Sunday, 21 September 2014
As soon as you've had a baby, your health visitor starts asking you about birth control. So what are the pros and cons of the options available? Nifa Mclaughlin investigates
From my mid-teens onwards I dabbled with most forms of contraception. The Pill made me sick, I put on weight and each month I turned into that mad woman in the attic from Jane Eyre. The Evra patch gave me migraines and sore breasts, and I just couldn’t get my head around a diaphragm.
After I had my babies close together I needed contraception I didn’t have to think about, so I tried an IUS. I could live with the contraction-like pains which shot through my abdomen for the first couple of months, and I loved not having to remember to take pills, but what finally made me snap was the appearance of teenage acne.
Approaching my mid-thirties, being a mum to two young girls and trying to be taken seriously in my career meant I had little time for slathering my face with magic acne potions and spending hours trying to cover up what was happening to my skin. The IUS had to go. I’m not the only one who feels at a loss when it comes to contraception post-birth.
A quick poll of my mum friends revealed that three of them had an IUS or IUD fitted and seemed happy, although one got an infection immediately after having her IUD fitted and ended up in hospital. Two friends went back on the Pill and were happy, but not with the hormones they were putting into their bodies. One friend had the injection and swore by it, and the rest used various forms of natural methods including condoms and digital ovulation monitors; most used the withdrawal method. It got me thinking, why were so many of my friends shunning ‘reliable’ contraception (and by that I mean around 97 to 99 per cent effective) for less reliable natural methods.
Short or long-term contraception?
Straight after you’ve given birth may not be the best time to choose a long-term method of contraception because while most of us can’t think of anything other than looking after our precious newborns, let alone getting frisky or, gulp, having another baby, the average gap between siblings is between two and three years. Add nine months of pregnancy to this, plus ‘trying time’ and you may well be thinking about baby-making again once your child reaches a year and a half. With this in mind, there are obvious contraceptive methods to avoid. Dr Alyson Elliman, a Consultant in Sexual and Reproductive Healthcare, and Vice President of the Faculty of Sexual and Reproductive Healthcare says that the most important question mums should ask themselves is ‘how crucial is it not to fall pregnant again?’.
If you definitely don’t want to be pregnant soon, the contraceptive injection is a good idea as it works by preventing ovulation and it can take a year for your fertility to return. An implant, an IUD or an IUS can also be good longer-term options because they stay in place for three to ten years, can be reversed and taken quickly out of your system should you want more children in the future, and you can pretty much forget about them being there.
You actually can’t get pregnant for the first 21 days post-partum, so contraception isn’t needed, but after that – and before your six-week check – you can get pregnant,’ explains Lynn Hearton, Helpline and Information Services Manager for the Family Planning Association (FPA). ‘It’s also a myth you can’t get pregnant while breastfeeding. If you are breastfeeding all the time, day and night, hormonal feedback to the brain stops you ovulating,’ she continues. ‘But if you give your baby anything else, for example top-up feeds with formula or water, or your baby starts to sleep for longer periods during the night, you need to use another method such as condoms.’
She goes on to add that once you understand breastfeeding and contraception, it can be a good contraceptive method for the first couple of months after you’ve given birth, providing you are feeding on demand (again, she emphasises day and night feeding) and your periods haven’t started yet. It can help you while you decide which longer-term contraception method might work for you.
‘If you’re breastfeeding it’s wise to stay away from anything which contains oestrogen as it can interfere with the production of breast milk,’ Alyson explains. ‘So avoid the combined pill, the patch and the vaginal ring – instead consider an implant, IUDs, an IUS or the injection which contain no oestrogen.’
Affecting your periods
Which method you choose depends on many things, including, importantly, if your periods have changed. ‘My periods came back at around six weeks but they were totally different to before,’ explains Abi, a first-time mum. ‘I used to be quite light and irregular but post-birth my periods were really heavy, so I chose to use a contraceptive patch to try to lessen the onslaught!’ Lynn explains that it’s normal for your periods to change after having a baby and for many women who spent pre-baby years on the Pill, they’ll be introduced back to a cycle unaffected by hormones once their periods return.
Lynn adds that lots of women aren’t comfortable with their periods reducing to almost nothing, or stopping completely, while using contraception such as an IUS. Mum-of-two Rebecca Hilliar, had an IUS fitted for a while after she had her first baby, but wasn’t comfortable with the absence of her periods. ‘I’m not fond of my period, but it’s an old friend I’d rather see than not!’ she explains.
The chaotic, sleep-deprived world new mums inhabit probably isn’t the right environment for remembering to take a pill every day, or even planning visits to the GP to get contraception on an on-going basis unless you are well-organised. ‘Having babies is a time when many women reassess the contraception they use,’ says Alyson. ‘But it’s a good idea to try out methods you were using before you had children if you were comfortable with them.’ Unfortunately, just like when you first started using contraception, finding a method that suits you will probably be a bit of trial and error.
Lynn adds that it’s wise to remember your body and your lifestyle have changed dramatically: ‘You’re essentially starting from scratch postnatally, so if old methods don’t agree with you, consider trying something new. An IUS or IUD is actually less painful to fit in women who’ve experienced childbirth and methods you may have dismissed in your child-free days such as a diaphragm or a patch may now suit your lifestyle.’
Before I had children, I saw my period as a nuisance, but post-birth I’m more in touch with my body and can view it as something that enabled me to have babies. I understand now that stomach cramps and painful boobs are all part of the journey to finding contraception which perfectly suits us and our new lifestyles now we’re mums.’
After having babies, some women may decide to give their bodies a break from the hormones contraceptives can contain. Barrier methods such as condoms don’t involve hormones, but can be fiddly and unromantic, to say the least. Natural Family Planning can be an option, especially for those who feel more in tune with their bodies post-birth. It involves looking at your cycle and signs
from your body that you are ovulating and only using contraception when you are in your ‘fertile days’ (typically around ten to 16 days before the start of your next period). However, Lynn warns that natural methods can be hugely unreliable especially after having babies when your cycle can be erratic. ‘I deal with plenty of women who don’t mind either way whether they get pregnant again – for them, natural methods are great. But for most women, playing “roulette” with whether they get pregnant or not is not really an option.’ Using something like Persona, which monitors the hormones in your urine and tells you whether it’s safe to go with or without contraception, can be an option, but only if you understand that it is not as reliable as other methods on the market.
Hormonal: These methods contain different levels of oestrogen and progestogen (man-made varieties of naturally occurring hormones). They’re around 99 per cent effective if used correctly.
The combined pill:The Pill works in cycles so you take one pill each day for 21 days and then have seven pill-free days at the end. Ideal if: You don’t want sex to be disrupted by fitting a contraceptive device, you’re happy to take hormones, you suffer from acne or heavy or irregular periods. Not ideal if: You are breastfeeding (the Pill contains hormones), you are over 35 and smoke or were a recent smoker.
The mini-pill or progestogen-only pill (POP): The mini-Pill only contains progestogen not oestrogen and is taken daily. Ideal if: You’re organised (you have to take the pill at the same time each day), you are breastfeeding, you suffer from painful periods, you are over 35 or a smoker. Not ideal if: You’ve ever suffered from ovarian cysts, breast or liver cancer or have had an ectopic pregnancy.
Vaginal ring: The vaginal ring is a flexible plastic ring inserted into your vagina on the first day of your period and is taken out 21 days later. Seven days after removing it you insert a new one. The ring continually releases the hormones oestrogen and progestogen. ideal IF: You don’t want sex to be disrupted by fitting a contraceptive device, but don’t like the idea of hormones. You don’t want to have to remember to take a pill every day (you only have to change it once a month). Not ideal if: You’re overweight, over 35 or a smoker, have had heart problems or suffer migraines.
The Evra Patch: A 5cm patch that you stick on to your skin which releases a daily dose of oestrogen and progestogen. Each patch lasts for seven days. You have a patch-free seven days once in every 28 days. ideal if: You’ve tried using the Pill and it makes you nauseous.
Not ideal if: It has the same drawback as the combined Pill, see above.
Barrier methods: These methods literally act as a barrier, stopping sperm from reaching the egg.
Male and female condoms: Both are 95 per cent effective if used correctly (placed in position before penetration begins)
Ideal for: Breastfeeding mums, those after a temporary solution, women who don’t want to take hormones, smokers, those who want protection from STIs. Not ideal FOR: Those who don’t want to interrupt foreplay (although the female condom can be put in place in advance).
Diaphragm or cap: Soft domes made of either silicone or rubber, which the woman inserts just before sex. Between 92 and 96 per cent effective when used correctly with spermicide. Ideal IF: You don’t want hormones in your system, you’re breastfeeding, you smoke. Not ideal IF: You don’t want to interrupt sex to insert a device, you have weak vaginal muscles, you’re allergic to spermicide.
Long-acting reversible contraception (LARC)
Hormonal IUS (Intrauterine system): An IUS (or Mirena) is a small device that contains progestogen that is fitted inside your uterus by a health professional. The progestogen thickens the mucus so it becomes difficult for sperm to swim to the egg and also thins the lining of the womb so it’s less likely to accept a fertilised egg. In some women ovulation is stopped altogether. Can be left in for five years. ideal if: You’re happy to take hormones, are breastfeeding, looking for longer-term contraception, have heavy or painful periods. Not ideal if: you have cervical problems, have had any bleeding between periods or after sex, have had breast cancer, heart problems or blood clots.
Contraceptive Injections: The injection lasts for either eight or 12 weeks depending on which one you go for. The injections slowly release progestogen into your system and are 99 per cent effective if you have your repeat injections on time. ideal if: You don’t mind hormones in your system, you are breastfeeding, you smoke, you don’t want to get pregnant again in the next year (it can take a while before you fertility returns to how it was before). Not ideal if: You’ve had any of the following: breast cancer, osteoporosis, heart disease or diabetes affecting the eyes or kidneys, or you want to get pregnant fairly soon.
Contraceptive implants: A small flexible tube the size of a hairgrip which is inserted under the skin in the inner upper arm. It slowly releases progestogen over three years, stopping your ovaries from releasing an egg each month. It’s advantage is your fertility returns as soon as it’s removed. ideal if: You are breastfeeding, you’re happy to take hormones, you don’t mind your periods changing or stopping. Not ideal if: You’ve had breast cancer or serious heart disease, have had bleeding between periods or after sex.
Non-hormonal IUD (Intrauterine device or coil): This is the only long-term reversible contraceptive that releases no hormones, and it’s fitted in exactly the same way as the IUS. ideal if: You’re breastfeeding and want longer-term protection (can be left in for five to ten years). Not ideal if: You’re allergic to copper, have cervical problems or heavy periods (the IUD can make periods heavier).
Natural Family Planning: This means getting to know your cycle and looking at signs from your body that you are ovulating. Effective if practised properly, but because women’s cycles post-birth can be erratic it can be unreliable, too. Computerised fertility monitors (such as Persona) can track hormonal levels in urine. Not ideal if:You definitely don’t want to get pregnant!
Permanent methods: Sterilisation (for both men and women) is the only permanent method to stop pregnancy from happening, but the general message these days is that the LARC methods are ever more reliable and reversible, should your circumstances ever change.
For more info visit fpa.org.uk England 0845 122 8690; Northern Ireland 0845 122 8687
‘I’m so much more emotional now as a new mum, so I don’t feel like I need more hormones in my system confusing everything'
Amy, mum to four-week-old Lola
'I use Persona, so have to wee on a stick each morning and it tells me whether it’s safe to have unprotected sex, or whether to use protection. The funny thing was I also used it to work out when I was ovulating when conceiving Evan, so it works both ways!’
Esther, mum to Mya, four and Evan, eight months
'I use the copper coil, but I think I’m one of the lucky ones that doesn’t experience heavier bleeding. I like the fact it has no hormones, but it’s long-term.’
Laura, mum to James, 18 months
'Ten weeks after having Jasper, I had
the Mirena coil fitted and it was the best decision. My periods are so light I barely notice them and it wasn’t that painful to fit. I knew I needed a method which was reliable and that I didn’t have to remember because I’m definitely on the scatty side.'
Heather, mum to Olivia, six,and Jasper, three
'I’ve been advised not to have any more children for medical reasons, so six months ago I had the implant inserted which I’m happy with. I like not having to think about contraception.’
Natasha, mum to Sebastian, one
'I have just gone back on the pill. I didn't really want all those hormones back in my body again but I think, for me, it's the most reliable method'
Sophie, mum to Mia, four, and Finn, 14 months
'When Ted was 7 months old, I started the contraceptive injections again. I just find it so much easier not having to remember to take the pill. Before that we just used condoms which we both hated'
Lauren, mum to Jessica, five and Ted, one