When can a woman start birth control after giving birth?

When to Start Birth Control After Giving Birth

Women can start progestin-only contraceptives immediately after birth, while combined hormonal contraceptives should be delayed until at least 21 days postpartum in non-breastfeeding women and 6 weeks postpartum in breastfeeding women. 1, 2

Timing Based on Breastfeeding Status

For Breastfeeding Women:

1. Progestin-Only Methods (Safe for immediate use):

   • Progestin-only pills (POPs) can be started immediately postpartum 1
   • Implants can be inserted at any time postpartum 1, 2
   • No backup contraception needed if started within 6 months postpartum while fully or nearly fully breastfeeding and amenorrheic 1
   • Ideally started at 6 weeks postpartum to decrease infant exposure to hormones while still maintaining contraceptive protection through lactational amenorrhea 2, 3

2. Combined Hormonal Contraceptives:

   • Should be avoided until at least 6 weeks postpartum 2, 4
   • May reduce milk production 2, 3

3. Intrauterine Devices (IUDs):

   • Can be inserted immediately postpartum (within 10 minutes of placenta delivery) or after 4-6 weeks 2
   • Breastfeeding is not associated with increased IUD expulsion 5

4. Lactational Amenorrhea Method (LAM):

   • Effective for up to 6 months if:
     • Woman is exclusively or nearly exclusively breastfeeding (≥85% of feeds)
     • Has not had return of menses
     • Baby is less than 6 months old 1, 2

For Non-Breastfeeding Women:

1. Progestin-Only Methods:

   • Can be started immediately postpartum 1, 4
   • If started ≥21 days postpartum and no menstrual cycles have returned, use backup contraception for 2 days 1

2. Combined Hormonal Contraceptives:

   • Should be avoided for the first 21 days postpartum due to increased thromboembolism risk 1, 4
   • From 21-42 days postpartum, use should be based on individual venous thromboembolism risk factors 4
   • After 42 days, no restrictions for otherwise healthy women 4
   • Requires 7 days of backup contraception if started >5 days after menses begin 1

3. Intrauterine Devices:

   • Can be inserted immediately postpartum or after 4 weeks 2

Important Considerations

1. Return of Fertility:

   • Ovulation can resume as early as 21 days postpartum in non-breastfeeding women 6
   • For maximum protection, non-breastfeeding women should be protected from the fourth week postpartum 5

2. Thromboembolism Risk:

   • All women should avoid estrogen-containing methods for 2-3 weeks postpartum to avoid elevated thromboembolism risk 5, 4
   • Women with additional risk factors for thromboembolism should be especially cautious with combined hormonal methods 2

3. Contraceptive Effectiveness:

   • Progestin-only methods have failure rates <1% with perfect use 2
   • Combined hormonal methods have failure rates of 0.3% with perfect use and 7% with typical use 2

4. Backup Contraception Requirements:

   • For POPs: 2 days of backup if started >5 days after menses begin 1
   • For implants/combined hormonal methods: 7 days of backup if started >5 days after menses begin 1

Practical Approach

1. Before discharge from hospital:

   • Discuss contraceptive options during pregnancy so preferred method can be provided immediately after delivery 6
   • Consider immediate postpartum LARC (long-acting reversible contraception) placement if appropriate 6

2. For temporary contraception until preferred method is available:

   • Use condoms or spermicides if needed 5

3. Ensure reasonable certainty woman is not pregnant before starting contraception by confirming she is within 4 weeks postpartum 1

Remember that contraceptive choice is a personal healthcare decision, and women should be provided with comprehensive information about all suitable options based on their breastfeeding status and medical history 2.