After giving birth you may feel like you'll never want to have sex again. This is normal and at some point you probably will, so it's good to be prepared for how you might be feeling physically and emotionally - and to consider what form of contraception you may want to use.
Taking your time
Physically, there’s no real reason why you shouldn’t have sex as soon as the bleeding you get after birth has settled, and any cuts or tears have healed. Before that, sex may be uncomfortable and there’s a risk of infection if you haven't healed up properly.
In practice, many couples wait longer than that. Either of you may feel too tired for sex. You may feel a bit bruised from the birth physically and not be ready emotionally. Talk to each other about how you feel. Everybody is different; it’s up to you when you feel ready to have sex again. Doing pelvic floor exercises can help your body to recover. Remember too that you’ll both probably be a bit nervous, so usesome lubrication and don’t rush it. If you're finding that sex actually hurts, stop and talk to your GP.
Contraception after giving birth
Becoming pregnant again too soon can be stressful in many ways. It is generally recommended to wait at least 12 months between having a baby and becoming pregnant again in order to help increase the chances of the next pregnancy being successful. You should start using your chosen method of contraception no later than three weeks after the birth if you don’t want to become pregnant straight away. It may be that the method of contraception you used before you became pregnant may not be the most suitable one now. If you have chosen not to use contraception soon after birth, it is important to discuss this with your midwife, health visitor or GP within three weeks of giving birth.
Long acting, reversible contraception (LARC)
Long acting reversible contraception (LARC) are much more reliable methods of contraceptive than the pill and condoms, and are longer lasting so can be more convenient. They are also reversible which means once you stop using that method your fertility returns.
Lots of women use a LARC method because
- it is safe to breastfeed with any LARC method
- it doesn't interrupt sex
- it lasts for a long time (different options last from 12 weeks up to five or even ten years)
- it is the most reliable way a woman can protect herself from unplanned pregnancy
- the failure rate is less than 1%, making it the most effective contraception available.
The implant is a small (4cm) thin flexible tube that is placed under the skin of your inner, upper arm. It steadily releases progestogen hormone into your bloodstream to prevent an egg being released (ovulation) to prevent pregnancy. Periods may become irregular, lighter or stop altogether.
A specially trained nurse or doctor fits the implant using a local anaesthetic to numb the area. Most women can feel the implant, but it can't be seen. Once the implant is in place, you don't have to think about contraception for three years. It is OK to breastfeed with an implant. Fertility returns quickly following removal.
Intrauterine device (IUD – also known as the coil)
An intrauterine device (IUD) is a small, T-shaped device with copper that is inserted into your uterus (womb) by a specially trained doctor or nurse. The fitting takes minutes after an initial brief examination. The IUD releases copper into the womb which prevents sperm from surviving in the cervix, uterus or fallopian tubes. It may also prevent a fertilised egg from implanting in the uterus. This method can last for between five and ten years, depending on the type fitted, and is safe to use during breastfeeding. Fertility returns quickly following removal.
Intrauterine system (IUS – similar to a coil)
An intra-uterine system (IUS) is a small, T-shaped device that is inserted into the uterus (womb). It slowly releases the hormone progestogen. This prevents pregnancy by thickening the cervical mucus to prevent sperm from reaching the egg, preventing implantation of a fertilised egg into the womb. It also thins the lining of the womb, making periods lighter or stop altogether. You can safely breastfeed while using this method of contraception. Once fitted it can last three to five years (depending on the device used). Fertility returns to normal quickly following removal.
The contraceptive injection or jag is given every 12-13 weeks and releases the hormone progestogen into the body, which stops an egg being released from the ovaries (ovulation) to prevent pregnancy. Periods may become irregular or stop. Regular periods and fertility may take up to a year to return after stopping the injections. It is safe to breastfeed while on the injection.
The pill (combined and progestogen only)
If you’re breastfeeding, it’s recommended that you avoid the combined pill (types with both oestrogen and progestogen) as the oestrogen may reduce the amount of milk you produce. This also applies to the contraceptive patch and contraceptive vaginal ring.
The progestogen-only pill (mini-pill) is more suitable if you are breastfeeding. You take this pill every day without a break. There is no evidence it has any effect on breastfeeding.
The condom is the simplest choice of contraception for many women and can be used with other forms of birth control. Condoms also offer protection against some sexually transmitted infections. They don't contain any hormones so there are very few side effects and are safe to use during breastfeeding. Condoms are available free from sexual health clinics and many GP surgeries.
If you use a diaphragm or cap, you need to get it checked to make sure it still fits as the size and shape of the cervix can change during birth.
Natural family planning
Natural family planning methods are used by couples to achieve or avoid pregnancy based on evidence based and scientifically accurate information about fertility. The Billings Ovulation MethodTM teaches you to recognise the natural signs and symptoms of fertility and infertility in each menstrual cycle at any stage of
your reproductive life, including during breastfeeding. Couples choosing this method should be taught by an accredited BillingsTM teacher. Information, teaching centres and statistics available at Fertility Care Scotland or call 0141 352 7930.