Birth control while breastfeeding: What options are safe?

Birth control while breastfeeding: What options are safe?

Nicole Galan
by Debra Rose Wilson, PhD, MSN, RN, IBCLC, AHN-BC, CHT
Another pregnancy may be the
last thing a woman has on her mind after she has had her baby and is caring for
her newborn.
Once sexual activity has
resumed, couples should think about their birth control options if they want to
prevent another pregnancy from occurring.
After childbirth, most doctors
will recommend that a woman visits her doctor within 6 weeks to ensure that all
is well. The doctor will also ask about family planning issues and birth
control preferences.
Many couples do not wait 6
weeks to re-establish sexual relations, and women are still able to become
pregnant even when breast-feeding.
Contrary to popular belief, it
is perfectly safe to take birth control pills while breast-feeding. In fact,
there are many different options, depending on personal preferences, medical
history, and cost.

Fast facts on birth control
while breast-feeding:

  • There are many factors to
    consider when deciding on a form of birth control.
  • Several different forms of
    birth control do not involve the use of hormones.
  • Hormonal options are also
  • Women should discuss their
    options with their doctor and partner if appropriate.
Lactational amenorrhea method
The lactational amenorrhea
method (LAM) works on the basis that exclusive breast-feeding suppresses a
woman’s fertility, preventing pregnancy while she is caring for a young infant.
For some women, LAM can be a
very effective family planning method as long as certain conditions are met:

  • the woman’s period has not
    returned since she gave birth
  • the baby is exclusively
    breast-feeding on demand and is not eating any other foods or liquids
  • the baby is less than 6 months
If the mother and baby meet
all of these conditions, then the chance of pregnancy is very low, less than 2
percent according to World Alliance for Breastfeeding.
Once the woman stops
exclusively breast-feeding and the baby starts taking supplemental foods, such
as formula or baby cereal, the woman’s body will begin preparing for pregnancy
and ovulation will begin.
If any of the factors listed
above change, the woman should consider using additional birth control to
prevent pregnancy.

Non-hormonal birth control

These range from readily
available and relatively inexpensive options, such as condoms, to devices
requiring a prescription and surgical options. Some of these options include:

Barrier contraception

Physical barriers to conception,
such as condoms, diaphragms, or the cervical cap, are still an effective method
of contraception.
Barrier contraceptives do not
contain any hormones so do not affect a woman’s milk supply or her ability to
Doctors usually advise women
to wait until their first postpartum check before inserting anything into their
vagina. This is because there is a higher risk of infection until the cervix
has closed and any tears have healed.
Also, many women find that
they need to be resized for a new diaphragm or cervical cap, due to the
cervical and vaginal changes that occurred during pregnancy, delivery, and
Copper intrauterine device

There are two different types
of IUDs: copper and hormonal. Copper IUDs are a highly effective form of birth
control that do not have any effect on the milk supply. The IUD is a small coil
that is, in this case, wrapped in a small amount of copper.
It prevents implantation,
sperm movement, and fertilization. A doctor needs to insert an IUD, which is
effective in preventing pregnancy for up to 10 years. If a woman decides that
she wants to get pregnant again, the IUD can be easily removed.


This method is a permanent
form of birth control and involves cutting the fallopian tubes, which connect
the ovaries to the uterus. Tying up or blocking the tubes then completely
prevents sperm cells from meeting with an egg.
Like the other forms of
non-hormonal contraception, this method will not have any effect on a woman’s
milk supply. Many women choose to have this procedure done during a planned
cesarean delivery.

Hormonal birth control

According to the Infant Risk
Center, most forms of hormonal contraceptives are probably safe and will not
affect a nursing infant. However, the bigger concern is the effect that these
forms of contraception will have on a woman’s milk supply.
Hormonal birth control usually
contains forms of the hormones estrogen and progesterone.
While some women may tolerate
hormonal contraceptives without an issue, sometimes the estrogen in these
products can cause a woman’s milk supply to dry up completely. This is a bigger
risk in women who are nursing an older baby, or those who are already dealing
with low milk supply issues.
As a result, most doctors will
recommend using a progesterone-only option:

Progestin-only pills (POPs)
POPs are similar to a
traditional birth control pill but only contain progesterone. These types of
pills do not contain any sugar or placebo pills, so each of the pills the woman
takes will be active.
This option is less likely to
affect a woman’s milk supply adversely.

Depo-Provera is a
progesterone-only injection that will protect against pregnancy for up to 3
Some women can be sensitive to
progesterone, however, and there is no way to reverse the medication once
injected. As a result, the doctor may suggest a woman takes POPs for a month or
two to see how the progesterone affects her and her milk supply before taking a
longer-acting dose.
In addition to the copper IUD,
some IUDs are coated in progesterone. This type of IUD works in the same way as
POPs and the Depo-Provera injection.
In some women, however, the
hormonal IUD has been found to decrease milk supply. Hormonal IUDs are
effective for 3 to 5 years, depending on the brand, and can be easily removed
if a woman changes her mind about pregnancy.
Hormonal forms of birth
control do not protect against the transmission of sexually transmitted
infections. Women who have multiple sexual partners should also consider using
a barrier method.
Making the decision

It is important for a woman to
discuss her options with her doctor and her partner, if applicable.
Sterilization or insertion of
an IUD may or may not be covered by medical insurance and can be quite
These options are also
permanent or for long-term use, so may not be appropriate for someone looking
to expand their family in the near future.
Other options, such as the
condom or female condom, are less expensive and readily available. These do not
have the same level of effectiveness as other options, however.
Finally, it is important for a
woman to consider her breast-feeding goals and how her milk supply tolerates
the use of hormonal options. If she notices that her milk supply is decreasing
with POPs, she should seek ways to increase milk supply. This may be a
temporary drop in supply.
Breast-feeding for longer and
more frequently will increase milk supply. Pumping after feeding will also help
to increase the amount of milk.
Kayode Ojo
Kayode Emmanuel Ojo is the Co-Founder and Managing Director at SHEFFA Limited. He is presently studying Computer Science at the National Open University, Victoria Island, Lagos.