Unplanned pregnancies can happen in the first few months after childbirth, so it pays to think about your contraception options in advance if you want to delay or avoid another pregnancy.
Key points about contraception after pregnancy
- Discuss your contraception options with your lead maternity carer (LMC) during your pregnancy.
- Don’t wait for your period to return or until you have your postnatal check before you use contraception as you could get pregnant again before then.
- Start using contraception from 3 weeks (21 days) after the birth.
- If you want to get pregnant again, it's best to wait at least 1 year after giving birth before getting pregnant again.
- If you do get pregnant earlier, don’t worry – ask for advice from your doctor, nurse or midwife.
When should I start thinking about contraception?
It is best to discuss your contraception options with your lead maternity carer (LMC) during your pregnancy.
When deciding on a suitable contraceptive method for after the birth, you may want to discuss the following:
- what methods are available
- how well the different methods work
- you and your partner's preferences
- your medical history
- any problems you have had in your pregnancy
- whether you’re planning to breastfeed
- whether you would like to have another baby
- possible side effects.
When will my period start again?
If you’re not breastfeeding, the earliest your period can return is 5–6 weeks after the birth. Breastfeeding usually delays the return of your periods. Your periods are more likely to start again when you breastfeed less often and feed for shorter lengths of time, but for some women, they may return earlier.
You can become pregnant before your period returns. This is because ovulation (releasing an egg) occurs about 2 weeks before you get your period.
How soon do I need to use contraception?
You need to start using contraception from 3 weeks (21 days) after the birth. It’s unlikely you will get pregnant earlier than this. Many methods of contraception can be started straight after the birth.
Don’t wait for your period to return or until you have your postnatal check before you use contraception as you could get pregnant again before then.
If you’re fully breastfeeding you can choose to rely on this for contraception to begin with. Learn more about breastfeeding and contraception.
When can I start my chosen method of contraception?
These methods can be used or started any time after the birth:
- contraceptive implant
- intra-uterine device (IUD) – if an IUD is not inserted within 48 hours, you'll usually be advised to wait until 4 weeks after the birth
- Depo-Provera injection – when using the injection within 6 weeks of giving birth you may be more likely to have heavy and irregular bleeding
- progestogen-only pill
- fertility awareness methods – it may be more difficult to identify your fertile time immediately after giving birth or when you’re breastfeeding.
You can start the combined pill from 3 weeks after the birth if you’re not breastfeeding, or from 6 weeks if you are breastfeeding. Because your risk of blood clots is higher during pregnancy and after giving birth, you may be advised to wait until 6 weeks even if you’re not breastfeeding.
Read more about the methods of contraception.
Can breastfeeding act as a contraceptive?
Breastfeeding is also known as lactation. It can help to delay when you start ovulating (releasing an egg) and having periods after the birth. This is known as lactational amenorrhoea (LAM) and it can be used as a contraceptive method. LAM can be up to 98% effective in preventing pregnancy for up to 6 months after the birth.
All of the following conditions must apply:
- You’re fully, or nearly fully, breastfeeding.
- This means you’re only giving your baby breast milk, or you’re infrequently giving other liquids in addition to your breast milk.
- Your baby is less than 6 months old.
- You haven’t had a period since the birth.
The risk of pregnancy increases if any of these conditions apply:
- you start breastfeeding less often
- there are long intervals between feeds – both day or night
- you stop night feeds
- you use supplement feeding
- your periods return.
Once your baby is more than 6 months old the risk of getting pregnant increases, so even if you don’t have periods and are fully or nearly fully breastfeeding, you should use another contraceptive method.
Can contraception affect my breast milk?
If you’re using a hormonal method of contraception, a small amount of hormone will enter your milk but no research has shown that this will harm your baby.
It’s advised that you wait until your baby is 6 weeks old before starting the combined pill. The combined pill contains the hormone oestrogen which may affect your milk production starting.
Using the IUD doesn’t affect your milk and copper from it doesn’t get into the milk.
What if I want to get pregnant again?
If you do want to get pregnant again, it's best to wait at least 1 year after giving birth before getting pregnant again. This can help you have a healthier pregnancy and birth and reduce the risk of complications such as an early birth or a very small baby. If you do get pregnant earlier, don’t worry – ask for advice from your doctor, nurse or midwife.
If you want to get pregnant again, choose a reversible contraception option.
- Most contraception methods are quickly reversible, including an implant or IUD, and your normal fertility will return quickly.
- If you use the injection (Depo Provera), your fertility may not return for several months after your last injection has worn off. It can sometimes take up to 1 year for your periods and fertility to get back to normal. So if you want to get pregnant sooner, this may not be the best method to choose.
Can I use emergency contraception after the birth?
If it’s 21 days or more since the birth and you have sex without using a contraceptive method, or you think your contraception might have failed, you can use emergency contraception. It’s unlikely you will get pregnant earlier than 21 days (3 weeks) after the birth.
There are 2 main types of emergency contraception:
- copper intra-uterine device (IUD) – a small object that is placed inside your uterus (womb)
- emergency contraceptive pill (ECP).
You can use an emergency pill from 21 days after childbirth and within 72 hours of unprotected sex. You can use the emergency IUD from 28 days after childbirth. It should be used less than 5 days after unprotected sex. You can continue to breastfeed if you use the emergency IUD or an emergency pill. Read more about emergency contraception.
- New Zealand Aotearoa’s guidance on contraception Ministry of Health, NZ, 2020
- Contraception after pēpi Family Planning, NZ
|Dr Alice Miller trained as a GP in the UK and has been working in New Zealand since 2013. She has undertaken extra study in diabetes, sexual and reproductive healthcare, and skin cancer medicine. Alice has a special interest in preventative health and self-care, which she is building on by studying for the Diploma of Public Health with the University of Otago in Wellington.|