications which can be used to control bleeding. 

How will I know if IUC is in place? 

The IUC has threads which hang a short distance through the cervix into the top of the vagina. You will be referred to a community service at 6 weeks to have the threads trimmed if needed, and to check that the IUC still remains in place. If you cannot feel the threads or think you can feel the IUC then you should use condoms until your GP or community sexual health service has examined you. 

What if I become pregnant while using an IUC? 

Very few women become pregnant while using an IUC. If you think you might be pregnant or have unusual abdominal pain you should seek medical help as soon as possible. 

Where can you have an IUC inserted? 

If you are having an elective caesarean section you can have an IUC fitted at the time—please let your midwife or doctor know if you would like this arranged. 

If you choose to wait to have an IUC inserted, you can do this from four weeks after the birth with your GP or local community sexual health service. 

When can an IUC be removed? 

An IUC can be removed at any time by a doctor or nurse pulling gently on the threads. This service may be available at your GP surgery or at local community sexual health service.

Progestogen-only implant 

The progestogen-only implant is a method of long-acting reversible contraception. It is highly effective with a failure rate of 0.05% (1 in 2,000) and lasts for 3 years. The implant is a small, flexible rod (no larger than a matchstick), which is placed just under your skin in the upper arm. It releases progestogen hormone similar to the natural progesterone produced by your ovaries. 

How does the implant work? 

The main way it works is to stop your ovaries releasing an egg each month. It also thickens cervical mucus making it more difficult for sperm to penetrate and makes the lining of your uterus thinner, so it is less likely to accept a fertilised egg. 

Can anyone use the implant? 

Most women can have the implant fitted. A midwife or doctor will ask you about your medical history to make sure that the implant is suitable. An implant may not be suitable for you if you take certain medications, have current or previous breast cancer or have liver disease. 

Advantages of the implant 

  • It does not interfere with breastfeeding 
  • It can be inserted as soon as your baby is born 
  • It lasts for three years 
  • As soon as the implant is taken out you will be able to get pregnant again 
  • It may reduce heavy or painful periods 

Disadvantages of the implant 

  • You may have irregular bleeding 
  • You may have temporary side effects such as headaches, breast tenderness and mood changes—these should stop within a few months 

How is the implant inserted? 

The implant is placed under your skin in the inner area of your upper arm. You will be given a local anaesthetic to numb the area before it is inserted. The procedure only takes a few minutes and you will not need any stitches. After it has been inserted you will be shown how to check it is in position. Occasionally, you may notice redness or bruising of the skin in your arm, where your implant is inserted, which usually settles within a week. You will be asked to leave a skin plaster on for at least 24 hours to help reduce the bruising. No routine follow-up is required, however if you have any concerns consult your GP or local community sexual health service for further advice. 

How will an implant affect my menstrual periods? 

Your periods will probably change, you may: 

  • No longer have periods (1 in 5 women) 
  • Have infrequent bleeding (1 in 3 women) 
  • Have regular bleeds (1 in 4 women)
  • Have prolonged or frequent bleeding (1 in 4 women) 

These changes are not harmful and may or may not settle within a few months. 

Where can you have the implant inserted? 

On the postnatal ward or birth centre—please let your midwife or doctor know if you would like this arranged. Or at your GP or local community sexual health service. 

When can the implant be removed? 

You can have the implant removed at any time. This can be done at your GP practice or community sexual health service. After removal, there is no delay in return to fertility.

Progestogen-only injection (POI)

A POI contains a form of progestogen similar to the natural progesterone produced by the ovaries. There are 3 forms of the injection. This following information is about the most widely used—Depo-Provera®—which needs to be administered every 13 weeks. 

How does the injection work? 

The main way it works is to stop your ovaries releasing an egg each month. It also thickens cervical mucus making it more difficult for sperm to penetrate and makes the lining of your uterus thinner, so it is less likely to accept a fertilised egg. 

Can anyone use the POI? 

Most women can use the POI—your midwife or doctor will ask you about your medical history to ensure you are suitable. An injection may not be suitable for you if you have liver disease, current or previous breast cancer, arterial disease, history of serious heart disease or stroke. 

How soon after delivery can I start using the POI? 

You can start using the POI immediately after the birth of your baby and before you leave the maternity unit or birth centre. 

How effective is the POI? 

If you have the injection every 13 weeks it is more than 99% effective. This means that fewer than 1 woman in 100 will become pregnant. If the next injection is delayed, about 6 in 100 women will become pregnant. 

Advantages of the POI 

  • It can be administered immediately after the birth of your baby 
  • It is safe to use during breastfeeding 
  • You do not have to think about contraception for as long as the injection lasts 
  • It is not affected by other medicines 
  • For some women, it may reduce heavy painful periods and help with premenstrual symptoms 

Disadvantages of the POI 

There are no serious side-effects with the contraceptive injection, however women may experience: 

  • Irregular bleeding—a majority of women will experience lighter bleeding, or it may stop altogether, and this may continue for some months after you stop using the injection 
  • Some women experience weight gain (<10%) 
  • There can be a delay of up to one year before the return of your periods and fertility, however this varies greatly between women 

Risks of the POI 

  • As with any injection, there is a small risk of irritation at the injection site 
  • You can have an allergic reaction to the injection, but this is very rare 
  • Prolonged use may lead to some thinning of your bones—this is not normally a problem, but if you have a risk factors for osteoporosis, it is advisable to use an alternative method of contraception 

How is the POI given? 

You need to have an injection of Depo-Provera® once every 13 weeks—it is injected into muscle, usually in your buttocks. 

Where can you get the contraceptive injection?  

You can be given the injection before you leave the unit and will need to arrange your next injection at 13 weeks with your GP or community sexual health service. 

Progestogen-only pill (POP) 

The POP is a tablet containing the hormone progestogen. This is similar to the natural progesterone produced by the ovaries. The following information is about the POP containing a progestogen called Desogestrel which is the most effective POP. 

How does the POP work? 

The main way it works is to stop your ovaries releasing an egg each month. It also thickens cervical mucus making it more difficult for sperm to penetrate and makes the lining of your uterus thinner, so it is less likely to accept a fertilised egg. 

Can anyone use the POP? 

Most women can use the POP. The midwife or doctor will ask about your medical history to ensure that you are suitable. The POP may not be suitable for you if you take certain medications, have current or previous breast cancer or have liver disease. It is not suitable if you have a soya or peanut allergy. 

How soon after delivery can I start the POP? 

You can start taking the POP immediately after the delivery of your baby and before you leave the maternity unit or birth centre. If you delay, pills should be started before the baby is 21 days old. 

How effective is the POP? 

The effectiveness of the POP depends on how well you follow the instructions. If the POP is taken perfectly then it is more than 99% effective, with fewer than 1 in 100 women getting pregnant in one year. If the POP is not always taken according to instructions, this changes to 9 in 100 women. 

Advantages of the POP 

  • It can be started any time after the birth of your baby 
  • It is safe to use during breastfeeding 
  • It can be stopped at any time and your fertility will return to normal straight away 
  • It may help with premenstrual symptoms and painful periods 

Disadvantages of the POP 

There are no serious side-effects with the POP, but: 

  • More than half of women using POP will notice a change in bleeding pattern—bleeding may become irregular, light, more frequent, last longer or stop altogether,  this may settle down and is not harmful 
  • You need to remember to take the pill around the same time every day 
  • You may get some side-effects such as spotty skin, breast tenderness and headaches—these may settle within a few months

Risks of the POP

The POP is very safe. Infrequent risks include: 

  • Developing small, fluid-filled cysts on the ovaries which are not dangerous and do not usually need to be treated (occurs in up to 1% of women) 
  • If you become pregnant while taking the POP, there is a small risk (10%) that the pregnancy will be in the tube (ectopic pregnancy)  

How do I take the POP? 

You should take one tablet daily around the same time every day. It is best to attach pill taking to an activity that you do at the same time each day to prompt you to remember it. There are 28 pills in a packet and after finishing a pack you should move straight onto the next pack. Do not take breaks. 

What do I do if I forget to take it on time or miss a pill? 

If you are less than 12 hours late:

  • Take the pill as soon as you remember
  • Take your next pill at the normal time and you will still be protected from pregnancy 

If you are more than 12 hours late:

  • You should restart your pills as soon as you remember and use a condom or abstain from sex or for 48 hours
  • If you have had unprotected sex during this time you should talk to your pharmacist/GP/community sexual health service about emergency contraception 

What should I do if I am sick or have diarrhoea? 

If you vomit within 2 hours of taking the POP, it will not have been absorbed, so take another pill as soon as you can. Use additional precautions during and for 48 hours after sickness or diarrhoea has stopped. 

Where can I get the POP? 

On the postnatal ward or birth centre—please let your midwife or doctor know. You will be given a 6-month supply on discharge and further supplies can be obtained from your GP or local community sexual health service. 

Contributors
George Vasilopoulos