New mothers may have concerns about contraception after childbirth. Generally, doctors recommend exclusive breastfeeding (where the baby consumes only breast milk) for the first six months, which can provide a natural contraceptive effect of about 90-95% during this period. However, if mothers seek more reliable contraception methods that do not affect breastfeeding, several options are available:
Contraceptive Methods That Do Not Affect Milk Supply While Breastfeeding
Condoms:
Ideal for those who prefer to avoid hormones, engage in infrequent sexual activity, and need short-term contraception.
Progestin-Only Pill:
This hormonal contraceptive can be taken during breastfeeding without affecting milk supply, and it may even help increase milk production. It is taken in the same manner as combination hormonal pills, but users may experience irregular bleeding, especially if doses are missed or taken at inconsistent times. Each pack contains 28 pills and it is recommended to start taking them between days 21-28 after childbirth. If started later, it is essential to use additional contraception, such as condoms, during the first seven days of use.
This type of contraceptive should not be used by individuals with liver disease, uncontrolled high blood pressure, or a history of acute blood clots.
Injectable Contraceptives (DMPA)
There are two types of DMPA injections:
- Three-Month Injection: Provides contraception for three months.
- One-Month Injection: Provides contraception for one month.
This type of contraceptive can be used during breastfeeding without affecting milk supply. Injections can be started as early as six weeks after childbirth or within seven days after the return of menstruation.
Advantages of Injectable Contraceptives:
No need to remember to take a daily pill.
Provides longer-lasting contraception compared to oral contraceptives.
Possible Side Effects:
Irregular bleeding may occur.
Long-term use may lead to amenorrhea (absence of menstruation).
Potential side effects include weight gain and skin changes (such as melasma). Long-term use may also increase levels of bad cholesterol and reduce bone density; however, bone density can return to normal after discontinuation.
Implant Contraceptives
Implant contraceptives consist of a single type of hormone, Progestin, and do not affect milk supply. There are two types of implants:
- Single Rod (Nexplanon): Provides contraception for three years.
- Two Rods (Jadelle): Provides contraception for five years.
Implants are placed just beneath the skin on the inner upper arm, slightly above the elbow. It is recommended to insert the implant within the first five days of the menstrual cycle or within six weeks after childbirth. If it is past six weeks postpartum and menstruation has not returned, the implant can still be placed, but a pregnancy test should be conducted first. After placement, additional contraceptive methods, such as condoms, should be used for the first seven days. While using implants, menstruation may continue, but the flow may decrease. When the effectiveness period ends, the implant must be removed.
Intrauterine Device (IUD)
Currently, there are two types of IUDs:
- Hormonal IUD (Levonorgestrel IUD): Provides contraception for five years.
- Copper IUD: Provides contraception for ten years.
The safe time frame for placing an IUD after childbirth is at least six weeks postpartum to allow the uterus to heal properly and reduce the risk of perforation. Common side effects of IUDs may include increased vaginal discharge, irregular bleeding between periods, and reduced menstrual flow. Importantly, IUDs do not affect milk supply.
