Contraception may be the last thing on your mind when you’ve just had a baby, but it’s something you need to think about if you want to delay or avoid another pregnancy.

A gap of less than 12 months between childbirth and conceiving again is associated with an increased risk of preterm birth, low birthweight and small for gestational age babies.

The earliest your periods can return is five to six weeks after the birth if you’re not breastfeeding. Breastfeeding usually delays the return of your periods.

You can become pregnant before your period returns because ovulation (releasing an egg) occurs about two weeks before you get your period. You need to start using contraception from three weeks (21 days) after the birth.

Don’t wait for your periods to return or until you have your postnatal check before using contraception as you could get pregnant again before then.

If you’re fully breastfeeding, it can be up to 98% effective in preventing pregnancy for up to six months after the birth. However, this is only the case if you are fully (or nearly fully) breastfeeding, your baby is less than six months old, and you haven’t had a period since the birth.

The risk of pregnancy increases if you start breastfeeding less often, there are long intervals between feeds – both day and night, you stop night feeds, you use supplement feeding, or your periods return. It can often be difficult to predict when these changes to your breastfeeding routine might occur, so it is advisable to use another method of contraception as well as breastfeeding.

This will depend on what you and your partner prefer, your medical history, any problems you had in your pregnancy and if you’re breastfeeding.

You can find out more about all the different contraceptive methods at Contraception Choices.

You can also discuss your options with your GP or make an appointment with Swindon Sexual Health Service.

At Great Western Hospital we offer the progesterone only pill (‘mini-pill’); which we recommend for all new mothers. This can be started immediately after giving birth and you can take home a three month supply.

This will give you contraceptive cover until you have had time to think about and decide which long-term contraceptive method you would like to use.

One pill should be taken each day, with no gaps. It is important that it is taken at the same time each day as if it is taken more than 12 hours late it will be ineffective.

Ideally the pill would need to be started before/on 21 days, if later you would need to take use an additional contraceptive for one week.

  • Effectiveness - Over 99% effective if always taken according to instructions (perfect use). With typical use, around 91% effective.
  • How it works - Contains the hormone progestogen, which thickens cervical mucus to prevent sperm reaching an egg. In some cycles it stops ovulation (releasing an egg).
  • Breastfeeding - A small amount of the hormone will enter the milk, but no evidence has shown that this will harm your baby.
  • Advantages - This may help with premenstrual symptoms and painful periods.
  • Disadvantages - Periods may stop, or be irregular, light, or more frequent. There may be temporary side effects such as acne, breast tenderness, weight change, headaches and you may get ovarian cysts.

The other option offered on the postnatal ward is the contraceptive injection (Depo-Provera). The contraceptive injection can be given any time after you have given birth if you're not breastfeeding.

If you're breastfeeding, the injection will usually be given after six weeks. Ideally the contraception would need to be started before/on 21 days, if later you would need to take use an additional contraceptive for one week.

  • Effectiveness - Over 99% effective, Depo- Provera lasts 13 weeks.
  • How it works - Contains the hormone progestogen, which thickens cervical mucus to prevent sperm reaching an egg. In some cycles it stops ovulation (releasing an egg).
  • Breastfeeding - it's safe to use while you're breastfeeding. If you're breastfeeding, the injection will usually be given after six weeks. As there are limitations of the data regarding the effects of MPA in breastfed infants less than six weeks old, Provera should be given no sooner than six weeks post-partum when the infant's enzyme system is more developed.
  • Advantages - This may help with premenstrual symptoms and painful periods. Also, you wouldn’t need to remember to take a pill every day.
  • Disadvantages - Periods may stop, or be irregular, light, or more frequent. There may be temporary side effects such as acne, breast tenderness, weight change, headaches. Can cause thinning of bones, risk of infection at the site or rarely allergic reaction. You are more likely to have heavy and irregular bleeding if you have the injection during the first few weeks after giving birth.

The contraceptive implant (Nexplanon) is a small flexible plastic rod that can be placed under the skin in your upper arm which may also be used, this would need a referral to the sexual health team. Please do let the midwife or doctor know if you are interested in it.

If you would like to be prescribed the progesterone pill or an injectable contraceptive, please ask your Midwife for the request form.

Please complete your details and medical history and sign the form. A doctor will then be happy to talk to you and prescribe.
If you do experience any side effects or are considering any other contraceptive options, please contact your GP.