Postpartum: Postpartum birth control

I have just had my first child and the doctor has told me to refrain from having intercourse until after my six week checkup. I am not breastfeeding and would like to make sure I don't get pregnant. How soon can I safely start back on my birth control pills?

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

In a woman who is not breastfeeding, you may safely begin oral contraceptives at three weeks postpartum. Some care providers begin contraceptives as early as five days postpartum, or as late as four weeks. The reason most authorities recommend the two to three week interval is to avoid the period of peak risk for thrombo-embolic complications (blood clots). This is a very rare side effect, but waiting this period of time is the safest course.

Norplant or Depo-Provera, because they contain no estrogen, can be implemented immediately after the birth.

Diaphragm fitting and cervical cap placement should wait until the six week checkup to be initiated.

Foam and condoms are a good interval form of protection.

You are wise to consider this now because most women do not wait until six weeks postpartum to make love again. Unless a woman has had a traumatic birth, for example if she has had a severe laceration or uterine hemorrhage, a couple can make love when the woman feels "ready" and the red discharge has turned to a scant pink or white. This generally occurs at two to four weeks.

For the "first time," it is a good idea to give yourself plenty of time and take it slowly. It is often necessary to dilate tissues, which have been sutured, and be sufficiently aroused so you produce enough lubrication. (Lack of lubrication can be due to anxiety or hormonal changes unique to the postpartum period.) The use of a water-based lubricant such as KY, AstroGlide or Slippery Stuff is generally a good idea.

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