Birth Control Options for Breastfeeding Mothers
For breastfeeding mothers, progestin-only contraceptives and non-hormonal methods are the most suitable options, with long-acting reversible contraception (LARC) methods being the most effective choices. 1
Safe and Effective Options for Breastfeeding Mothers
Highly Recommended Options (Most Effective)
Copper IUD (Cu-IUD): Category 1 (no restriction) for breastfeeding women, can be inserted immediately postpartum or any time thereafter. Does not affect breastfeeding and provides up to 10 years of protection. 1
Levonorgestrel IUD (LNG-IUD): Category 2 (benefits outweigh risks) if inserted <1 month postpartum, Category 1 if ≥1 month postpartum. Provides 3-5 years of protection depending on the type. 1
Progestin Implant: Category 2 if <1 month postpartum, Category 1 if ≥1 month postpartum. Provides 3 years of protection with failure rates <1%. 1
Lactational Amenorrhea Method (LAM): Highly effective temporary method for the first 6 months postpartum if the mother is exclusively or nearly exclusively breastfeeding (≥85% of feeds), remains amenorrheic, and the baby is less than 6 months old. 1
Other Suitable Options
Progestin-Only Pills (POPs): Category 2 if <1 month postpartum, Category 1 if ≥1 month postpartum. Can be started immediately postpartum. 1
Depot Medroxyprogesterone Acetate (DMPA): Category 2 if <1 month postpartum, Category 1 if ≥1 month postpartum. 1
Barrier Methods: Condoms, diaphragms - safe for use while breastfeeding but have higher failure rates than hormonal and intrauterine methods. 1
Methods to Avoid or Use with Caution
- Combined Hormonal Contraceptives (pills, patch, ring): Category 4 (unacceptable health risk) if <1 month postpartum, Category 3 (risks usually outweigh benefits) if 1 month to <6 months postpartum while breastfeeding. May reduce milk production. 1
Timing of Contraception Initiation
Immediate Postpartum Period (<48 hours)
Copper IUD: Can be inserted immediately after delivery of placenta (within 10 minutes) in both vaginal and cesarean deliveries. Higher expulsion rates compared to interval insertion but better continuation rates. 1
LNG-IUD: Can be inserted immediately postpartum, though expulsion rates are higher than with interval insertion. 1
Implant: Can be inserted at any time during the delivery hospitalization. 1
Early Postpartum Period (>48 hours to <4 weeks)
Progestin-only methods (implant, POPs, DMPA): Can be initiated. 1
IUD insertion: Generally delayed until ≥4 weeks postpartum if not inserted immediately after delivery. 1
Later Postpartum Period (≥4 weeks)
- All contraceptive methods can be considered based on medical eligibility criteria, with progestin-only and non-hormonal methods preferred for breastfeeding women. 1
Special Considerations
No need for backup contraception if progestin-only methods are started while the woman is <6 months postpartum, amenorrheic, and fully or nearly fully breastfeeding. 1
IUDs are safe for nulliparous women and those who have never given birth before. 2
Copper IUDs are first-line for women with history of thromboembolism or coronary events. 3
Avoid IUD insertion in cases of active genital tract infection or unexplained vaginal bleeding. 3
Effectiveness Comparison
LARC methods (IUDs, implants): <1% failure rate with typical use. 1
DMPA: 6% failure rate with typical use. 1
POPs: 9% failure rate with typical use. 1
LAM: Highly effective if all criteria are met, but another method must be used once any of the criteria are no longer met. 1
Barrier methods: Higher failure rates (18% for male condoms, 12% for diaphragms with typical use). 1
Common Side Effects to Discuss
Copper IUD: May increase menstrual bleeding and cramping. 3, 4
LNG-IUD: May cause irregular bleeding initially, but often leads to lighter periods or amenorrhea over time. May have hormonal side effects like headaches, acne, and breast tenderness. 3, 4
Implant: May cause irregular bleeding patterns, headaches, and mood changes. 1
DMPA: May cause irregular bleeding, weight gain, and delayed return to fertility. 1