How to protect yourself while feeding. Woman in the postpartum period

A miracle happened. The baby you've been waiting for for nine long months has finally arrived. Now you, parents, are completely immersed in caring for him. At first, both of you are terribly tired, night feedings are exhausting, and you can’t even think about resuming sexual relations. Yes, and extra pounds have appeared, the figure is not the same as before pregnancy. No, you need to wait a little, especially since the doctor recommends not having sex for the first 4-6 weeks... But nature takes its toll, and your sexual relationship will soon resume. Contraception is probably the last thing on your mind right now. Is it worth taking care of her at all, isn’t breastfeeding enough?

It’s worth it if you want to avoid an unplanned pregnancy in the first months after giving birth, because, contrary to popular belief, this is not so uncommon. Studies have shown that in women who breastfeed, menstruation resumes on average after 2-6 months, depending on the intensity of feeding, and in non-breastfeeding women - 4-6 weeks after birth. If you do not have lactation or breastfeed irregularly, then ovulation, and therefore the ability to conceive, can resume as early as 25, and on average 45 days after birth. And since ovulation occurs 14 days before your period, you may already be fertile without knowing it.

Consequently, pregnancy can occur even before the first menstruation appears, so in order to start using contraception, you should not wait for the restoration of the menstrual cycle, the start of complementary feeding and a reduction in the frequency of breastfeeding.

According to surveys, two-thirds of Russian women resume sexual relations within a month after childbirth, and within 4-6 months - almost all (98%). At the same time, doctors are greatly alarmed by the fact that after giving birth, 20-40% of sexually active Russian women do not use any methods of contraception. Meanwhile, the probability of pregnancy in the absence of reliable contraception in nursing mothers 6-8 months after birth reaches 10%, and in non-breastfeeding mothers - 50-60%. Thus, women who have recently given birth in Russia should be considered a high-risk group for unplanned pregnancy.

And pregnancy during this period is generally extremely undesirable. Doctors believe that the minimum interval between births should be about 3 years. Why? Despite the fact that the involution of the organs of the reproductive system (their return to their previous state) ends 4-6 weeks after birth, complete restoration of the body takes at least 1.5-2 years. Breastfeeding also places a significant burden on a woman’s body. But after this, a woman still needs to replenish her supply of important microelements, such as iron, calcium, etc. As studies have shown, when pregnancy occurs earlier than 2 years after birth, the risk of developing pregnancy complications doubles (preeclampsia, anemia, intrauterine growth retardation), childbirth and the postpartum period.

Thus, we inevitably come to the conclusion that in the postpartum period and for 2 years after childbirth, a woman needs effective, reliable and safe contraception.

Choosing a contraceptive method after childbirth

Ideally, you should get advice and choose a suitable method of contraception after childbirth during pregnancy. If you don’t have time before giving birth, consult a doctor at the maternity hospital. If you still cannot decide on a contraceptive method or you have doubts and questions, then before resuming sexual relations (even while breastfeeding), you should definitely seek advice from a gynecologist, for example, an antenatal clinic or a family planning and reproduction center. The purpose of this article is to give a general idea of ​​contraceptive methods during the postpartum period and how these methods are combined and how compatible they are with breastfeeding, but you should only determine which of these methods is right for you in consultation with your doctor.

A non-breastfeeding woman should start using contraceptives from the moment she resumes sexual relations. Moreover, if there are no special contraindications, she can choose any of the modern arsenal of contraceptives.

The method of contraception for a nursing woman depends on the feeding regimen and the time elapsed after childbirth. In addition, the contraceptive should not adversely affect the child’s health or milk secretion. If you are exclusively breastfeeding, the start of contraception can be delayed by 6 months. If feeding is infrequent or early initiation of complementary feeding (all this is typical for residents of developed countries), a contraceptive method should be selected during a mandatory postpartum visit to the doctor no later than 6 weeks after birth.

And one more important note: the various methods of contraception, which will be discussed below, have different effectiveness, some of them involve serious limitations in use, and not all can be used in the first weeks after childbirth. Be prepared in advance for the fact that during this important and responsible period of your life, when it is better to postpone the next pregnancy in any case, different methods of contraception will often have to be combined, either by increasing the effectiveness of a method that is ideal for you, but not reliable enough, or by “ensuring yourself” in those circumstances when the effectiveness of a reliable method is reduced for some reason. And in determining the need and principles of combining various methods, as well as in selecting the most suitable remedy for your couple, again, only a doctor will help.

Methods of contraception after childbirth

Abstinence

Abstinence (sexual abstinence) has 100% contraceptive effectiveness, but most couples are not satisfied with this method even for a short time.

Lactational amenorrhea method (LAM)

Mechanism of action and characteristics. After childbirth, a woman’s body produces the hormone prolactin, which stimulates milk production by the mammary glands and at the same time suppresses ovulation, resulting in lactational amenorrhea (absence of menstruation during breastfeeding). This effect of prolactin on a woman’s body determines the contraceptive effect of breastfeeding. Each act of breastfeeding stimulates the secretion of prolactin, but if the break between feedings is too long (more than 3-4 hours), the level of prolactin gradually drops. Breastfeeding, started immediately after birth, is an effective method of natural contraception and at the same time provides the child with the most complete nutrition. In addition, sucking stimulates the production of oxytocin, a hormone that promotes not only the contraction of the muscles of the areola of the mammary gland (due to which milk is released from the nipples), but also the contraction of the uterus, which leads to a rapid restoration of its size and shape after childbirth.

MLA involves exclusive or near-exclusive breastfeeding, both during the day and at night. The effectiveness of MLA is maximum if feeding does not occur according to a schedule, but at the child’s first request (even at night), sometimes several times an hour, on average from 12 to 20 times a day, of which 2-4 times at night. The break between feedings should not exceed 4 hours during the day and 6 at night. In this case, each time it is necessary to give the baby the breast, and not express milk. The contraceptive effectiveness of MLA remains at an acceptable level if the share of complementary feeding is no more than 15%.

Terms of application. The first 6 months after birth with proper breastfeeding.

Efficiency. 98%.

Advantages

• Easy to use.
• Gives a contraceptive effect immediately from the start of use.
• Does not affect sexual intercourse.
• Promotes uterine contraction, reducing the risk of postpartum complications (bleeding) and leading to a speedy recovery of the body.
• Does not require medical supervision.
• Beneficial for the child (breastfeeding provides him with the most adequate nutrition, promotes the development of immunity, and reduces the risk of infection).

Flaws

• Requires strict adherence to the above breastfeeding rules.
• Not suitable for working women.
• Short-term use (6 months).
• Does not protect against sexually transmitted diseases.

Hormonal methods

ORAL CONTRACEPTIVES (OK)

OCs containing only progestins (“mini-pills”)

The tablets contain progestins - synthetic hormones, the contraceptive effect of which is to reduce the amount and increase the viscosity of cervical mucus (which prevents the passage of sperm into the uterus), change the structure of the mucous membrane of the uterine body (this prevents embryo implantation) and suppress ovulation.

Start of use. Breastfeeding women can start taking pills 5-6 weeks after birth, non-breastfeeding women - from the 4th week after birth or with the onset of menstruation.

Efficiency. 98% when taking pills correctly and regularly in combination with breastfeeding.

Advantages. They do not have a negative effect on the quantity, quality of milk and duration of lactation.

Flaws. In the first 2-3 cycles of use, intermenstrual bleeding is often observed, which is a consequence of the body’s adaptation to the drug. Some women may experience menstrual irregularities, including amenorrhea.

Features of application. OK prescribed by the doctor. They must be taken daily, without breaks, strictly at the same time. Violation of the time of taking or skipping pills, as well as the simultaneous use of certain antibiotics, anticonvulsants and sleeping pills, vomiting or diarrhea reduce the contraceptive effect. The ability to conceive is usually restored immediately after stopping the drug. After stopping feeding, you should switch to combined OCs, which are more effective.

Combined OK

They contain the hormones gestagen and estrogens, which suppress the growth and maturation of follicles and ovulation, as well as preventing implantation.

Start of use. After stopping breastfeeding, combined OCs are started to be taken with the resumption of menstruation. If you have not breastfed at all, you can use this type of contraception from the 4th week after birth.

Efficiency. When taken correctly and regularly, the effectiveness approaches 100%.

Advantages. After stopping taking the pills, the ability to conceive is quickly restored.

Flaws. It is not advisable to use during breastfeeding (estrogens reduce milk secretion and the duration of lactation).

Features of application. Similar to the use of OCs containing only progestins.

PROGESTAGENS, LONG-ACTING

Highly effective long-acting products. These include, for example, the injectable drug “Depo-Provera” and the subcutaneous implant “Norplant”.

Start of use. The first administration of the drug to nursing women is no earlier than 6 weeks after birth, to non-breastfeeding women - from the 4th week after birth.

Efficiency. 99%.

Advantages. They do not affect the quantity and quality of milk, the duration of lactation, and do not have a harmful effect on the child. One injection of Depo-Provera provides contraception for 12 weeks. "Norplant" provides protection against unwanted pregnancy for a period of 5 years. Removal of the implant is possible at any time.

Flaws. The disadvantages of OCs containing only progestins are similar (frequent intermenstrual bleeding and the onset of amenorrhea).

Features of application. Prescribed and administered by a doctor. In the first 2 weeks after administration, additional contraceptives should be used. It is necessary to strictly observe the intervals between administration of the drug. “Norplant” must be removed after 5 years, since after this period the effectiveness of the method sharply decreases. After discontinuation of the drug, restoration of a regular menstrual cycle and the ability to conceive usually occurs within 4-6 months.

Intrauterine contraceptives (spirals)

Start of use. In case of uncomplicated labor and no contraindications, an intrauterine device (IUD) can be inserted immediately after birth. This does not significantly increase the risk of infectious complications, bleeding or uterine perforation. The optimal time for insertion is 6 weeks after birth, which reduces the incidence of IUD loss.

Efficiency. 98%.

Advantages. Compatible with breastfeeding. Provides protection from pregnancy for up to 5 years. Gives a contraceptive effect immediately after administration. The IUD can be removed at any time. Restoring the ability to conceive after removal of the IUD occurs very quickly.

Flaws. Sometimes it causes discomfort in the lower abdomen resulting from contractions of the uterus during breastfeeding. For some women, in the first months after insertion of an IUD, menstruation may be heavier and more painful than usual. Sometimes the IUD comes out.

Features of application. The IUD is inserted by a doctor. It is not recommended for women who have suffered from inflammatory diseases of the uterus and appendages, both before pregnancy and in the postpartum period; as well as women who have multiple sexual partners, since in this case the risk of inflammatory diseases increases.

Barrier methods of contraception

CONDOM

Start of use. When resuming sexual activity after childbirth.

Efficiency. On average 86%, but with proper use and good quality it reaches 97%.

Advantages. The method is easily accessible and easy to use, and does not affect lactation or the health of the child. Greatly protects against sexually transmitted infections.

Flaws. If used incorrectly, the condom may slip or break. Use is associated with sexual intercourse.

Features of application. You should not combine the use of a condom with the use of fatty lubricants, which can cause the condom to rupture. Use a neutral lubricant with spermicide.

DIAPHRAGM (CAP)

Start of use. Not earlier than 4-5 weeks after birth - until the cervix and vagina shrink to normal sizes.

Efficiency. Depends on correct application. During breastfeeding, it increases to 85-97% due to a decrease in the ability to conceive at this time.

Advantages. Does not affect lactation and baby's health. Provides partial protection against some sexually transmitted infections.

Flaws. Use is associated with sexual intercourse.

Features of application. A medical professional should select a diaphragm for a woman and teach her how to use this method of contraception. After giving birth, you need to clarify the size of the cap; it may have changed. Used together with spermicides. The diaphragm should be removed no earlier than 6 hours after sexual intercourse and no later than 24 hours after its insertion.

SPERMICIDES

This method of chemical contraception is the local use of creams, tablets, suppositories, gels containing spermicides - substances that destroy the cell membrane of sperm and lead to their death or impaired motility.

Start of use. When resuming sexual activity after childbirth. While breastfeeding, they can be used independently; in the absence of lactation, they should be combined with other means of contraception, in particular with a condom.

Efficiency. When used correctly, 75-94%. The contraceptive effect occurs a few minutes after administration and lasts from 1 to 6 hours depending on the type of drug.

Advantages. In addition to those described for the condom, it provides additional lubrication.

Sterilization

Sterilization is a method of irreversible contraception in which ligation or clamping of the fallopian tubes (in women) or ligation of the vas deferens (in men) is performed surgically.

FEMALE STERILIZATION

Start of use. It is performed immediately after an uncomplicated birth under local anesthesia using laparoscopic access or by minilaparotomy, as well as during a cesarean section.

Efficiency. 100%

Advantages. The effect occurs immediately after the operation.

Flaws. Irreversibility. Low likelihood of postoperative complications.

Features of application. The method is acceptable only for those who are absolutely sure that they do not want to have more children. The decision to use the method should not be made under pressure from circumstances or emotional stress.

MALE STERILIZATION (VASECTOMY)

Under local anesthesia, a small incision is made in the scrotum and the vas deferens (similar to the fallopian tubes) is ligated. Sexual desire, erection, and ejaculation are not disturbed in any way, only the ejaculate does not contain sperm.

Efficiency. 100% if you follow the rule: you should use a condom for the first 3 months after surgery. The effectiveness of vasectomy can be confirmed by the absence of sperm in the ejaculate, detected using a spermogram.

Disadvantages and application features. Similar to female sterilization.

Natural Family Planning Methods

Based on abstinence from sexual intercourse on days favorable for conception.

Start of use. Only after establishing a regular menstrual cycle.

Efficiency. No more than 50% if all rules are followed.

Advantages. No side effects. Spouses bear joint responsibility.

Flaws. Determining favorable and unfavorable days requires special training of the couple by medical staff, careful record keeping, self-control and self-discipline. It is not recommended immediately after childbirth, as it is difficult to determine the timing of ovulation and first menstruation.

The birth of a desired child is a long-awaited and joyful event. Of course, in the first weeks, young parents do not think about resuming sexual contacts, and doctors recommend abstaining, but over time everything returns to normal, and sex is a natural side of a relationship.

You can often hear the opinion that if you breastfeed your baby, an unwanted pregnancy will not occur. But is it?

This statement is largely erroneous, since lactation cannot guarantee maximum protection. Contraceptives during breastfeeding are not only important, but also necessary. However, when choosing them, a woman should also think about the baby. Contraception during feeding has its own subtleties. It is important to choose the right means and methods of protection, because many of them can penetrate into the milk and cause harm to the baby. Often for breastfeeding women who do not use contraception, the appearance of a new pregnancy comes as a surprise, and not always pleasant. Therefore, you need to think about protection immediately after childbirth.

Lactational amenorrhea and its effectiveness

Lactational amenorrhea is a condition in which ovulation does not occur during lactation and menstruation is absent. In itself, this method of contraception during lactation is highly effective (up to 96%), but requires strict adherence to all conditions, namely:

• breastfeeding should begin immediately after childbirth, which is impossible in the case of a caesarean section;
• feeding the baby is carried out strictly according to the clock;
• the interval between feedings should not be more than 2 hours, even at night;
• there should be no supplementary feeding;
• Do not give your child pacifiers and bottles;
• You cannot feed your baby without a schedule, at his request.

If all conditions are met in the first six months after birth, this method of contraception during breastfeeding can provide sufficient protection, but in the future it will still be necessary to select the optimal means of protection. Of course, not every modern woman can withstand such strict conditions without violation, so you should not count on lactation as the only means of contraception.

Safe contraceptives during breastfeeding

Modern medicine offers quite a lot of contraceptives for nursing mothers; all that remains is to choose the right one, without forgetting about the health of the baby. The following are considered the safest methods of contraception during lactation.

Condoms . They can be used immediately after sexual intercourse is resumed, since condoms do not affect lactation or milk composition and (if used correctly) can provide up to 98% protection. Improper use can lead to damage to the condom or its slippage, in which case the protection effect will be zero.

Diaphragms and caps. Their use does not affect the composition of milk and is completely safe for the baby, but the use of this barrier contraception can only be started when the vagina and cervix return to normal and return to their previous size, that is, approximately 6 weeks after birth. The effectiveness of the method reaches 85%, but if used simultaneously with special spermicidal agents, the effect increases to 97%.

Spermicides . This type of contraceptive during breastfeeding can be used as an independent means, since the likelihood of conception during this period is reduced. The products have a local effect, work exclusively in the genital area, without affecting the composition of milk. But if lactation is small and the baby’s feedings are not regular, then it is better to use spermicides in a combined version - with barrier types of contraception.

Intrauterine devices . They can be inserted into the uterus 6 weeks after birth, but in this case the risk of its prolapse significantly increases if the internal organs have not yet returned to normal. The effectiveness of the method is 98-99%. The device is installed for an average of 5 years, and can be removed at any time with rapid restoration of fertility. Does not affect lactation and its quality.

Injection methods and subcutaneous implants. They have a prolonged effect. After childbirth, the first administration of such drugs (or implants) can be carried out after a month and a half, and in the absence of lactation - after a month. The effectiveness of the methods is maximum, 99%. Injections can provide protection for up to 3 months, and implants for up to 5 years, while the capsule can be removed at any time. They do not have a harmful effect on the baby.

What should not be used

This category includes all hormonal contraceptives for oral use. Such drugs can cause not only changes in hormonal levels and disruption of the menstrual cycle, which is not immediately established after childbirth, but also change the composition of milk and its quality, which can harm the baby. The effectiveness of the method is high, about 99%, but it is not suitable as a contraceptive for nursing mothers. After childbirth, oral contraception should be used only after the end of lactation.

After the birth of a long-awaited baby, in a flood of worries, you should not forget about such an important thing as protection. After childbirth, a woman’s body gradually returns to its normal state, and its ability to conceive can be restored very quickly. To protect yourself and your partner from a surprise in the form of an unplanned pregnancy, before resuming sexual activity you need to take care of choosing the appropriate method of contraception.

The need for contraception after childbirth

Contraception is protection against conception, which for some reason is undesirable. Why is contraception so important after childbirth? Even if the family plans to have another child, it is necessary to wait time so that the woman’s body can fully recover after 9 months of increased stress. According to doctors, the minimum time that should pass after childbirth before the next pregnancy occurs is 2 years. Research results have shown that pregnancies that occur earlier than this period often have complications for both the mother and the fetus. If the spouses no longer intend to have children, they must approach the issue of birth control with even greater responsibility.

After resuming sexual relations, it becomes necessary to choose the right method of contraception

When should you start protecting yourself?

Despite the fact that the female body will need several more years to recover after childbirth, the reproductive system can be ready for conception within 4-6 weeks. In non-breastfeeding women, the first ovulation most often occurs between 1.5 and 3 months, although deviations to a smaller extent are possible when conception becomes possible after 25 days. In nursing mothers, ovulation resumes on average after 2–6 months, and this period is associated with feeding habits.

The choice of contraceptive methods and the initiation of their use depend on the intensity of breastfeeding.

• If you are not breastfeeding, you need to start using protection from the very beginning of sexual relations. You are not limited in your choice of contraceptive methods and means.
• If your baby is on mixed feeding, you do not breastfeed him often enough or introduced complementary foods early, you must use contraception, as in the first case, immediately after returning to sexual activity. It is permissible to use only those contraceptives that cannot affect milk production and the health of the child.
• If you breastfeed on demand, you can rely on the lactational amenorrhea method for the first six months and delay the use of other contraceptives for 6 months.
• In case of emergency cessation of breastfeeding, you should start using contraceptives on the day of your last feeding.

Attention! Do not wait to use contraception until after your first period. Just because you haven't had a period since giving birth doesn't mean you can't get pregnant. Ovulation occurs on average 2 weeks before menstruation, so your fertility will be restored before you know it.

Methods of contraception immediately after childbirth

Today there are many methods of contraception. Some of them are based on the natural characteristics of the female body, others on the achievements of modern science.

There is no ideal method of contraception that would suit every couple.

Each method has its own characteristics, advantages and disadvantages and is suitable for a particular situation.

Lactational amenorrhea method (hormonal)

This method of postpartum contraception is based on the physiological state of a mother who feeds her child exclusively with breast milk - lactational amenorrhea. This condition is characterized by the absence of menstruation in a woman while breastfeeding. The contraceptive effect is achieved through the production of the hormone prolactin in the mother's body, which stimulates milk production and at the same time suppresses ovulation.

The lactational amenorrhea method is an effective remedy for unwanted pregnancy within six months after the birth of the baby

The production of prolactin occurs when the baby is put to the breast and drops approximately 3-4 hours after feeding. If the mother feeds the baby on demand, the amount of prolactin in the body is maintained at a constant high level, ovulation is blocked, and conception cannot occur.

The lactational amenorrhea method, or LAM, was recognized in 1988 in Italy after research was conducted on the effect of breastfeeding on ovulation. Its effectiveness was confirmed by three clinical studies in 1995.

The lactational amenorrhea method is considered effective if all of the above requirements are met.

1. The baby should be fully or almost completely breastfed. Minimal complementary feeding is possible, but its share should not exceed 15% of the infant’s diet, and it should not completely replace one of the feedings (water, juice and other drinks are also taken into account).
2. The intervals between feedings should not exceed 4 hours during the day and 6 hours at night. The frequency of breastfeeding should be on average 12 to 20 times a day, of which at least two feedings occur at night.
3. It is necessary to give the baby the breast during each feeding; expressing milk cannot replace breastfeeding.
4. Lack of menstruation. Bleeding that occurs during the first 42 days after birth is not considered menstruation.
5. The child is less than 6 months old.

Despite the high effectiveness of the method, a minimal percentage of the chance of getting pregnant still remains. If you want to be one hundred percent sure that pregnancy will not occur, you can combine the lactational amenorrhea method with an additional means of contraception, which is acceptable during breastfeeding.

Advantages of the method:

• if all requirements are met, the method provides reliable protection against conception - its effectiveness is 98%;
• does not cause difficulties in use;
• the contraceptive effect begins immediately after the start of breastfeeding;
• does not affect sexual intercourse;
• has no side effects;
• does not require observation by a gynecologist;
• stimulates uterine contractions, reduces the risk of postpartum hemorrhage;
• useful for the child, promotes the formation of his immunity, provides protection against infections.

Flaws:

• can be used for a relatively short time (no more than 6 months);
• requires strict adherence to the conditions and rules of breastfeeding;
• does not protect against sexually transmitted diseases.

The chances of getting pregnant throughout the time you use LAM vary. In the first 3 months, strict adherence to the rules of feeding on demand completely eliminates the possibility of becoming pregnant. In the next 3 months, the probability of conception is 2%. After 6 months, the chance of pregnancy before menstruation returns is about 6%.

Coitus interruptus

This method of contraception involves interrupting sexual intercourse before ejaculation begins. In this case, the man is responsible for preventing conception. During sexual intercourse, he must remove the penis from the vagina before ejaculation to prevent sperm from getting inside.

Advantages of the method:

• does not require financial costs;
• quite easy to use;
• better than no protection.

Disadvantages of the method:

• low efficiency – about 70%;
• the need for constant self-control on the part of men and vigilance on the part of women;
• negatively affects a man’s nervous system and can lead to the development of neurosis;
• does not protect against sexually transmitted infections.

A fairly high probability of getting pregnant is due to two reasons:

1. A man may not have time to remove his penis from the vagina before ejaculation begins.
2. Pre-ejaculate, the fluid that comes from the penis before ejaculation, may contain sperm.

Barrier contraceptives are divided into two types:

• mechanical (condom, diaphragm, uterine cap);
• chemical containing spermicides (creams, gels, vaginal tablets, suppositories).

Barrier methods of protection against unplanned pregnancy can be freely used from the beginning of the resumption of sexual activity after childbirth

Condom

It is the most common and reliable means of preventing sperm from entering the vagina. A condom can be used from the moment you resume sexual activity after childbirth. The effectiveness of the product reaches 98%, but improper use and poor quality of the product itself significantly reduce the reliability of the method.

Attention! The use of fatty lubricants destroys the structure of the material from which the condom is made. It is better to use a neutral lubricant with spermicide.

Benefits of using a condom:

• accessibility and ease of use;
• no impact on lactation and milk quality;
• protection against sexually transmitted infections.

Flaws:

• If used incorrectly, there is a risk of tearing or slipping;
• associated with sexual intercourse;
• requires regular financial expenses, high-quality products are quite expensive;
• cannot be used if you are allergic to latex.

Diaphragm (cap)

Diaphragms and caps are dome-shaped latex products with a flexible rim. The diaphragm is located in the vagina and creates a mechanical obstacle to the penetration of sperm into the uterus. The cap is smaller in size, placed directly on the cervix and held on it by suction. Due to this, it is considered a more effective remedy than the diaphragm. You can use this method of contraception from the moment when the cervix and vagina shrink to their normal size, which occurs approximately by the 5th week after birth. The diaphragm (cap) is inserted before sexual intercourse and removed no earlier than 6 hours after it, but should not remain in the vagina for more than a day.

Diaphragms and caps are selected individually by a gynecologist

The effectiveness of the method directly depends on correct use and ranges from 73 to 92%. The use of a diaphragm or cap must be combined with spermicides to enhance the contraceptive effect. The combination of these remedies with the lactational amenorrhea method completely negates the risk of unwanted pregnancy. The size of the device is selected individually with the help of a gynecologist and depends on the size of the vagina or cervix.

Advantages:

• no effect on lactation and child health;
• in combination with spermicides – partial protection against sexually transmitted diseases (STDs).

Flaws:

• relatively low contraceptive effect;
• the need to use additional means - spermicides;
• the likelihood of allergic reactions;
• inability to independently select the aperture size;
• if the size is incorrectly selected, the diaphragm may put pressure on the urinary ducts and increase the likelihood of inflammatory processes;
• installation is quite complex and requires skills;
• use is associated with sexual intercourse.

In case of inflammatory diseases of the pelvic organs, cervical erosion, uterine flexion and prolapse of the vaginal walls, this method of contraception is contraindicated.

Spermicides

Chemicals that cause a decrease in the motor activity of sperm or their death. These substances are included in special gels, creams, suppositories and vaginal tablets. The effectiveness of spermicidal agents when used independently is low and amounts to 75–94%, so it is recommended to use them in combination with the lactational amenorrhea method. In the absence of lactation, spermicides are used as adjuncts when using condoms or a diaphragm.

The use of spermicides can be started when sexual relations resume after childbirth. The drugs are introduced into the vagina 15–30 minutes before the start of sexual intercourse and retain a contraceptive effect for 1–6 hours, depending on the type of drug.

Advantages:

• availability;
• ease of use;
• local effect that does not affect lactation;
• reducing the risk of contracting sexually transmitted infections;
• creating additional lubrication.

Flaws:

• low efficiency, not recommended as a stand-alone remedy;
• the possibility of allergic reactions and irritations;
• the need to wait a pause after administration.

Spermicide products can be in the form of gels, creams, capsules, tablets and suppositories.

Oral contraceptives (OC)

Oral contraceptives come in two types: combined and progestin (mini-pill). These types differ significantly from each other, have different mechanisms of action and are selected depending on the situation. Combined oral contraceptives (COCs)

They are tablets containing the female sex hormones estrogen and progestin (an analogue of progesterone). Their action is to suppress ovulation, thicken mucus in the cervix, prevent egg implantation and reduce sperm activity. It is not recommended to combine the use of COCs with breastfeeding, since estrogens affect lactation, reducing its duration and milk quantity. The effectiveness of COCs is very high and is 99% when taken regularly - 1 tablet once a day at the same time.

Combined oral contraceptives must be taken strictly on schedule

If you did not breastfeed from the very beginning, you can use combined OCs as early as 3 weeks after birth. If lactation ceases, the use of COCs is possible after the resumption of menstruation.

Advantages:

• excellent contraceptive effect, approaching 100% when used correctly;
• not associated with sexual intercourse;
• ease of use;
• immediate contraceptive effect when used from the 1st day of the cycle;
• rapid restoration of reproductive function - about 3 months;
• reducing the risk of certain diseases, such as mastopathy, ovarian and uterine cancer.

Flaws:

• incompatibility with breastfeeding;
• the need for daily intake;
• effectiveness may decrease while taking certain medications (indicated in the instructions for the drug);
• increases the risk of diseases such as thrombosis, varicose veins, breast cancer, as well as the risk of stroke and heart attack;
• incompatibility with smoking;
• age limit – can only be used up to 35 years of age;
• a wide list of possible side effects;
• lack of protection against STDs. OCs containing only gestagens (progestins) act on the mucus in the cervix, making it thicker, and on the mucous membranes of the walls of the uterus, changing their structure. Such changes do not allow the seed to penetrate the uterus, and if penetration does occur and fertilization takes place, they do not allow implantation of the embryo. Mini-pills also have an effect on ovulation, but do not always completely suppress it, so their contraceptive effect is slightly lower than that of COCs - 95%.

Mini-pills (progestin contraceptives)

They do not affect breastfeeding, so breastfeeding women can take them 5-6 weeks after birth. Non-breastfeeding mothers can start taking it 3 weeks after giving birth or after the start of menstruation. In combination with breastfeeding, the effectiveness of progestin OCs increases to 98%.

Photo gallery of various types of progestin contraceptives

Exluton - the latest generation drug Lactinet is the latest generation contraceptive, designed specifically for nursing mothers
Charozetta - a new monophasic drug Microlute is safe for new mothers

Advantages:

• do not affect lactation;
• the ability to conceive is restored almost immediately after cessation of use;
• can be used in women who, for health reasons, have contraindications to COCs;
• suitable for women over 35 years old, as well as smokers;
• fewer side effects compared to COCs.

Flaws:

• effectiveness is lower than that of combination drugs;
• the need for strict adherence to the dosage schedule;
• increased risk of ectopic pregnancy and development of ovarian cysts;
• the possibility of side effects.

An intrauterine device (IUD) is a T-shaped device made of plastic with the addition of metals (gold, silver or copper) or a synthetic hormone. The contraceptive effect of the IUD is to significantly reduce the possibility of fertilization, and if it occurs, to prevent the attachment of the fertilized egg to the walls of the uterus.

The IUD is installed by a doctor 1.5–2 months after birth, when the uterus returns to its normal state. If the pregnancy ended with a cesarean section, the IUD is inserted no earlier than 6 months after the operation. This method of contraception is very attractive for many women who have given birth because of its high reliability and long period of use - after inserting an IUD, you do not have to worry about the occurrence of an unplanned pregnancy for 3-5 years. However, a large number of contraindications, possible consequences and side effects sometimes negate all the advantages of the IUD and do not allow it to become the most convenient and safe means of birth control after childbirth.

The spiral combines high efficiency and a large number of disadvantages

Advantages of the method:

• high efficiency – 98–99%;
• long-term effect – up to 5 years;
• instant contraceptive effect - effective immediately after administration;
• possibility of deletion at any time;
• compatibility with breastfeeding;
• lack of influence on sexual intercourse;
• fairly rapid restoration of the ability to conceive.

Flaws:

• A common side effect is increased pain during menstruation, increased intensity and duration of discharge;
• likelihood of rejection;
• increased risk of ectopic pregnancy;
• the need for independent monthly monitoring of the presence of spiral threads;
• high risk of miscarriage during a future pregnancy due to depletion of the uterine endometrium;
• possibility of spontaneous loss;
• lack of protection against STDs;
• increased likelihood of developing inflammatory processes in the pelvic organs;
• abortive mechanism of action – rejection of an already fertilized egg;
• decreased ability to get pregnant after stopping use;
• if any of the contraindications are present, use is prohibited.

Contraindications to the insertion of the IUD are any pathologies and disorders in the pelvic area, diseases of the genital area, and cervical erosion. Your doctor should tell you a complete list of contraindications; insertion of the IUD should only occur after a comprehensive examination.

Surgical sterilization

Sterilization can be either female or male and represents an irreversible loss of fertility. This method of preventing unwanted pregnancy is suitable only for those families who are absolutely sure that they will no longer want to have children.

Sterilization is the only method that is 100% effective.

Female sterilization

Female sterilization is carried out at the request of the woman and is an operation during which the fallopian tubes are clamped, tied, or “sealed” with a laser. May be performed during cesarean section. In Russia, sterilization is allowed only to women who have reached the age of 35 or have at least two children. Indications for sterilization can also be serious diseases that are incompatible with bearing a child.

Such a responsible step as sterilization of one of the spouses should be carefully considered.

The advantage of female sterilization is its immediate and permanent contraceptive effect. The main disadvantage is the irreversibility of the operation. In addition, sterilization has its contraindications.

Approximately 3% of women who underwent sterilization regretted it later.

Male sterilization (vasectomy)

Sterilization in men involves blocking the vas deferens. The operation is performed under local anesthesia, sexual desire, erection and ejaculation are preserved, only the ejaculate no longer contains sperm. After surgery, you must use a condom for 3 months. The success of the operation is confirmed by a spermogram, which should show the complete absence of sperm in the ejaculate. The advantages and disadvantages of a vasectomy are the same as those of female sterilization.

Vasectomy is considered an irreversible method of contraception, although surgery is now available in some cases to restore men's fertility.

Prevention from unplanned pregnancy occurs by abstaining from sexual activity on days when conception is possible. There are several natural planning methods:

• calendar method;
• method for determining basal temperature;
• cervical mucus monitoring method;
• symptothermal method.

The last method is the most accurate because it is based on the results of a whole set of observations: changes in basal temperature, cervical mucus and the position of the cervix. If the first 3 methods have no more than 50% efficiency, the symptothermal method, with proper observation, has a high reliability that approaches 99%.

Natural family planning methods are the responsibility of both spouses

Advantages:

• no side effects or harm to health;
• full participation of both partners, joint responsibility;
• improving knowledge of the characteristics of the female body;
• immediate restoration of the ability to conceive;
• use for both prevention and initiation of conception.

Flaws:

• a large percentage of pregnancies that have taken place due to inaccuracies in observations;
• high complexity of the method;
• the need for training and counseling over several months;
• not suitable for use immediately after childbirth until a regular menstrual cycle has been established;
• poor compatibility with breastfeeding - observations during this period can be very difficult;
• the need to abstain on certain days of the cycle;
• the existence of many factors that can distort the accuracy of observations;
• lack of protection against sexually transmitted infections.

Video: everything you need to know about contraception after childbirth

Features of contraception for a nursing mother

Breastfeeding itself is an excellent method of contraception provided to women by nature. To increase the reliability of the lactational amenorrhea method, which is effective for six months after childbirth, you can use various contraceptives. The main condition when choosing methods during breastfeeding is the absence of a negative impact on lactation and the health of the child.

When choosing a contraceptive method, a nursing mother should remember the effect of certain drugs on the quality of milk and the health of the child.

Contraceptive methods compatible with breastfeeding:

• condoms;
• diaphragm, cap;
  spermicides;
• non-hormonal intrauterine device;
  oral contraceptives with gestagens (mini-pills);
• sterilization;
• ENP - natural family planning.

Video: what contraceptive methods can a nursing mother use?

During the postpartum period and for two years after childbirth, contraception occupies an important place in a woman’s life. Having studied all possible methods of contraception after childbirth, you should choose the safest and most reliable method that is right for you.

When a woman becomes a mother, she does not cease to be a wife. And for some time after giving birth, she begins to be interested in issues related to contraception. Is it possible to take birth control pills during breastfeeding? What drugs are there? Or is it better to use barrier methods when feeding? Or maybe there is no need to use protection at all during lactation? In this article we will try to answer all these questions and even look at the situation a little more broadly.

Why is a second pregnancy in a row undesirable?

Some mothers who gave birth to their first child and did not encounter serious difficulties during pregnancy and childbirth do not pay special attention to protection. Pregnancy will come - good. I still want another child. Otherwise, I’ll shoot early and be free.

This approach is, of course, possible, but a woman must understand that too short a break between births can have a bad effect on both the mother herself and both children: the older and the younger. What problems may arise (of course, everything is individual, and such problems may not arise, but every woman needs to know about this)?

1. A woman fully recovers after pregnancy, childbirth and breastfeeding only after 2.5-3 years. Exhaustion of the body can lead to miscarriage or premature birth.

1. Having experienced serious stress during pregnancy and lactation, a woman is psychologically unprepared for its repetition.

1. If a new pregnancy occurs earlier than 2 years after the previous birth, then the woman’s body often does not have time to restore iron reserves, especially if the child has been on breastfeeding for a long time. And during the second pregnancy, iron deficiency anemia occurs. This condition often leads to late toxicosis and premature birth. The baby may develop poorly in utero and be born with insufficient body weight. Serious problems can be expected even if there is not too much bleeding during childbirth.

1. Caring for two very young children is very difficult, especially if there is no one to help the mother.

1. The older child loses his mother's attention too early. Often you have to stop breastfeeding ahead of time. A situation when the mother goes to the maternity hospital can be very stressful for the baby. If the mother has to remain in confinement for a long time, the child may receive psychological trauma that will affect him throughout his life.

1. A repeat pregnancy that occurs too early after a cesarean section is especially dangerous. A seam that has not yet had time to fully form may simply come apart.

Medical abortion is easier to tolerate. But, firstly, it needs to be done on time, and a woman caring for a baby rarely listens to her own condition and may well miss the early signs of pregnancy. Secondly, mothers who have recently given birth to a baby find it psychologically very difficult to tolerate even medical abortion in the early stages. In addition, medical abortion usually means refusing breastfeeding.

So let’s take it as an axiom that a breastfeeding woman needs to take protection.

When is it time to start protecting yourself?

In the first weeks after childbirth, gynecologists usually do not recommend that women have sex, even if there were no cuts or tears during childbirth, and no stitches were applied. The reason for this is that during childbirth, almost everyone develops microcracks, which can easily become infected, which can lead to serious inflammation. The inner surface of the uterus is a continuous wound, which can also easily become infected.

Before this, it is advisable to see a doctor to make sure that recovery after childbirth went well. At the same time, you can discuss with your doctor what contraception for nursing is.

Lactational amenorrhea

It is believed that pregnancy is impossible while breastfeeding. Is it so? Yes, but not so. Indeed, the phenomenon of lactational amenorrhea exists. But, firstly, not for everyone. And secondly, it is necessary that the mother feeds the child on demand, including at night, and does not supplement or supplement with anything. And even in this case, there is no point in hoping that she will not ovulate even after 6 months after giving birth.

The fact is that ovulation occurs before menstruation, therefore, even while breastfeeding, a woman can become pregnant, even if she has never had menstruation after giving birth. So it’s better not to rely on the lactational amenorrhea method, but to use other methods during breastfeeding.

Hormonal contraception

One of the most reliable methods of contraception, the effectiveness of which is 98-99% depending on the drug, is hormonal. Previously, it was believed that oral contraceptives were not suitable for breastfeeding women. But science has long moved forward, and doctors may well recommend birth control pills for nursing mothers.

It is unacceptable to take pills containing both estrogen and progesterone.

Such drugs pass into milk. And the child has absolutely no use for them.

In addition, such drugs reduce the secretion of breast milk. And this is another reason why combined oc should not be taken while breastfeeding.

The recently popular vaginal ring NuvaRing also contains estrogen, so NuvaRing cannot be used during lactation.

When breastfeeding you can drink the following OK:

• tablets containing only progesterone;
• mini-pills, progestogen-based pills.

These drugs do not affect the baby and do not reduce milk supply. But both tablets and mini-pills must be taken at exactly the same time every day. A missed pill in the hassle can cause your baby to have a brother or sister.

What hormonal drugs can be an alternative to oral contraceptives:

• contraceptive injections;
• capsules injected under the skin.

Both injections and capsules contain the hormone progestogen. Their efficiency is close to 99%. You don't need to take them every day like you do pills every day. After all, injections are made once every 8-12 weeks, and the capsule lasts for as long as 5 years.

Disadvantages of all hormonal contraceptives:

• possibility of intermenstrual bleeding;
• excessive discharge during menstruation;
• do not protect against sexually transmitted infections;
• After discontinuation of the drug, conception may not be possible immediately.

Intrauterine device

This is a good method for nursing mothers. Has high efficiency. An intrauterine device is installed for several years, does not affect the baby in any way, and does not affect lactation. But it does not protect against infections and can lead to painful menstruation. Not used after caesarean section.

You can insert an intrauterine device as early as 6 weeks after birth. Until this time, there is usually no need for contraception. But if a woman begins intimate relationships earlier, then she should use barrier methods just in case.

Barrier methods of contraception

Barrier methods of protection include the use of:

• condoms;
• caps and diaphragms;
• spermicides.

All these methods are easy to use and can be used during lactation. But they are less effective compared to hormonal drugs. But condoms protect against various infections, which is very important after childbirth.

To increase effectiveness, you need to use high-quality condoms. Choose a new size of caps and diaphragms due to changes in the size of the cervix and vagina.

Spermicides: suppositories, creams, gels are best used in conjunction with other methods, since these products are not very effective. The names of some drugs: “Pharmatex”, “Zhinofilm”, “Sterimine”.

Calendar method

Suitable only for women with regular cycles. But since after childbirth time is needed for its recovery, the calendar method is not recommended for use during this period.

During breastfeeding, almost all means of protection are acceptable for use. And birth control pills for nursing mothers are easy to find. Only combined hormonal drugs are prohibited. But it is still advisable that a woman select a contraceptive method together with her gynecologist, since their experience allows them to determine the best contraceptives for nursing mothers.

Sometimes women who breastfeed neglect means of protection against pregnancy: they are sure that the absence of menstruation is a guarantee of the safety of unprotected sexual relations. Meanwhile, the onset of another pregnancy immediately after childbirth, even during breastfeeding, is possible. Medically speaking, amenorrhea during lactation does not protect mothers from becoming pregnant again.

Upon discharge from the maternity hospital, gynecologists warn women that it is necessary to take contraceptives from the beginning of sexual activity, without waiting for the resumption of the menstrual cycle. With equal success, you can use self-control methods (natural contraception), barrier medications, and birth control pills while breastfeeding.

Nature has arranged it so that a woman becomes ready for a new conception almost immediately after pregnancy, and the very fact of breastfeeding does not protect against this. It is necessary to resume the use of contraceptives immediately after the start of sexual activity

Barrier protection

After childbirth, a number of chemicals, medications, and hormonal agents are not recommended for nursing mothers. You can protect yourself from unwanted pregnancy by other methods:

1. Mechanical (barrier). Mechanism of action: put a barrier to the penetration of sperm into the mucous membrane of the cervix. Male products include the condom, known since time immemorial, convenient and reliable. It has no side effects if the woman does not have allergic reactions to the contraceptive material. During sexual intercourse, women after childbirth can use a rubber cap - a diaphragm. This product can be used repeatedly, after consulting a gynecologist on its correct use. The same doctor will install a long-term cervical cap for a nursing woman, selecting it according to size.
2. Chemical spermicides. The action is based on the instant destruction of sperm in an acidic environment. Available in the form of vaginal tablets, creams, rinses, suppositories. When using, remember that after one and a half minutes, sperm can reach the fallopian tubes. When rinsing, do not miss this moment. You can use creams and suppositories 10 minutes before sexual intercourse. The method is not highly effective. During breastfeeding, supplement it with other methods of protection to be safe.

Physiological contraception

This article talks about typical ways to solve your issues, but each case is unique! If you want to find out from me how to solve your particular problem, ask your question. It's fast and free!

Natural contraception is based on the principles of determining the approximate time of ovulation of an egg. It is considered the safest for the health of nursing mothers, but not reliable enough: if the menstrual cycle was disrupted during pregnancy, it did not recover during breastfeeding. The difficulty for tired mothers lies in constant self-control with the following methods of contraception:

1. Calendar cycle. A woman must keep a diary for six months. It begins on the first day of the cycle and ends on the last day before menstruation. The woman notes the shortest and longest cycle, proceeds to mathematical calculations in order to determine the time of ovulation as accurately as possible. The days when it is necessary to use protection are determined: as a rule, from 8 to 23 days of the cycle.
2. Observation of cervical mucus (cervical method). Before ovulation, the amount of discharge increases, which ends a day after ovulation. The dangerous days continue for another 4 days.
3. Temperature. Based on measuring basal temperature immediately after sleep. The thermometer is kept in the rectum for 5-7 minutes immediately after waking up, without getting up or sitting down in bed. The data is entered into a graph, which can be used to confidently determine postovulatory infertility, which occurs on the fourth day after the temperature peak. The method can be considered reliable after 3-4 months of maintaining a symptothermal calendar or schedule.

If you are “protected” using natural contraception, set yourself up for daily monitoring. Gynecologists will explain that these are health-friendly procedures, but they do not 100 percent protect mothers from unwanted pregnancy while breastfeeding. The antenatal clinic will tell you what is the best way to protect yourself from unplanned conception.

Lactational amenorrhea

This natural method of contraception deserves to be discussed separately. Before the development of modern pharmaceuticals, women considered feeding their children the best thing that nature gave them. In the first six months after the birth of a baby, a woman’s body experiences a high concentration of prolactin, a hormone that has contraceptive properties. The required concentration in the female body is maintained when several conditions are met:

1. No more than six months should pass after giving birth.
2. The menstrual cycle has not established itself.
3. Breastfeeding should be regular: every three hours during the day and at least every 6 hours at night. Advice: even if you started feeding your baby at 3-4 months, apply it to your breast constantly. The more often you feed him, the more reliable the protection.

Natural protection during breastfeeding is due to high levels of the hormone prolactin, which blocks ovulation. The effectiveness of the method is high, but it stops working if the baby is six months old or the mother begins menstruation.

Important! For the health of mothers and babies, natural contraceptive measures are the safest. Natural protective measures do not affect the hormonal processes occurring during the postpartum period, but do not guarantee complete safety. Medications increase contraceptive levels.

Contraceptive drugs

During breastfeeding, mothers can use medications aimed at correcting hormones. According to WHO, modern drugs are effective in 99 cases out of 100. They come in the following types:

• birth control pills;
• spirals;
• subcutaneous implants.

Gynecologists do not recommend that nursing mothers take pills with estrogens, which are part of combined products (gestagen + estrogen). They harm lactation and have many side effects, including postpartum depression. A nursing woman should avoid such effects on her body. In addition, biphasic estrogen tablets affect the development of infants.

Gynecologists advise taking birth control pills with microdoses – “mini-pills” – as protection. For nursing mothers, start taking mini-pills no earlier than 6 weeks after the start of breastfeeding. Microdoses of gestagens in mini-pills block ovulation, but do not affect the quantity and quality of breast milk.

The effect of the estrogen antagonist drug occurs only in case of continuous use. Tablets should be taken once every 12 hours, otherwise the effect of taking non-combined tablets is reduced.

The pharmaceutical industry represents this group with drugs called: “Exluton” (“Linestrenol”), “Laktinet” (“Charosezetta”), “Microlut” (“Levonorgestrel”), “Femulen” (“Continuim”). Manufacturers advise women to carefully monitor the behavior and development of the baby when using these medications and breastfeeding. Minidoses of the hormone can pass into breast milk. Monitoring by a gynecologist and pediatrician is required. Women in labor themselves may experience:

• bleeding between cycles;
• acne;
• disturbances in the functioning of the ovaries.

IUD and implant

Hormonal IUDs and subcutaneous implants are more convenient during breastfeeding: a woman stops controlling her pill intake and reduces self-control for five years. She may not worry about conception if the gynecologist recommends an intrauterine device after childbirth and warns her about possible inflammatory processes and ectopic pregnancy. Implantation of a subcutaneous implant in the forearm (a thin rod measuring 4 cm) does not produce side effects and protects a woman from unwanted pregnancy for up to 3 years without harming her health.

Emergency (postcoital) contraception for hot water supply

Emergency contraception is used as an emergency measure of protection. If a woman has not used contraceptives after giving birth, and the risk of unwanted conception is high, the gynecologist will offer emergency help - high doses of combined hormonal pills based on levonorgestrel. EC involves “shock administration” of drugs such as “Postinor”, ​​“Exapel”, “Ovidon”: two tablets every 12 hours. A sharp surge in hormones poses a danger to mother and child. It is better not to allow emergency intervention in ovulation, but to choose a reliable contraceptive for the lactation period.