When I was pregnant, my prenatal appointments seemed to go by like a blur, especially towards the end of my pregnancy. They were usually the same: I'd hear my baby's heartbeat, they'd weight me and measure my belly, and then my doctor would ask if I had any questions. I didn't know it then, but now that I'm a "seasoned" mom I've learned that there's one question every mom-to-be needs to ask her doctor or midwife, and it's probably not at the top of her pregnancy to-do list:
What should I do for birth control after my baby is born?
I understand why most gestating women aren't considering postpartum contraception. When you're pregnant, birth control is pretty much the last thing on your mind. In fact, pregnancy was honestly the only time in my adult life when I didn't have to think about side-stepping pregnancy. But just because I wasn't considering birth control post-birth, didn't mean it wasn't really, really important. I don't know about you, but the last thing I wanted to worry about when I am exhausted, hormonal, and caring for a newborn was taking a pill or making a doctor's appointment.
Birth control you don’t have to think about every day, only once every few years? That is every new mom’s dream.
According to the American Congress of Obstetrics and Gynecology (ACOG) nearly every woman in the United States who has had sex has also used birth control at some point in their lives. Still, as a culture we seem to have a lot of collective embarrassment and shame associated with the act of foregoing pregnancy. And when it feels like the current sociopolitical culture continuously slut-shames women who enjoy sex, and seeks to restrict their access to contraceptives and abortion care, even a trusted conversation between a pregnant woman and her health care provider can be difficult to initiate.
When you have postpartum sex — before or after the recommended six-week wait — lots of things might happen. Unfortunately, one of them is an unintended pregnancy. Research published in the journal Obstetrics and Gynecology shows that between 40 to 57 percent of women report having unprotected sex before their six-week postpartum visit. Since ovulation occurs on average at 39 days postpartum in non-lactating women, or even earlier, formula or combo-feeding moms can be at risk for an unintended or short-interval pregnancy, before they think to ask about birth control.
Planning for contraception after birth is so important
If you plan on breastfeeding, you may have heard that you can't get pregnant, while nursing. Unfortunately, using breastfeeding as birth control is not a sure thing. According to Planned Parenthood, relying on breastfeeding to suppress ovulation is about 98 percent effective, if all of the stars and moons are aligned, that is. It only works well if you breastfeed exclusively, don't go more than four hours between feedings, and if your period hasn't returned.
So it's no wonder that, according to ACOG, at least 70 percent of pregnancies that happen in the first year postpartum are unintended. Whoa. So yeah, it's totally worth bringing up with your provider before your baby is born. Some obstetrics providers agree. Romper corresponded with Certified Nurse Midwife Anette Ferrell, MSN, ARNP, CNM, via email. Ferrell is passionate about prenatal family planning for some very good reasons, writing:
Planning for contraception after birth is so important. Short-interval pregnancies are associated with an increased risk of poor outcomes, including preterm birth, and preeclampsia, and trying to figure out which contraceptive you want after you deliver when a woman is sleep-deprived and maybe not ready to think about being sexually active again, is sometimes too much to consider.
ACOG recommends all obstetrics providers counsel women prenatally about their options for birth control, including long-acting reversible contraceptives (LARCs) like IUDs and implants that may be easier for postpartum moms to manage. Ferrell agrees.
I counsel my patients on all available options, but my favorite option for postpartum contraception are the LARCs. There are several options of intrauterine devices (IUDs) and a subdermal implantable option, Nexplanon. These have the highest patient satisfaction and there is no worry about user error, which decreases failure rates. They are compatible with lactation if the mom wishes to breastfeed. Birth control you don’t have to think about every day, only once every few years? That is every new mom’s dream.
Unfortunately, I learned the hard way that waiting until your postpartum appointment to ask about birth control can be a really bad idea. After my second child was born, I asked my midwife if she could prescribe Nexplanon — a birth control implant that lasts up to three years. The last thing I wanted to do as a sleep deprived mom was to have to remember to take a pill at the same time every day. Unfortunately, she told me that she was unwilling to prescribe birth control, or even refer me to someone who would. It seemed unbelievable that a women's health provider wouldn't provide birth control. I had to call four different providers before I found one who could provide the birth control that I wanted.
This time around, I asked my OB-GYN about birth control options before delivery and was able to schedule my tubal ligation for about six weeks afterward I gave birth. It was so nice to have peace of mind and a supportive provider to help me manage my reproductive health, and not leave something that important up to chance.
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