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Key takeaways

• Your fertility can return quickly after birth, even if you are breastfeeding.
• It is recommended to wait at least 18 months before your next pregnancy.
• Many effective contraception methods are available, including while breastfeeding.
• Discuss your options with a doctor, midwife or health visitor to find the best choice for you

Contraception after birth

Your fertility can return quickly after childbirth. You could become pregnant as early as 3 weeks after your baby is born. This can happen even if you are breastfeeding and your periods have not yet started again.

If you are having sex that could lead to pregnancy, you should start using contraception no later than 3 weeks after your baby is born. Discussing contraception with your maternity team before you give birth can help you decide on a method. This can also help avoid delays when you are discharged from the hospital.

There are many benefits to leaving a gap of at least 18 months between pregnancies. This can help you have a healthier pregnancy and birth. This gives your body time to recover, which can support a healthier pregnancy and birth next time.

Sometimes, pregnancy is not always planned. If you do become pregnant sooner, your midwife will ensure you receive the best care.

Long-acting reversible contraception (LARC)

Long-acting reversible contraception (LARC) methods are very effective. They can often be placed immediately after birth or at your postnatal check. They are generally suitable if you are breastfeeding.

Intrauterine devices (IUD and IUS)

An intrauterine device (IUD) – often called a coil – is a small, T-shaped plastic and copper device. A doctor or nurse places it into your womb (uterus). It releases copper to stop the egg from implanting in your womb or being fertilised.

An IUD can stay in for 5 to 10 years, depending on the type. Copper IUDs do not affect breastfeeding.

A levonorgestrel-releasing intrauterine system (IUS) – such as Mirena – is a progestogen-only contraceptive. It releases a hormone (levonorgestrel) directly into your womb. It is effective for up to 8 years and can also be used for very heavy periods.

When can an IUD or IUS be fitted?

You can have an IUD or IUS fitted at the time of birth or within 48 hours of giving birth. If not fitted within this time, it is usually recommended to wait until 4 weeks after the birth.

You can start these types of contraception straight after birth, including if you are breastfeeding. There is a chance hormonal contraception could affect your milk supply. However, there is not much evidence to support this.

An IUD can also be used as emergency contraception. This can be fitted from 28 days after giving birth, unless it was fitted within 48 hours of birth.

Contraceptive implant

The contraceptive implant – such as Nexplanon – is a single, rod-shaped implant. It releases a hormone (etonogestrel) that stops you from getting pregnant. It must be removed no later than the end of the third year.

While some NHS guidance states the implant can be started straight after birth, other advice suggests waiting until 28 days after the birth. This is particularly to be cautious about milk supply. Discuss the timing with your doctor, midwife or health visitor.

It may be advisable to try one month of progestogen tablets before using a long-acting hormonal contraceptive like the implant or injection. This can help you see if the hormone affects your milk supply.

Shorter-acting and barrier methods

Progestogen-only pill (POP)

The progestogen-only contraceptive pill (POP) – also known as the mini-pill – is generally recommended during breastfeeding. You need to take it at the same time every day.

A delay of more than 3 hours may mean it might not protect you from pregnancy. Vomiting and severe diarrhoea can also affect how it is absorbed.

The POP is generally started 3 weeks after birth but can be started immediately. New guidelines suggest that using the POP from birth will not reduce your milk supply. However, some breastfeeding specialists have different experiences. It is important that you have all the information to help you decide what is right for you about the risk of starting contraception early.

Avoid using any form of a hormone called progesterone in the first week after the birth. This may reduce early milk production.

• If started up to 21 days after the birth, you do not need to use another form of contraception (like condoms).
• If started more than 21 days after the birth, you will need to use another form of contraception (like condoms) for 2 days.

Contraceptive injection

The contraceptive injection – such as Depo-Provera – can be used immediately after birth. It is then repeated every 12 weeks.

While some NHS guidance states the implant can be started straight after birth, other advice suggests waiting until 28 days after the birth. This is particularly to be cautious about milk supply. Discuss the timing with your doctor, midwife or health visitor.

It may also be advisable to try one month of progestogen tablets before using the injection. This can help you see if the hormone affects your milk supply.

Combined pill

If you are breastfeeding, it is generally advised to wait for 6 weeks after birth before starting the combined pill. This is to reduce the small risk of a blood clot in a deep vein (deep vein thrombosis, or DVT).

The combined pill contains a hormone called oestrogen, which can sometimes affect milk supply and slightly increase the risk of blood clots. Therefore, your doctor will usually suggest other methods while you are breastfeeding.

Barrier methods

You can use barrier methods of contraception such as condoms, diaphragms, and caps. These do not affect breastfeeding. Lubricants and creams or gels that stop sperm from working (spermicides) are also safe to use while breastfeeding.

You can use male and female condoms as soon as you feel ready to have sex. You can usually start using a diaphragm or cap around 6 weeks after giving birth.

If you used a diaphragm or cap before pregnancy, see a GP or nurse at a contraception clinic. This is to make sure it still fits correctly. Childbirth or changes in weight might mean you need a different size.

Choosing the right method for you

When choosing contraception, think about what is right for you. It can be helpful to talk with your partner about how you both feel about the timing of another baby. Consider your breastfeeding plans. Think about whether you are exclusively breastfeeding, or if your baby has started solid foods or is having other milks. This can affect when your body might start releasing eggs again (ovulation). Most evidence suggests that progestogen-only methods of contraception have no adverse effects on lactation, infant growth or development.

Speak to your midwife, health visitor, or family planning nurse for more information on contraception. They can help you make an informed decision about the best method for you.