After you have your baby, there are several options for contraception. You can choose any or none of these! Your midwife will discuss your options with you in the antenatal period, and confirm your preferences postnatally.
If you have a caesarean birth, contraception is recommended as an interpregnancy interval (time between the end of one pregnancy and the beginning of the next) of at least eighteen months is recommended by RANZCOG (Royal Australian and New Zealand College of Obstetricians and Gynaecologists).
Contraception is offered postnatally as it is very easy to become pregnant unintentionally after birth. Fertility can return before your period returns, and interpregnancy intervals of less than twelve months can increase your risk of preterm birth and low birth weight babies. Breastfeeding provides some contraceptive benefits, but this is not a reliable method of preventing pregnancy.
Options for Contraception
This is a pair of rods inserted into your upper arm which release a substance similar to progesterone slowly over 4-5 years. It is very effective at preventing pregnancy and can be inserted straight after birth if there is someone available to do so, or during your postnatal stay if you have one. They can be removed when you are ready to try for another baby, and fertility usually returns quickly (within 1-3 weeks). The contraceptive implant is likely to change your menstrual bleeding (periods) in unpredictable ways, you may bleed more or less than you used to, or not at all.
Depo-Provera is an injection of a substance similar to progesterone which releases slowly over 13 weeks. It is very effective at preventing pregnancy and can be given straight after birth, which your midwife can do, or can be started in the immediate postnatal period. It must be repeated every 13 weeks to continue to give protection, and while your fertility can return straight away, most people find that it takes 6-12 months after a Depo-Provera injection for their fertility to return. It can cause irregular or no menstrual bleeding (periods), or occasionally very heavy menstrual bleeding.
Condoms, when used correctly, are a safe and affordable option – your midwife can prescribe these for you. Condoms need to be used correctly every time to prevent pregnancy. They are the only option on this list that can prevent the spread of sexually transmitted infections.
Progestogen-only pills are also known as the mini-pill. They need to be taken around the same time each day to work effectively. They can be started immediately after birth.
In the first 21 days after pregnancy, these are not needed as getting pregnant in this time is extremely unlikely. After this, if you have unprotected sex, you can use ECPs within 3 days to help prevent unintended pregnancy. If you weigh more than 70kg, then you will need a double dose of ECPs
Copper IUDs or hormonal IUSs can be placed straight after birth, but there is a slightly higher chance of them coming out at this time. It is more common to have them placed 4-6 weeks after birth. Depending on the IUD/IUS, it will last 3-10 years and can be taken out at any time. Fertility usually returns almost immediately after copper IUD removal, and within a few weeks after hormonal IUS removal.
These pills contain both progesterone- and oestrogen-like substances. These have more contraindications than mini-pills and are not recommended during breastfeeding as they can lower your milk supply. If you are not breastfeeding, they can be started 21 days after birth if they are your preference. Many midwives do not prescribe combined oral contraceptives.