13 October 2012

Breastfeeding & Contraception

Today we have a lovely interview with Caroline Cooper. Dr Caroline Cooper is a Women’s Health Specialist working in Contraception and Sexual Health clinics in Cambridge. She is a member of The Faculty of Sexual and Reproductive Health and of the Institute of Psychosexual Medicine, and is actively involved in the education and training of other health care professionals in all aspects of sexual and reproductive health.

So first things first Caroline, tell us a little bit about yourself and what you do?
Hi Laura- I'm a specialist in sexual and reproductive health and have many years of experience working in general practice looking after new breastfeeding mums.
What do you think about Breastfeeding & Contraception, is it a hard subject to approach with new Breastfeeding mums?
Not at all, I think that women expect their doctor or midwife to discuss contraception with them, and are often surprised if we don't. In fact this should ideally be discussed with a woman before her baby is born so that she has time to consider what method will be right for her, as it may be a change from her previous contraception. 
How long should you wait after the birth of your baby before taking contraception if Breastfeeding?
The earliest any woman needs to start using contraception after having a baby is 3 weeks.
What are the best contraceptives to use when you are Breastfeeding?
Breastfeeding mums are advised to avoid combined hormonal contraceptives containing oestrogen hormones for the first 6 months of breastfeeding. This is found in many of the commonly used contraceptive pills, the patch and the vaginal ring. The progesterone only pill or mini pill that you take every day can safely be started at any time after delivery. Breastfeeding mums may want to consider long-acting reversible contraception so that they don't need to remember to take a Pill every day. A copper IUD or hormone containing IUS can be fitted from 4 weeks after your baby is born, and an implant can be fitted from 3 weeks. All these methods are rapidly reversible if you decide to try for another baby. The progestogen only injection can be used from 3 weeks, but some women may get troublesome bleeding, so it is often started at 6 weeks.
Don’t forget barrier methods will be safe for breastfeeding Mums and a diaphragm or cap can be fitted when your baby is six weeks old. Condoms can be used at any time, but breastfeeding Mums can sometimes get vaginal dryness so may need to use a non-oil based lubricant with them.
Do these have any effects on milk production?
There is no evidence that progestogen only contraception affects breast milk volume.
Would any of the hormones in these contraceptives affect the baby in any way?
Progestogen only contraception has been shown to have no effect on infant growth.
As an alternative is Breastfeeding enough of a contraceptive on its own?
Yes many breastfeeding mums may be unaware that  breastfeeding is an effective contraceptive, and this can often be forgotten by healthcare professionals too. For a baby up to six months oId, if a woman is fully breastfeeding, and her periods have not yet returned she only has a 2% chance of pregnancy. This is comparable to many other types of contraception. It is important that the woman is feeding her baby on demand, and not giving any supplementary feeds. Use of pacifiers can also make this method less effective. Once night feeds stop or weaning starts this method can no longer be relied on.
Is there anything else you think would like to tell us?
Don't worry if you have forgotten to start a regular method of contraception and need emergency contraception  - this can still be used. It is not needed in the first 3 weeks after your baby is born or if the conditions are met for breastfeeding itself to be a contraceptive. Otherwise you can still safely take the progestogen emergency contraceptive pill or have a copper IUD fitted whilst breastfeeding.
Remember that breastfeeding Mums still have a huge choice of contraception, and its important to find time to have a chat with your doctor or midwife to find the method that suits you best!

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