Is breastfeeding an effective contraceptive?

Have you recently given birth, and considering your contraception options? Find out whether breastfeeding may help – and if not, what will.

After giving birth, contraception may not be at the forefront of your mind. However, you can get pregnant again as little as 21 days after having your baby, therefore, it’s wise to plan what form of contraception you want to use.

There are many options out there for new mums, popular choices tend to be the contraceptive pill or barrier methods like condoms. However there is another natural method that many aren’t aware of – breastfeeding. 

LloydsPharmacy Online Doctor conducted a survey of 500 British women and found that almost half (49%) were not aware that breastfeeding was a contraceptive option for new mums. 

The survey also found that over three quarters (85%) of women would not feel comfortable using breastfeeding as their only form of contraception. 

Dr Bhavini Shah from LloydsPharmacy Online Doctor outlines the different options available to new mothers and answers common questions about postpartum contraception. 

Is breastfeeding an effective contraceptive?

While breastfeeding, your body generates a hormone called prolactin, stimulating milk production. Prolactin also inhibits the release of hormones responsible for triggering egg production (ovulation). 

As a result, the likelihood of falling pregnant is reduced during the breastfeeding period. This is known as lactational amenorrhoea (LAM) and it can be used as a contraceptive method for up to six months after giving birth. However you must be fully breastfeeding and not have started having periods again.

Breastfeeding alone is not a long-term contraceptive option and does not provide complete protection against pregnancy so it’s advisable to consider other birth control options, especially after your baby is six months old.

When can you start using the contraceptive pill after birth? 

After having a baby, it’s possible to become pregnant even before your period has started again so it’s advised that you begin contraception in the first three weeks. Your first postpartum period can arrive within four to ten weeks if you are bottle-feeding. If you are breastfeeding, it can be much later on.

It is advised that you can start the progesterone-only pill any time after birth however you can only begin the combined pill from three weeks after birth if you are not breastfeeding, or six weeks if you are.

The time it takes for fertility to return varies between women. However, it’s important not to take any risks if you don’t want to become pregnant again. You should speak with your midwife during your pregnancy or just after about the options available.

What are your options?

There are two main types of contraceptive pill: the combined pill and the progestogen-only pill (also known as the mini pill).

The progestogen-only pill contains only progestogen and no oestrogen. It works by thickening cervical mucus, making it harder for sperm to reach the egg, and sometimes by thinning the lining of the uterus, which can make it less receptive to a fertilised egg.

Progestogen-only pills are often recommended for women who can’t take oestrogen or have certain health conditions that may be aggravated by oestrogen. 

The combined pill contains synthetic versions of two hormones: oestrogen, and progesterone. There are various combinations and doses available, but they generally work by preventing ovulation (the release of an egg) and thickening cervical mucus, making it difficult for sperm to reach the egg.

Three benefits of taking the progestogen-only pill 

Choosing the progestogen-only pill, also known as the mini pill, after giving birth can be the preferred option for several reasons.

1) It has less impact on breastfeeding

Progestogen-only pills are often recommended for breastfeeding mothers. They don’t contain oestrogen, which was thought to interfere with milk production.

Although these pills are considered safer during breastfeeding compared to the combined pill, change to evidence suggests that progesterone only methods have no adverse effects on breastfeeding. Studies have shown that a very small amount of the hormone can be present in breast milk but that it does the baby no harm.

2) It has fewer side effects

Some women may be sensitive to oestrogen or have conditions that make them more prone to side effects from oestrogen-containing contraceptives. Progestogen-only pills offer an alternative without oestrogen.

3) A lower risk of blood clots

Especially in the immediate postpartum period, progestogen-only pills might be recommended due to their lower risk of blood clots. This consideration is particularly important in the weeks following childbirth, where the risk of blood clots is higher.

Three reasons why the combined pill may be a better option

For some women, the combined pill might be more suitable. You can start 21 days after the birth if you are not breastfeeding, although a woman who starts at three weeks may be at higher risk of blood clots than one who starts at six weeks. 

Your healthcare professional can assess your individual risk and advise on whether you are suitable for Combined Hormonal Contraceptives. You may prefer to take the combined pill for the following reasons.

1) You are not breastfeeding

If you do not plan to breastfeed or have stopped breastfeeding, the combination pill might be a viable option.

2) You want to regulate your periods 

You may prefer the regularity that combination pills offer in terms of menstrual cycles. They can help regulate periods and provide more predictable bleeding patterns after childbirth.

3) You want a pill you’ve tried before

If you have been on a particular type of combination pill before pregnancy and found it effective with minimal side effects, you might want to continue with the same pill postpartum.

Ultimately, the decision should be made by discussing options with your midwife or GP who can consider individual health factors, medical history, lifestyle, and postpartum plans to determine the most appropriate contraceptive option after childbirth.

When can you have sex after giving birth? 

The timing for resuming sexual activity after giving birth varies from person to person and can depend on factors like the type of delivery, physical recovery, and personal comfort. However, there are no rules and the decision is up to you and when you feel comfortable.

It can help to talk to your partner or a healthcare professional such as a nurse, doctor or health visitor about any concerns or questions you have.

Author: Dr Bhavini Shah from LloydsPharmacy Online Doctor