One and a half months after the birth of a baby, 15% of non-nursing and 5% of nursing mothers recover ovulatory processes. And this means that by the third month, conception is possible. How to protect yourself during this period without harm to the health of mother and baby.
How to choose?
It is believed that in the first one and a half to two years after childbirth, it is undesirable to become pregnant. The female body has not yet recovered enough for bearing, and an abortion can cause dangerous complications in the reproductive and hormonal systems, and a sentence for the reproductive system.
Therefore, the selection of optimal contraception should be carried out carefully, seriously, with mandatory consultation with a specialist. After all, when a woman is breastfeeding, the method should not affect lactation and the health of the baby.
Usually in this case, women are advised to combine, protect themselves in several ways.
Natural Ways
The choice of method that can be recommended to a woman depends on what type of feeding the baby is on, and whether there are contraindications for a particular method of contraception. Natural protection completely eliminates negative factors. Its effectiveness is low, it requires certain rules to be observed.
Abstinence
- Only by the end of the second month, the uterus is completely restored and cleansed.
- The organ is highly susceptible to infection.
- Penetration into the injured perineum brings pain.
With difficult births, caesarean sections, ruptures and incisions, the period required for the full adaptation of the organ is doubled.
Often, young mothers immediately after childbirth do not want to resume sexual activity. They temporarily do not need it: priorities have changed, complexes have appeared due to a changed body, depression and chronic fatigue.
Complete abstinence in this period gives 100% contraception and allows the mother to recover, does not affect lactation processes. This method is used as an intermediate method, and in the future it is not suitable for couples.
lactational amenorrhea
Breastfeeding blocks the synthesis of the ovulation stimulating hormone estrogen and increases prolactin levels.
This means that if the egg does not mature, then conception is impossible.
But in order for this method of protection to work, certain conditions are important:
- The mode of natural feeding should be free - at the first request of the baby.
- The breaks between breastfeeding are no more than 4 hours during the day and six at night.
The method is suitable for the first six months, before the menstrual cycle resumes.
Advantages of lactational amenorrhea:
- The negative impact on the health of mother and baby is excluded.
- No contraindications.
- Will not protect against infection and genital infections.
- If the intervals between feedings are more than 4 hours, the baby is supplemented, he is 4 months old, introduce other contraceptives.
If a woman begins spotting, of any duration and intensity, then this indicates that the childbearing function has recovered.
calendar ways
They also refer to natural remedies for women. Their essence is to periodically, on certain calculated days on which you can conceive, refrain from sexual intercourse. Contraception after childbirth by the calendar method is used only when the menstrual cycle is fully restored.
- With an established cycle, ovulation occurs in the middle. If 28 days pass from the first day of one period to the first day of the next, the middle of the cycle (ovulation) comes to the 14th day. In this case, it is better to refrain from sexual intercourse or use additional methods for 5 days before and the same amount after.
- By rectal temperature in the morning, lying in bed. If on ordinary days it is not higher than 36.9 ° C, then with ovulation and before menstruation - 37.1 ° C.
- According to the properties of saliva. Cervical mucus and saliva during ovulation contain an increased amount of salts. With the help of a magnifying glass and special glasses, saliva is examined, and if it looks like a fern leaf in a dried state, ovulation has begun.
Postpartum contraception by calendar methods is not used immediately and is considered effective only with a fully established menstrual cycle.
Non-hormonal methods
This group of protection includes intrauterine and barrier means. They prevent the penetration of sperm into the vagina and cervix, and according to their method of exposure, there are mechanical (condom, vaginal diaphragm, cap), chemical (spermicides).
Intrauterine contraceptives
The spiral is allowed to enter a healthy woman on the second day after childbirth. If, due to contraindications, such a procedure has not been carried out, an intrauterine device is placed after childbirth at week 8.
If there is a spiral in the uterine cavity, it acts as a foreign body and prevents the fertilized egg from implanting and attaching.
Advantages of the method:
- It is considered one of the most effective.
- Does not affect the lactation process.
- No negative impact on the health of the mother, child.
- Provides long-term (5 years) contraception.
Disadvantages of intrauterine contraceptive:
- Setting and removing the spiral is an exclusively medical procedure.
- Not allowed for women with multiple sexual partners.
- Contraindicated in inflammatory and infectious diseases of the genitourinary system.
- In rare cases, periods become more abundant and painful.
A woman with an intrauterine device is obliged to visit a gynecologist every six months. After 5 years, the remedy must be removed.
Condom
Contraception after childbirth using condoms is the most popular, affordable and effective way, without a negative effect on the body and lactation. Often in the postpartum period, women complain of vaginal dryness, and condoms with lubricants eliminate this unpleasant symptom.
In addition, this type of barrier contraceptive protects against any kind of infection of the dilated cervical canal, prevents cervical cancer, and is easy to use.
Spermicides
The chemical method of protection includes the use of topical agents with spermicides. The main active ingredients nonoxynol and benzalkonium chloride reduce mobility and destroy spermatozoa. Additional components allow the drug to spread evenly into the vagina.
Dosage forms of drugs:
- Candles (Farmateks, Eroteks, Sterilin, Patenteks, Concepttrol).
- Cream, capsules (Farmateks).
- Film (ABF).
The action of the drugs begins in a few minutes, lasts about 6 hours.
Chemical methods of contraception after childbirth are suitable for women of any age and are allowed for the lactation period. They are available and available over the counter.
There are no hormonal components in spermicides, they are allowed to be used for a long time and combined (supplemented) with other contraception in the postpartum period. The effectiveness of the chemical method of protection is about 95%.
The group of barrier methods also includes diaphragms, caps and sponges, which, after deep insertion, close the vaginal lumen and protect the cervical canal from sperm. But today these funds are unpopular. Installing the diaphragm and caps requires some experience and skill.
Barrier methods do not provoke serious medical risks. Side effects include irritation and allergic reactions.
Hormonal contraception
Can you take birth control pills after giving birth? Yes. If a woman is tuned in to such a method of protection, then monocomponent agents based on a progestogen are shown.
Other combined oral preparations, which include several hormones, negatively affect the quality of milk, the physical and mental health of the baby.
Mini-drank
Hormonal pills with gestagens are indicated to a greater extent for nursing mothers. In those who have weaned a child from the breast, their effectiveness is reduced due to the onset of a full menstrual cycle.
Benefits of taking:
- If contraceptive pills are taken regularly, without interruptions, the effectiveness reaches 97%.
- The function of conception remains unoppressed.
- Do not affect the duration of the lactation period.
Minipill Disadvantages:
- The contraceptive effect is significantly reduced from violated rules of admission, combination with antibiotics, antidepressants.
- In the middle of the cycle, spotting is possible.
The mini-pill (Chirozetta, Ovretta, Micronor, Exluton) contains little progestogen. But this is enough for ovulation to stop, changes in the endometrium and cervical mucus to take place.
Prolonged gestagens
Long-acting drugs - injectable contraceptives with hormonal implants, are prescribed no earlier than six weeks after childbirth. Their effectiveness reaches 99%, and the benefits are like those of a mini-pill. The list of prolonged progestogen contraceptives includes:
- Depo Provera. Injectable drug. It is administered intramuscularly, forming a depot. With slow absorption provides protection for 12 weeks.
- Norplant is a subcutaneous implantable contraceptive. One injection in the forearm gives and maintains a contraceptive effect for 5 years.
Prolonged gestagens between injections require strict adherence to intervals, and after cancellation, the conception function is restored in the first six months.
Combined oral preparations
In the postpartum period, contraception with two-component preparations is allowed in two situations: breastfeeding has ended, or it was not at all.
Oral contraceptive pills are a modern, effective, reliable and safe approach to contraception. In addition, this type of drug is widely used for the treatment and prevention of many gynecological pathologies.
- Microdosed (Novinet, Logest)
- Low-dose (Regulon, Minisiston, Yarina).
- High-dose (Non-Ovlon, Anteovin).
The drugs have a list of contraindications, so they must be prescribed by a doctor after a thorough examination.
The pills are taken daily and regular intake provides 100% contraception.
Postcoital drugs
This type of protection is indicated only for episodic sexual intercourse and as an "ambulance" for a broken condom and missing pills. Postcoital contraception includes:
- Oral contraceptives in high dosages.
- A drug with a high content of progestogen Postinor.
- Mifepristone is a drug that interrupts ovulation and causes menstrual flow.
A group of postcoital drugs can cause uterine bleeding, and therefore is prescribed only by a doctor.
Drugs should not be taken during lactation, as they change the amount and composition of milk.
Hormonal intrauterine contraception
This type of protection is allowed for the postpartum and lactation period. Acting locally, the system (Mirena) gives the minimum concentration of hormones in milk, does not affect the quantitative and qualitative characteristics.
The essence of the method:
- Introduction into the uterine cavity of a special system with progestogen and levonor-gestrel.
- The composition, acting locally, affects the characteristics of cervical mucus with the endometrium, inhibits spermatozoa.
- This method is equal in efficiency to surgical sterilization, and has been working for 5 years.
- “Set and Forget” is a reliable and convenient way, especially for mothers busy taking care of a small child.
The system has another advantage. It reduces the volume, shortens the duration of menstruation, prevents inflammation and ectopic pregnancy. Hormonal intrauterine contraception is prescribed as a remedy for menorrhagia, uterine bleeding, benign neoplasms, desmenorrhea.
After childbirth, a woman's body is weakened, and requires maximum attention and care. Even if sexual intercourse is not possible for some time, a man should not forget about tenderness, affection and understanding during this difficult but unforgettable period in family life.
Postpartum contraception plays a leading role in a woman's life. Doctors recommend re-pregnancy no earlier than 2 years after childbirth, so that during this period of time the body has time to recover, and the woman gain physical and mental strength. But, of course, not all methods of contraception are acceptable and effective in the first 6-12 months after the birth of a child.
Features of postpartum contraception
The main requirement to be met contraceptive methods after childbirth- this is the safety of their use in relation to the child (many harmful substances, drugs and hormones penetrate into breast milk). In addition, all methods of contraception in the postpartum period should be as effective as possible.
It is necessary to take care of the issue of contraception immediately after childbirth, even before the onset of sexual activity.
There is an opinion that a woman cannot become pregnant after childbirth, especially if she is breastfeeding. In fact, reproductive ability is restored in some young mothers as early as 3 weeks after the birth of a child. Therefore, it is necessary to take care of the issue of contraception immediately after childbirth, even before the onset of sexual activity.
This method of contraception after childbirth is the most optimal and convenient. The method is based on lactational amenorrhea - the physiological state of a woman, when menstruation is absent, while breastfeeding continues. Prolactin, which promotes the formation of breast milk, inhibits the synthesis of sex hormones in the ovaries, thereby preventing ovulation.
For the lactational amenorrhea method to be effective, it must meet the following requirements:
- number of feedings. The number of feedings should be at least 6 times a day, that is, the break between feedings during the day should be no more than 3 hours, and at night no more than 6 hours. Optimal feeding of the child is not according to the regimen, but on demand (the more often, the better).
- duration of the method. The method is quite reliable in the first 6 months after birth, when the baby is fed only breast milk. After six months, complementary foods are introduced into the baby's diet, which reduces the frequency of breastfeeding, milk production, and, accordingly, prolactin.
- Absence of menses. The presence of menstruation even against the background of lactation indicates the restoration of ovulation and the ineffectiveness of the method of lactational amenorrhea.
- "Pure" breastfeeding. If a woman does not have enough milk, as a rule, they resort to supplementary feeding (mixed feeding), which also reduces the reliability of the lactational amenorrhea method.
Advantages of the lactational amenorrhea method:
- efficiency, subject to all the rules, reaches 98%;
- ease of use;
- instant effect (as soon as a woman starts breastfeeding, the method starts immediately);
- does not affect sexual intercourse;
- there are no side effects;
- reduced risk of postpartum hemorrhage;
- transmission of mother's antibodies to the child through breast milk;
- no medical supervision required.
Hormonal contraception after childbirth
Hormonal preparations also have sufficient contraceptive efficacy. In the postpartum period, especially during lactation, it is recommended to take mini-pills that contain only progestins (6 weeks after birth). If a woman is not breastfeeding, then they can be taken 4 weeks after the birth of a child or replace mini-pills with combined oral contraceptives (containing progestogen and estrogen) immediately after the resumption of menstruation. Combined hormonal pills are not recommended for women who are breastfeeding, as they reduce the amount of milk produced and impair its quality.
Mini-drinks (for example, Exluton) are taken continuously (28 tablets in one package). The contraceptive effect is based on thickening of the mucus in the cervical canal, which prevents the penetration of spermatozoa into the uterus, and structural changes in the endometrium, which makes implantation of a fertilized egg impossible.
It is possible to inject hormonal contraceptives containing progestogen (Depo-Provera 1 time / m in 12 weeks) and subcutaneous (Norplant capsules are sewn under the skin in the forearm).
Disadvantages of hormonal contraception:
- requires constant and regular intake of tablets;
- possible intermenstrual bleeding, nausea, acne, decreased libido;
- possible increase in body weight;
- increases the risk of ectopic pregnancy (slow peristalsis of the fallopian tubes).
Methods of contraception after childbirth are aimed at preventing the onset of a new pregnancy and protecting against sexual infections. The difficulty of choosing a method of protection lies in the fact that it is necessary to take into account not only contraindications in a woman, ease of use and effectiveness, but also lactation. Breastfeeding imposes restrictions on the choice of some methods of contraception in the postpartum period.
Why use protection after childbirth?
Pregnancy and childbirth do not rejuvenate the female body, but increase the load on all organ systems. Even in young women, against the background of bearing a child, diseases associated with pregnancy develop, and chronic pathologies become aggravated. Therefore, after childbirth, a recovery period is necessary. The optimal period of contraception after natural childbirth is 2 years.
Those who gave birth by cesarean section should not only wait 2-3 years, but also undergo an examination to make sure that the scar on the uterus is complete. Only then can you start planning a new pregnancy. For those who ignore medical recommendations, the following complications await:
Therefore, postpartum contraception is a necessity that will help plan a new pregnancy, properly prepare for it and reduce the risk of complications.
An unplanned pregnancy can occur during lactation. But due to increased prolactin, a nursing mother has a higher risk of early termination, and sometimes the fetus freezes at 5-6 weeks.
Advantages and disadvantages of natural contraception after childbirth
Protection after childbirth must be effective. And methods of natural contraception have a high Pearl index, which indicates a high frequency of pregnancy. For the calendar method, the indicator fluctuates at the level of 9-40, which depends on the correct assessment of the results of monitoring the menstrual cycle, the method of protection on dangerous days. It means that 9 to 40 women out of 100 will become pregnant within a year if they use this method of contraception.
Natural methods of protection against pregnancy are suitable only for permanent couples who are sure that their partner does not have a sexual infection. Those who prefer risky sexual behavior should use barrier contraceptives.
Calendar method of contraception after childbirth
To prevent pregnancy while breastfeeding, you must wait for the restoration of the menstrual cycle. In what period this will happen against the background of lactation, it is impossible to determine. In a young mother who breastfeeds only, including at night, menstruation can begin as early as 4 months, but sometimes the first bleeding appears after a year, and it takes several more months to establish a regular cycle.
To start using the calendar method, it is necessary to observe menstruation for at least 3 months, and the optimal period is 1 year. This will calculate:
- the exact duration of the cycle;
- average number of days;
- the shortest and longest cycle;
- approximate ovulation date.
This method of contraception for nursing mothers after childbirth is not suitable. Doctors allow sexual activity within a month from the date of birth of the child, so another way is needed that will allow you not to get pregnant ahead of time.
After childbirth, the calendar method can be used for those who are not breastfeeding. It is necessary to wait for normal menstruation and start monitoring its duration. To increase the accuracy of the results, you can additionally carry out:
- measurement of basal temperature;
- evaluate cervical mucus throughout the cycle;
- after the end of menstruation, check the position of the cervix daily.
The formation of the cycle after childbirth lasts individually, but by objective signs it is possible to determine the moment of restoration of fertility.
Breastfeeding women do not ovulate. This condition is provided by the hormone prolactin. Its release outside the lactation period is suppressed by dopamine. But at the moment the baby is attached to the breast, a signal is sent from the nipple to the brain, which leads to the suppression of the release of dopamine. Therefore, the concentration of prolactin in the blood increases.
Prolactin inhibits the secretion of follicle-stimulating hormone and gonadotropic-releasing factor. Therefore, the follicle does not mature in a woman, ovulation is inhibited, and a new pregnancy is impossible. Unprotected intercourse during lactational amenorrhea is relatively safe. But its effectiveness gradually decreases after 3 months after childbirth.
A prerequisite for this method of contraception is completely natural feeding of the child and mandatory feeding at night. During sleep, the hormone melatonin is synthesized, which is also involved in the regulation of dopamine and the lactation process. Therefore, if you refuse night feeding, the synthesis of prolactin is inhibited, the cycle can be restored.
If a woman began to introduce artificial mixtures into the diet, replacing them with night feeding or several daytime ones, other methods of contraception should be used.
In ordinary life, the beginning of the menstrual cycle is counted from the first day of menstruation. But during lactation after childbirth, the restoration of the cycle occurs imperceptibly: the concentration of prolactin in the blood decreases and FSH increases, the growth of follicles and estrogen synthesis are stimulated. Then ovulation occurs, the symptoms of which go unnoticed. If there was no fertilization, after 2 weeks menstruation will begin, which will mean the end of the first cycle and the beginning of the next. If a woman becomes pregnant, then there is no menstruation. Therefore, many nursing mothers learn about a new pregnancy only after a few months.
Pros and cons of barrier means after childbirth
After childbirth does not require a visit to the doctor or compliance with additional terms of use. These methods do not affect lactation. They can be used as early as a month after childbirth. The advantage of barrier contraception is protection against genital infections.
But some couples refuse them, citing a decrease in sensitivity during sex. Such statements have no basis, modern condoms are made of very thin latex.
Condoms in the postpartum period
After pregnancy, contraception with condoms is the safest method. The advantages of this method are:
- no effect on lactation;
- protection against infection;
- no medical consultation and examination required;
- does not change the hormonal background;
- can be used by women with somatic diseases.
A condom can also have additional properties. To prolong sexual intercourse, there are condoms with anesthetics, and for latex allergies, special polyurethane products are used.
In women during lactation, the level of estrogen is reduced, so physiological dryness of the vagina occurs. Condoms solve another problem - they are treated with a lubricant that reduces friction and discomfort during sex.
The use of femidoms after childbirth
Instead of male condoms, you can use other types of contraceptives for women after childbirth:
- female condom;
- neck caps;
- diaphragm.
But the concept of "femid" is most often applied to the female condom. It is made of latex or polyurethane and resembles a male condom in shape, but with two rigid rings at opposite ends. One of them is inserted into the vagina, and the second remains outside.
The effectiveness of the use of femidom according to the Pearl index is 5-25, but the method of contraception is not widely used among women. Many of them complain of discomfort during intercourse or pain, men also note psychological discomfort.
Both diaphragms are agents with low contraceptive efficacy, which can be increased by the simultaneous use of spermicidal agents.
Intrauterine devices for postpartum women
After childbirth, many women decide on. It will protect against pregnancy, but is not able to prevent infection, therefore it is suitable for permanent couples. Advantages of the intrauterine device:
- does not affect the hormonal background;
- can be used during breastfeeding;
- suitable for women with contraindications for hormonal contraception (with excess weight, diabetes, a tendency to thrombosis);
- does not require constant monitoring;
- long term contraception.
To install the spiral, you need to see a doctor 3 months after giving birth. Women who are not breastfeeding should wait until the cycle is restored, because. the spiral is installed during menstruation.
A preliminary examination is mandatory, which includes a smear for the degree of purity of the vagina and ultrasound of the uterine cavity. If signs of inflammation are determined, treatment is prescribed, contraception with a spiral is postponed for 3-6 months after the end of the course.
With the help of a spiral with hormones, women with hyperplastic processes in the uterus can be protected. If fibroids, endometriosis were diagnosed before childbirth, a hormonal IUD will help prevent the progression of the disease after childbirth.
Hormonal contraception after childbirth
When you can start drinking, the doctor should decide. After examining and assessing the condition after 30 days, he will select the appropriate drug. Safe for breastfeeding mothers:
- Lactinet;
- Charosetta;
- Modell Mam.
The preparations contain gestagens, they have a lesser contraceptive effect than in combination with estrogens, so it is important to strictly observe the time of taking the pills.
After childbirth, local hormonal contraceptives can also be used. The Novaring vaginal ring is produced, which contains levonorgestrel. It is placed in the vagina after the end of menstruation for 21 days. After that, the ring is removed, waiting for the onset of menstrual bleeding and moving on to a new contraceptive.
Attention! Hormonal depot forms for contraception during lactation are not used, because. their active components penetrate into the blood and act on the child.
Chemical methods of contraception
Chemical methods of contraception after childbirth include spermicidal agents. These are various pills that are placed in the vagina before intercourse. They dissolve, form a protective film. The action is based on the destruction of spermatozoa, and protection against sexual infections is also provided.
The positive side of spermicides is that in women with vaginal dryness, they provide additional lubrication. The active components of the funds are not absorbed into the blood, therefore, they do not affect the condition of the child, lactation and the health of the mother. After childbirth, spermicides can be used after a month.
But the method of contraception has disadvantages:
- when using candles, abundant foam may appear during sex, which causes psychological discomfort;
- tablets more often than other means, cause a burning sensation;
- you can not use soap and other detergents after sex;
- sometimes an allergic reaction is possible.
Spermicides do not affect uterine contraction, do not suppress fertility. Therefore, these funds are often used after childbirth.
Other methods of contraception after childbirth
With contraindications to the listed methods of protection against pregnancy, doctors may advise additional contraception after childbirth in women:
Sterilization can be used in women after 30 years, as well as at a younger age if there are at least 2 children. Sometimes doctors suggest tying the tubes of pregnant women during a caesarean section if it has already been done 3 times. Women with three scars on the uterus are not recommended for a new pregnancy due to the high risk of complications, rupture along the scar, placentation disorders.
For emergency contraception, drugs based on large doses of progestogens are used. Nursing mothers need to express themselves within 3 days after taking the pill, and later choose the appropriate method of protection against pregnancy.
After giving birth, a woman needs to visit a doctor within a week from the date of discharge from the hospital, and then again after 30 days to assess how the uterus has contracted and choose a method of contraception. Doctors recommend using local hormonal methods as more reliable and safe. For those who are not breastfeeding, COCs can be started immediately.
But if there are contraindications to hormones, it is necessary to select another method. For a married couple, a reliable remedy is an intrauterine device, if the birth took place without infectious complications. An alternative way is condoms and spermicides. Natural methods of contraception are not recommended in the postpartum period due to hormonal changes.
You can use any suitable methods of protection against pregnancy. Breastfeeding women need to select those that do not penetrate into breast milk and do not affect its production.
Lactation
It is a natural way of protecting a woman from a new conception while she takes care of a helpless baby. When a baby suckles at the breast, it stimulates the secretion of prolactin in the mother's body, the hormone that produces milk. Prolactin, in turn, suppresses ovulation, so for lactating women, the resumption of the menstrual cycle can take from several months to several years, depending on the duration of feeding and personal characteristics. This effect persists if the interval between feedings is no more than 3-4 hours, otherwise the level of prolactin begins to fall. But even so, the chance of conception in lactating women 6-8 months after birth is 10%, and with the introduction, this probability increases.
condoms
A very popular and effective method of barrier contraception. Protects against unwanted pregnancy and STDs (sexually transmitted diseases). Condoms do not affect the quality of breast milk in any way. Until the postpartum discharge ends, you can only have sex in a condom, since the body is extremely vulnerable to infections.
In the story, see about new types of contraception:
Diaphragm (vaginal cap)
It is a dome made of thin rubber with an elastic ring at the base. It is installed in the vagina before sexual intercourse and prevents the penetration of spermatozoa into the cervix. Does not affect lactation. For greater effectiveness, it must be used in conjunction with a spermicidal lubricant. Do not use if there is erosion or inflammation in the uterus.
Oral contraceptives
Creams, suppositories, gels, vaginal tablets with spermicides
Spermicides are chemicals that destroy or immobilize spermatozoa. Does not interfere with lactation. The main disadvantage is that they are not effective enough, they must be used in combination with condoms or a diaphragm.
Intrauterine device
It is administered by a gynecologist for up to five years. It is better to put it in 6 weeks after childbirth, when the uterus recovers sufficiently, although it is permissible to do this immediately after the baby appears. The IUD does not affect breast milk in any way and reliably protects against pregnancy, but does not protect against infections. Not recommended for women who have had inflammatory diseases of the uterus and appendages.
Female or male sterilization
A radical solution to the problem of protection. Tubal ligation can be performed immediately after childbirth. Or suggest that the husband undergo a vasectomy - ligation of the vas deferens. This method has one drawback - irreversibility. It is suitable for those who are firmly convinced that they no longer want to have children.
Why you need protection after childbirth
Unfortunately, there is an opinion that in the first months / year after the baby is born, conception is impossible, especially if the child is breastfed, and therefore almost half of the couples who have just become parents neglect contraception. Result - . Conception can occur even before the arrival of the first menstruation - after all, ovulation occurs about 2 weeks before it and it is easy to miss the moment when fertility returns.
Too early conception after childbirth is undesirable, even when you are not opposed to a second child. Bearing children greatly depletes the body, and a new pregnancy can be difficult for a woman and adversely affect the development of the fetus. Doctors say that pregnancy that occurs in the first two years after childbirth is twice as likely to occur with complications. Therefore, even after natural childbirth, not to mention a caesarean section, it is worth taking care of high-quality contraception.
- Easy to use.
- Does not adversely affect the health of the mother and child.
- It is a natural prevention of postpartum complications (bleeding), helps to restore the mother's body after childbirth.
- Useful for a child.
- Has no contraindications.
- Not related to sexual intercourse.
Flaws:
- Requires strict adherence to the rules of breastfeeding.
- Does not protect against sexually transmitted diseases.
- In cases where lactation crises occur (there is less milk), it is required to combine it with other methods of contraception.
- The least effective of all the means used for postpartum contraception.
barrier methods of contraception
Condom
The effectiveness of the method, when used correctly, approaches 100%.
Advantages:
- Easy to use.
- It can be used immediately upon the resumption of sexual activity after childbirth.
- Does not adversely affect lactation and the health of the child.
- The condom is the only contraceptive that protects against sexually transmitted diseases.
- Possibility of combination with other methods of contraception; for example, when using a calendar method of contraception, a condom can be used on the days of expected ovulation.
Flaws:
- The need to strictly follow the instructions for using a condom.
Diaphragm or cap
The diaphragm is a membrane that is inserted deep into the vagina, closing its lumen. The cap is a cylinder that is put on the cervix. These devices protect the cervical canal (the canal leading to the uterine cavity) from the penetration of spermatozoa into it. The diaphragm or cap can be inserted 20-30 minutes before sexual intercourse.
It should be noted that at present this method of contraception is practically not used in our country.
This method is used no earlier than 6 weeks after childbirth, which is associated with the restoration of the size of the cervix and vagina.
If lactational amenorrhea is noted during breastfeeding, then the effectiveness of this method increases to 80-90%.
Advantages:
- Does not affect lactation and the health of the child.
- Partially protects against sexually transmitted infections.
Flaws:
- The use is associated with sexual intercourse: you need to make sure that this contraceptive is available in advance.
- The selection and insertion of the diaphragm for the first time should be carried out by an obstetrician-gynecologist. If you used this method of contraception before childbirth, then after childbirth you need to clarify the size of the diaphragm. The diaphragm is used together with spermicides (substances that inhibit the activity of spermatozoa). The diaphragm or cap should be removed no earlier than 6 hours after intercourse and no later than 24 hours after insertion, since their longer stay in the vagina can lead to infection of the vagina and the penetration of pathogens into the cervical canal and further into the uterus, appendages .
- The diaphragm requires special care.
Spermicides
This method of contraception is the local use of creams, tablets, suppositories, gels containing spermicides, for example, Contraceptin, Pharmatex, Patentex Oval. Cream or tablets are administered 5-20 minutes before sexual intercourse (the exact time is indicated in the instructions for the drug).
This method can be used when resuming sexual relations, both against the background of breastfeeding, and in combination with other methods of contraception.
The effectiveness of the method, when used correctly and depending on the drug, reaches 95%.
The contraceptive effect occurs within a few minutes after administration and lasts from 1 to 6 hours, depending on the type of drug.
Advantages and disadvantages:
The advantages and disadvantages are the same as when using a condom. In cases where there is dryness in the vagina (this phenomenon is quite common in lactating women), the formation of additional lubrication is an advantage.
Methods of hormonal contraception
Hormonal contraceptives are synthetic analogues of sex hormones produced in a woman's body. The drug may contain one (gestagens) or two (estrogens and progestogens) hormones. The contraceptive effect of drugs containing only gestagens is based on a decrease in the amount and increase in the viscosity of cervical mucus (which prevents sperm from entering the uterus). Combined hormonal contraceptives containing two hormones inhibit the growth and maturation of follicles - the precursors of the egg, prevent ovulation (the release of the egg from the ovary) and implantation - the introduction of the fetal egg into the uterine wall. The use of hormonal contraceptives has its own characteristics and rules. The drugs are prescribed by a doctor.
Preparations containing one hormone (gestagen)
Oral contraceptives (OC) - pills, or "mini-dranks"
This group of drugs can be started 6 weeks after birth. The drug should be taken daily, without interruption, at the same time - if the rules of administration are not followed, the effectiveness of this method is sharply reduced. With proper and regular use, the effectiveness of the method reaches 98%.
After stopping breastfeeding, it is recommended to switch to combined OCs.
Advantages:
- It does not adversely affect the quality, quantity of breast milk and the duration of lactation, as well as the health of the mother and child.
- The ability to conceive is restored immediately after discontinuation of the drug.
Flaws:
- If you violate the rules for taking the drug, while taking certain antibiotics, anticonvulsants and hypnotics, as well as vomiting and diarrhea, the contraceptive effect is reduced. In these cases, the use of an additional method of contraception (for example, a condom) is required.
- In the first months of taking the drug, bleeding may occur between periods, which eventually disappear without the use of additional measures.
Long acting progestogens
This group of long-acting drugs is represented by injectable contraceptives and hormonal implants. For the first time, such a drug can be administered no earlier than 6 weeks after childbirth.
Injectable contraceptives(for example, "Depo-Provera") are a solution containing one hormone - a progestogen. Thanks to the injection that the doctor makes, a depot is created in the muscles, from where the drug is slowly excreted, providing contraception for 8-12 weeks (depending on the type of drug).
Subcutaneous implant(for example, "Norplant") also contains one hormone - progestogen. It is administered by a doctor subcutaneously into the forearm in the form of capsules, from which the hormone is released at a constant rate. The contraceptive effect persists for 5 years, after which the effectiveness decreases sharply. Capsules for such contraceptives are of two types: silastic (synthetic, they must be removed, and the removal of the capsule is possible at any time) and made from biodegradable materials that do not need to be removed - they decompose under the action of enzymes present in the body. It is necessary to strictly observe the intervals between the administration of the drug. After discontinuation of the drug, the restoration of a regular menstrual cycle and the ability to conceive occurs within a year.
The efficiency of the method is 99%.
Disadvantages and advantages:
The disadvantages and advantages are the same as those of OK containing only gestagens.
Preparations containing two hormones (combined OK)
Reception of combined OK is possible if the woman stopped breastfeeding or did not breastfeed at all. This method of contraception can be used from the 6th week after childbirth. Tablets must be taken daily, without gaps, strictly at the same time. The effectiveness of the method is sharply reduced if the rules and conditions for taking tablets are not observed (the rules are similar to the use of OK containing only gestagens).
The drug is prescribed only by a doctor after an appropriate examination. At the same time, contraindications are excluded (fresh thromboembolism, hormone-dependent tumors, congenital defects in the excretory function of the liver, progressive liver diseases, sickle cell anemia, vascular diseases of the brain, myocardial infarction and coronary heart disease) and risk factors are identified (past thrombosis and thromboembolism, disorders liver function with bile stasis, hepatitis, gallbladder disease, hypertension, diabetes mellitus, epilepsy, ulcerative colitis - colon disease, allergies, uterus, chronic kidney disease).
The effectiveness of this method with proper and regular use is 100%.
Advantages:
- Prevents the development of certain diseases of the female genital organs and mammary glands.
- After stopping the drug, the ability to conceive is quickly restored.
Flaws:
- The adverse effect of estrogen (one of the hormones that make up the drug) on the quantity and quality of breast milk, reducing the duration of lactation. Therefore, it should be noted that the use of this method of contraception is acceptable only if you refuse breastfeeding.
- Strict adherence to the rules for taking drugs.
Postcoital contraceptives (contraceptives used after intercourse)
This type of contraception is used after casual sexual relations, rape, in case of damage to the condom or missed combination oral contraceptives.
As postcoital contraception, you can use:
- combined oral contraceptives in high dosage;
- preparations containing a progestogen, where the active substance is also contained in a large dosage ("Postinor");
- progesterone antagonists, which interrupt ovulation and cause menstrual-like discharge ("Mifepristone").
The use of drugs in this group may be complicated by heavy uterine bleeding; such a complication requires a doctor's consultation.
All these drugs are not used during breastfeeding, as they contain a fairly large amount of the hormone; the drug enters the milk, changing its quality and quantity.
Intrauterine contraceptives
IUDs - spirals, an intrauterine contraceptive, located in the uterine cavity, prevents the implantation of the fetal egg, which has nowhere to attach, since the uterine cavity is occupied by a foreign body.
The method can be used immediately after uncomplicated delivery in the absence of contraindications for the introduction of the IUD. The spiral is introduced no earlier than 6 weeks after childbirth, when the risk of its possible loss is reduced.
The efficiency of the method approaches 98%.
Advantages:
- The absence of a negative effect on lactation and the health of the child.
- The method provides a contraceptive effect immediately after the introduction of the spiral.
- Long-term (up to 5 years) protection from pregnancy.
- The ability to remove the IUD at any time.
- The restoration of the ability to conceive after the removal of the IUD occurs very quickly.
Flaws:
- The IUD is inserted and removed by a doctor.
- The method is not recommended for women who have multiple sexual partners, as well as those who have had inflammatory diseases both before childbirth and in the postpartum period.
- Sometimes the spiral causes discomfort in the lower abdomen, resulting from uterine contractions during breastfeeding.
- In some cases, after the introduction of the IUD, the first period of menstruation may become more abundant and more painful than usual. This is due to the fact that the inner lining of the uterus (endometrium) "gets used" to the presence of a foreign body, trying to reject it.
Women using intrauterine contraceptives should remember that they should regularly (at least once every 6 months) visit a gynecologist, since the "antennae" of the spiral is the entrance gate for infection to enter the uterine cavity, therefore, inflammation of the vagina and cervix must be timely discovered. You can not wear an intrauterine contraceptive for more than 5 years.
Surgical sterilization
Female and male sterilization is a method of irreversible contraception, in which ligation or clamping of the fallopian tubes (in women) or ligation of the vas deferens (in men) is performed surgically.
This method is acceptable only for those who are absolutely sure that they do not want to have more children. Sterilization is an irreversible method of contraception, so you need to be sure of the correctness of the decision made. Medical sterilization as a method of contraception is carried out in accordance with the legislation of the Russian Federation on health protection.
female sterilization performed immediately after uncomplicated childbirth (under local anesthesia by laparoscopic method or by minilaparotomy (a small incision is made on the anterior abdominal wall), as well as during a caesarean section. Sterilization can be performed at any time after childbirth at the request of the woman. Efficiency - 100%.
Advantages:
- Permanent highly effective method of contraception.
- The effect occurs immediately after the operation.
Flaws:
- Irreversibility.
- Small chance of postoperative complications.
male sterilization(vasectomy) can be performed at any time. Under local anesthesia, a small incision is made in the scrotum and the vas deferens are tied (similar to the fallopian tubes). The method does not affect male potency. The absence of spermatozoa in the ejaculate, detected with the help, can confirm the effectiveness of the manipulation.
Efficiency - 100%.
Advantages and disadvantages
The advantages and disadvantages are the same as female sterilization.
Natural (calendar) method of family planning
Natural methods of contraception are based on periodic abstinence on fertile days.
The calendar method can be used only after the establishment of a regular menstrual cycle. The essence of this method is that conception is most likely if the couple is sexually active 2-3 days before ovulation and the same time after: at this time, the likelihood of a meeting of spermatozoa with that has come out of the ovary increases. If you know exactly the time of ovulation, on the days when conception is most likely, you need to be protected by one method or another, on the other days you can not be protected at all. In order to determine the time of release of the egg from the ovary, there are several methods:
- With a stable duration of the menstrual cycle, it often occurs in its middle. So, for example, if 30 days pass from the first day of one menstruation to the first day of the next, then it is most likely that ovulation will occur on the 15th day. In this case, you should additionally protect yourself 5 days before the expected ovulation and 5 days after. The ten-day period will surely cover the days that are critical in relation to conception.
- Measurement of rectal temperature. After menstruation until ovulation, the temperature in the rectum does not exceed 36.9 ° C, during ovulation the temperature rises above 37 ° C and stays at higher figures until menstruation. The temperature should be measured in the morning every day at the same time without getting out of bed.
- The study of the properties of saliva. In the cervical mucus and saliva during the period of ovulation, the salt content increases, so if you look at the dried saliva through a microscope or a large magnifying glass, then the salt crystals in saliva will look like fern leaves. There is a special device for home use, where there is a glass on which you need to apply saliva, and several magnifying glasses. Thus, the woman herself can determine the time of ovulation.
It is clear that by observing your body, measuring temperature or studying saliva, you can assume the time of ovulation in subsequent cycles, additionally protect yourself before and after the expected ovulation.
The effectiveness of the method is low - no more than 50%, subject to all the rules.
Advantages:
No side effects.
Flaws:
- The method is not recommended to be used immediately after childbirth, as it is difficult to determine the period of ovulation and the first menstruation.
- There is a need for special training for the couple in natural methods of family planning.
Anastasia Khvatova,
Obstetrician-gynecologist of the Center for Family Planning and Reproduction.
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