Birth Control While Breastfeeding
Though breastfeeding itself is a form of reliable contraception, there are women who cannot or do not want to depend on this method alone. When combining contraception with breastfeeding there are many factors to take into consideration.
Natural Family Planning
Your milk supply depends on the right balance of hormones in your body. For this reason, non-hormonal methods of birth control are preferable while breastfeeding. For the first six months of breastfeeding, most women can depend on the LAM method. Once the LAM method is no longer applicable, you may switch to one of the other forms of natural family planning. Studies found that breastfeeding mothers using natural family planning instead of LAM misinterpreted many non-fertile days as fertile resulting in more days of abstinence than necessary. It is best to use only LAM as long as it is applicable and another method of natural family planning when your fertility returns.
Barrier methods are compatible with breastfeeding. However, since breastfeeding lowers the level of estrogen in our bodies causing vaginal dryness, barrier methods may be irritating or difficult to use without a lubricant.
Though slight amounts of spermicide may be absorbed into your blood and your milk, it will not harm your baby. Use of spermicide is considered compatible with breastfeeding and work as a lubricant as well.
Non-hormonal IUDs are compatible with breastfeeding. The Mirena/Progestasert IUD contains progesterone. Though progesterone is usually compatible with breastfeeding, in some cases progesterone causes a decrease in milk supply. If this happens, you will have to have the IUD removed.
Progesterone-Only Methods of Birth Control
Though some progesterone passes into your milk, the American Association of Pediatrics (AAP) has approved the use of progesterone in breastfeeding mothers. There are several kinds of progesterone-only contraceptives including the progesterone- IUDs, the mini-pill, monthly shots (Depo-Provera), progesterone releasing vaginal rings, and implants (Norvo). The progesterone containing IUD releases less progesterone into the blood stream than these other methods. As mentioned above, some women's milk supplies are negatively affected by progesterone. You may want to try the mini pill for a month to see if progesterone affects your supply before using something long lasting. If your supply drops, you can simply stop using the pills instead of struggling for months with a low supply caused by an injection or having to have your IUD removed.
Methods Containing Estrogen
Estrogen has been found to decrease milk supply and breastfeeding duration. Estrogen is found in combination contraception that combines estrogen and progesterone, including combination birth control pills, monthly injections (Lunelle), the birth control patch (Ortho-Evra), and the vaginal ring (NuvaRing). Since it known to decrease milk supply, women who want to use this method should wait until their babies are at least 6 months old and already eating solids. A trial period with birth control pills is recommended before using something long term.
Tubal ligation is compatible with breastfeeding. Tubal ligations performed immediately after birth may interfere with the early initiation of breastfeeding while the mother recovers from the effects of anesthesia and pain from the surgery. On the other hand, a vasectomy will not have any affect on breastfeeding.