Contraception après avoir eu un bébé

When can I start using contraception after giving birth?

Contraception after birth should be discussed during your pregnancy and again soon after giving birth. If you do not wish to become pregnant again, contraception will be needed after your baby reaches the age of 21 days. There are many choices available for women; your healthcare professional will help you to make the right choice for you, depending on individual factors such as your health and whether you want to have more children in the future.

The time for fertility to return is very variable between women. It is important not to take any risks, if you do not want to become pregnant again. Therefore, you should decide on the type of contraception you are going to use as soon as possible after birth, or even during your pregnancy - your midwife can discuss this with you. You will need contraception from 21 days after your baby is born.

Your periods usually return about four to ten weeks after your baby's birth if you are bottle-feeding, or combining breast and bottle. If you are breastfeeding then your periods may not start until much later. For some women this might be after you have stopped breastfeeding.

You can have sex as soon as you and your partner feel ready to. Some people find it takes a while to feel ready, both physically and emotionally. If you have had stitches, these are usually dissolvable so will not need removing. If you are having any discomfort from these then you should see your doctor or midwife. Some women find they need to use some vaginal lubricant if they feel more dry than normal.

If you had your baby in hospital, you might have discussed contraception with your midwife before you were discharged home. You will also be asked about contraception at your six-week (or eight-week) postnatal check. You can discuss it at any time with your health visitor, midwife, doctor or local family planning clinic. In some areas, the clinics that used to be called 'family planning' are now called 'CaSH' (contraception and sexual health). A woman's postnatal check at the GP surgery is often done at six weeks after birth, but it is fine to contact your doctor, or a CaSH clinic, earlier than that to arrange contraception if you need it.

When you breastfeed, a hormone called prolactin is produced by your body, which stimulates the production of your milk. Prolactin also blocks the release of the hormones which make you produce an egg. This means that you are less likely to become pregnant whilst you are breastfeeding.

You can use breastfeeding (the lactation amenorrhoea method) for contraception if you are:

• Fully breastfeeding, meaning:

  • Your baby is not having any solids or any other liquid; ou

  • You are nearly fully breastfeeding - you are mainly breastfeeding and only giving your baby other liquids very infrequently.

  • You are feeding at least every four hours during the day and at least every six hours at night;

• AND not having periods.

• AND six months or less since having your baby.

Fewer than 2 women in every 100 using this will become pregnant within those six months. This is less reliable than some other methods - for example, the implant for which only one woman in every 2,000 will become pregnant per year. This method becomes even less reliable once you start dropping feeds, particularly night feeds. When you stop fully (or nearly fully) breastfeeding, you can become pregnant. Many women decide to use some contraception in addition to breastfeeding, to reduce their risk of an unplanned pregnancy. There are methods available that will not affect your ability to produce milk.

All the methods of contraception listed below are effective but none is 100% reliable. Reliability of each method is written in terms of how many failures there are for each 1,000 women using it. For example, between 2 and 60 women in 1,000 women using the contraceptive injection for a year will become pregnant. When no contraception is used, more than 800 in 1,000 sexually active women become pregnant within one year.

The effectiveness of some methods depends on how you use them. You have to use them properly or they are less effective. For example, 3 women in 1,000 using the 'pill' perfectly for a year will become pregnant. Nearer to 90 women in 1,000 using the pill normally or typically (that is, pas perfect usage) will become pregnant. Examples of 'not perfect use' might be missing a pill or being sick (vomiting). In these situations it becomes less effective. Other 'user-dependent' methods include barrier methods, the progestogen-only pill (POP) and natural family planning, which has a very high failure rate of around 240 women in 1,000.

Some methods are not so 'user-dependent' and need to be renewed less frequently. These methods include the contraceptive injection, contraceptive implant, intrauterine contraceptive devices (IUCDs), and sterilisation.

When you choose a method of contraception after birth you need to think about:

• Quelle est son efficacité.

• Risques et effets secondaires possibles.

• Plans pour les futures grossesses.

• Préférence personnelle.

• Whether or not you are breastfeeding.

• If you have a medical condition, or take medicines that interact with the method.

The types of contraception after birth can be divided into short-acting, long-acting and permanent. If you are planning on having another baby in the next year or so then you should consider a short-acting contraceptive.

See the separate leaflets on each method for more details.

Combined oral contraceptive (COC) pill

The COC is often just called 'the pill'. It can be started from 21 days after the birth if you are not breastfeeding, although a woman who starts at three weeks is at a slightly higher risk of blood clots than one starting at six weeks. Previous guidance stated that you should not use combined hormonal contraceptive (CHC) methods until your baby is 6 months old, if you are breastfeeding. This was because it was thought to affect your milk supply. Research has shown this is not the case; breastfeeding women can now start any method of CHC at six weeks. Generally, if you wish to use CHC methods such as the pill, patch or vaginal ring, the benefits to you will outweigh the risks. This is however not the case for some women - for example, those with a strong family history of blood clots, or who have a particular type of migraine called migraine with aura. Your healthcare professional can assess your individual risk and advise you on whether it is safe to use CHC; if you have other risk factors, they may suggest that you wait until six weeks, even if you are not breastfeeding.

Progestogen-only pill (POP)

The POP used to be called the 'mini-pill'. It is commonly taken, especially if CHC methods are not suitable, such as in breastfeeding women if their baby is less than 6 weeks old, smokers over the age of 35 and some women with migraine.

The POP can be started immediately after the birth. It is safe for women who are 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.

Patch contraceptif

This contains the same hormones as the COC, but in patch form. It is as effective as the COC pill at preventing pregnancy. It can be started from 21 days after the birth if you are bottle-feeding, although this carries a slightly higher risk of blood clots than starting at six weeks. It may be used after six weeks when you are breastfeeding, as the benefits generally outweigh the risks.

The contraceptive vaginal ring

La anneau vaginal contraceptif is a flexible plastic ring which you put into your vagina. It contains similar hormones to those in the COC pill. It can be used from 21 days after your baby is born if you are bottle-feeding although this carries a slightly higher risk of blood clots than starting at six weeks. You may be able to use this method after six weeks if you are breastfeeding, as the benefits generally outweigh the risks.

Méthodes barrières

These include les préservatifs masculins, the préservatif féminin, diaphragms and caps. They prevent sperm entering the womb (uterus). You can use male and female condoms as soon as you feel ready to have sex after your baby is born. If you are concerned about sexually transmitted infections then it is always sensible to use a barrier method as well as any hormonal contraception.

Natural family planning involves fertility awareness. There is a great variation in how effective it is because it depends on the user doing it right; it generally has a high failure rate and is not recommended. There are various apps that can be used to assist with natural family planning.

These are more suitable forms of contraception for women who do not want to get pregnant again or for a few years.

Injection contraceptive

La injection contraceptive contains a progestogen hormone which slowly releases into the body. It is very effective and can be started immediately after the birth.

Implant contraceptif

La contraceptive implant is a small device placed under the skin. Each implant lasts three years. The implant can be inserted immediately after the birth of your baby.

Intrauterine contraceptive device (IUCD)

The IUCD is a small device made of plastic and copper which is put into the womb. It lasts 5-10 years, depending on the type. An IUCD can be inserted in the first two days after giving birth, or four weeks after giving birth. The risks of inserting one between two days and four weeks after giving birth generally outweigh the benefits. It can be inserted in the delivery room after a normal delivery, or in the operating theatre after a caesarean section.

Levonorgestrel intrauterine device (LNG-IUD)

La dispositif intra-utérin au lévonorgestrel (DIU-LNG) is a plastic device that contains a progestogen hormone. It was previously called the intrauterine system (IUS) and that term might still be used in some leaflets or websites. It is put into the womb, and lasts for either three, five or eight years, depending on the dose of hormone and the brand used. A LNG-IUD can be inserted in the first two days after giving birth, or four weeks after giving birth. The risks of inserting one between two days and four weeks after giving birth generally outweigh the benefits. It can be inserted in the delivery room after a normal delivery, or in the operating theatre after a caesarean section.

This involves an operation. It is very effective but this can vary from surgeon to surgeon. Male sterilisation (vasectomy) stops sperm travelling from the testes. Stérilisation féminine prevents the egg from travelling along the Fallopian tubes to meet a sperm. These methods are often used when your family is complete. You should be sure of your decision, as they are difficult to reverse and the NHS will not usually fund reversal. The failure rate of female sterilisation is 5 per 1,000 per year and the failure rate of male sterilisation is 1.5 per 1,000 per year.

If you have your baby by caesarean section, the surgeon may sometimes sterilise you at the same time. This is only done if you are very sure of your decision. Or you can return later when you and your partner have decided. Sterilisation at the time of caesarean section carries a slightly higher risk of failure than sterilisation at any other time.

Contraception d'urgence can be used at any time if you had sex without using contraception. Also, if you had sex but there was a mistake with contraception. For example, a split condom or if you missed taking your usual contraceptive pills.

There are two types of emergency contraception:

• An IUCD - inserted by a doctor or nurse, this can be used for emergency contraception up to five days after unprotected sex, or up to five days after the likely date of making an egg (ovulation) if you are sure of your cycle dates. It can be used from four weeks after the birth of your baby. This is the most effective method of emergency contraception. It has to be the copper intrauterine device, not the LNG-IUD.

• Emergency contraception pills. An emergency contraception pill works either by preventing or postponing ovulation or by preventing the fertilised egg from settling in the womb (uterus). They can be used at any time after the birth of your baby. You take it as one single pill. There are two types of emergency contraceptive pills:

  • Levonelle® must be used within 72 hours (three days) of unprotected sex. It can be used when you are breastfeeding. It can be bought at pharmacies or prescribed by a doctor.

  • EllaOne® can be used up to 120 hours (five days) after having unprotected sex. You should not breastfeed for a week after using ellaOne®. It can be prescribed by your doctor or at a family planning clinic. You must not start any other form of hormonal contraception within five days of taking EllaOne®, or the EllaOne® is more likely to fail. It may also fail if you have taken hormones within the seven days beforehand, so it may not be the best method if you need emergency contraception because you have missed some pills, but taken others.

You will not need emergency contraception if you have unprotected sex within 21 days of having your baby. You cannot get pregnant so soon after childbirth.