Fertility can return much more rapidly than many women assume after giving birth, and myths still abound about what contraception can and can't be used while breastfeeding. The British Pregnancy Advisory Service (bpas) has developed a pamphlet providing guidance on postnatal fertility and contraceptive options for new mothers, after noticing a rise in women experiencing unplanned pregnancies shortly after birth.
bpas has seen a particular increase among breastfeeding mothers with some believing it provided full contraceptive cover, while many women are unsure which methods are safe to use while nursing their baby - especially when it comes to emergency contraception.
The pamphlet advises:
- Fertility can return within 28 days after giving birth. However, if women want to avoid pregnancy they need to start using contraception 21 days postpartum
- Breastfeeding can provide effective protection against unwanted pregnancy but only if strict criteria are met - the baby must be less than 6 months old, women must be exclusively breastfeeding and feeding at regular intervals (every four hours during the day and six during the night), their periods must not have returned, and their baby must not be using a dummy.
- Women who are breastfeeding can safely use a range of contraceptives - including progestrogen-based methods such as the coil, implant and mini-pill.
- Progestogen-only emergency contraception (Levonelle) can be taken while breastfeeding without needing to "pump and dump" (express and discard breastmilk). Another form of emergency contraception, EllaOne, may be more effective in women with a BMI of over 30, but women are advised not to breastfeed their baby for 36 hours after taking it.
- The contraceptive patch and ring may be a particularly good option for women "in between" children who do not need years of protection but do not want to take a daily pill. These longer acting contraceptives don't require medical professionals to fit or remove, and provide protection on a weekly or monthly basis. Worringly, however, research conducted by bpas with Mumsnet found that less than 1% of new mums are being given advice about these methods.
A cross-party parliamentary inquiry into unplanned pregnancy led by Conservative MP Amber Rudd last year highlighted the need for new mothers to be given the full range of contraceptive options to enable them to make the choice that is right for them. The inquiry also recommended improvements to contraceptive advice post birth and highlighted the importance of finding opportunities in the antenatal period for these discussions.
Tracey Forsyth, bpas lead contraception nurse, said:
It's vital that new mums are able to access reliable information about contraception after they have had a baby. We know that for many women the dramatic change in their life means that they want to reconsider which method to use. For some it becomes hard to fit in the routine of taking a daily pill after the arrival of their baby, others may be unable to use their previous contraception if they choose to breastfeed, and some women are falling pregnant because they believed breastfeeding would automatically provide full contraceptive cover.
At bpas we are concerned to see women experiencing the turmoil of an unplanned pregnancy while looking after a new baby. All women should have access to clear, accurate advice about which contraception can be used after giving birth, the effectiveness of breastfeeding as a method of contraception, and information about safe methods of contraception that they can use in the postnatal period."