Just in case you’ve heard otherwise, you can get pregnant while breastfeeding. If you wish to continue breastfeeding, it’s important to know which contraceptives will work for you without disrupting milk production. It is also good to know that all of the choices recommended here will not hurt your baby through your milk. Because most care providers recommend that you abstain from sex for at least six weeks after baby is born, you have time to consider the birth control options discussed below.
Intrauterine Devices or IUDs
IUDs are small, T-shaped devices that your care provider inserts into your uterus, possibly at your six-week appointment after baby’s birth. For some people IUD insertion is incredibly painful, while others barely notice it is happening. IUDs are a long-term option given that they can last between five and twelve years, but they are not permanent and can be removed by a trained provider at any time if you decide you would like to get pregnant again.
Two types of IUDs are widely available: a copper IUD (marketed under the name ParaGard in the United States) and hormonal IUDs (US brand names Mirena or Skyla), which release low amounts of progestin, the synthetic version of the hormone progesterone. Both types of IUDs work by preventing sperm from reaching any eggs. They each have pros and cons, but where breastfeeding is concerned, they are great options because they are either hormone-free (copper IUD) or release hormones locally, that is mostly just in and around the uterus, (hormonal IUD), so they are less likely to disrupt milk production.
The Pill, Patch, and Ring
All three of these options are hormonal methods of birth control, meaning they contain a hormone or combination of hormones that are gradually released (patch and ring) or ingested (pill) over the course of your menstrual cycle. Most pills, the patch, and the ring contain a combination of the hormones progesterone and estrogen, which work to prevent pregnancy by preventing sperm from meeting an egg. The problem with this combination is that any birth control that contains estrogen could interfere with milk production.
The best option, therefore, is to ask your provider about the “mini pill,” which contains just progesterone and is therefore less likely disrupt breast milk production. One other thing to remember about the pill is that it only works if taken on schedule, which means every day. If you think you might have trouble remembering it, you might want to choose a different birth control option.
Injection and Implant
Two other progesterone-only options are the injection (available in the U.S. under the name Depo-Provera and also sometimes called the Depo shot) and the implant (called Nexplanon or Implanon in the U.S.). Both of these methods prevent pregnancy by preventing ovulation and by thickening cervical mucus, which makes it harder for sperm to swim. You have to get the injection from your care provider every three months. The implant is small—about the size of a match—and your care provider will place it under the skin of your arm near your bicep. The implant can last up to four years, but you can get pregnant soon after having it removed, making it a great option if you think you might want to have more children in the future. Both of these methods have advantages for breastfeeding parents: you don’t have to think about them too much, so there is less to keep track of, and because they do not contain estrogen, they are less likely to impact your milk.
Barrier methods of birth control include the diaphragm, cervical cap, condom, and female condom. All of these options prevent pregnancy by providing a barrier that stops sperm from getting inside the cervix and finding an egg. Some are easier to get than others; for instance, condoms and female condoms are available over the counter. The diaphragm and the cervical cap are available only with a prescription from your care provider, who will fit you to make sure you receive the correct size. All of these barrier methods are more effective when also used with spermicide, which you can also get over the counter.
Because they are non-hormonal, these strategies likely will not interfere with breastfeeding. But in order for them to be effective at preventing pregnancy, you must remember to use them every time you have sex. Another thing to keep in mind is that it’s possible that these barrier methods could feel irritating to your vagina and cervix if you have had a baby very recently. In that case, another option could be a better fit for you.