Contraception advice after pregnancy

Planning ahead

After the birth of your baby, it may take some time before you feel ready to have sex again, or you may feel ready sooner – every person is different, and there is no right or wrong way to feel. Once you resume sexual activity, you can become fertile very soon after birth, before your menstrual periods return, even if you are exclusively breastfeeding.

In general, it is recommended to space your pregnancies, for improved outcomes for both mother and baby. Advice will be tailored to your individual circumstances, but we usually recommend at least 12 months before getting pregnant after a vaginal birth and at least 18 months after a caesarean birth, however these timings may be different for you and your family. For these reasons, it is important to consider contraception that may be suitable for you after birth.

It is a good idea to start thinking about contraception during pregnancy, so that you have time to consider your options before your baby is born. Your midwife or doctor can discuss contraception with you during pregnancy, during your hospital stay after birth, or at your postnatal follow-up. Some methods can be provided before you leave hospital. All contraception is free in the UK.

Long-Acting Reversible Contraceptives (LARCs)

These methods are reliable and can be stopped if you wish to become pregnant again. They are all safe to use if breastfeeding.

• Intrauterine contraceptives/coils: A contraceptive coil is a small T-shaped device that is placed inside the uterus (womb) to prevent pregnancy. Some coils contain progesterone (for example, the Mirena® coil), while others contain no hormones (copper coils). They can be inserted at the time of caesarean birth, immediately after vaginal birth (within 4 hours), or from 6 weeks after birth. They are over 99% effective and can be removed at any time if you wish to become pregnant.
• Progesterone coil (e.g. Mirena, Jaydess): may improve period pain, lighten periods and you may experience no periods, so this can be beneficial if you have heavy and/or painful periods. It lasts for 3-8 years.
• Copper (non-hormonal) coil: is suitable for those who want non-hormonal contraception and who do not have heavy periods, as this can be a side effect. It lasts for up to 5 years.
• Inserting a coil at the time of birth does not significantly increase the length or risks of a caesarean birth. Coils inserted immediately after birth have a slightly higher chance of coming out than those inserted at other times. It is therefore important to attend your coil check 4–6 weeks after insertion to confirm that the coil is in the correct position and, if required, have the threads trimmed.
• Implant: can be inserted in the hospital after birth, before you are discharged home, or later by your GP or at a sexual health clinic. The implant is a small, flexible rod placed under the skin in the upper arm, and releases progesterone hormone. It is 99% effective at preventing pregnancy for up to 3 years and can be removed any time.
• Depot injection: can be started in the hospital after birth, before you are discharged home. The depot is an injection of progesterone hormone, which is repeated every 3 months by your GP or at a sexual health clinic.

The Pill:

• There are two main types of contraceptive pill: the progesterone-only pill (mini-pill) and the combined pill, which contains the hormones oestrogen and progesterone. Progesterone-only pill: can be started in hospital after birth (any time within 3 weeks) and is safe to use if breastfeeding Some people opt for the progesterone-only pill while deciding on a longer-term contraception (i.e. prior to getting a contraceptive coil). It is 91% effective at preventing pregnancy. It needs to be taken daily and at the same time every day, which can be difficult to do with a new baby. Your GP can issue repeat prescriptions as necessary.
• The combined pill (oestrogen and progesterone): can be started from 6 weeks after birth in women and birthing people who are breastfeeding, or any time after birth if not breastfeeding as long as there are no other risk factors for venous thromboembolism (blood clots). It is important that all women and birthing people who are considering the combined pill have a risk assessment for venous thromboembolism (blood clots), prior to starting the combined pill. This can be done in hospital, and your GP can issue repeat prescriptions as necessary.

Permanent Contraception

These methods are suitable for people who have decided their family is complete.

• Sterilisation/tubal ligation: for people planning caesarean birth, this can be done during the surgery. It involves cutting and tying, or completely removing, the fallopian tubes so eggs can no longer be fertilised by sperm. Your periods still occur as usual. The procedure is more than 99% effective at preventing pregnancy, and is a permanent form of contraception. Sterilisation can be performed under anaesthetic on a separate occasion.
• Vasectomy: male partners can be sterilised by having a procedure known as vasectomy. It is a short procedure done under local anaesthetic and is a permanent form of contraception. It is more than 99% effective at preventing pregnancy. Men considering vasectomy should discuss this with their GP.

Other methods of contraception

These methods are generally less reliable with typical use.

• Barrier methods (male condoms, female condoms/diaphragms): male condoms can be used safely any time after birth. Female condoms/diaphragms can be used 6 weeks after birth, a different size may be needed after birth. Barrier methods have a higher failure rate for preventing pregnancy with typical use than long-acting reversible contraception. However, male and female condoms are the only methods of contraception that also protect against sexually transmitted infections (STIs).
• Contraceptive hormonal patch (oestrogen and progesterone): is a small square patch approximately 5cm x 5cm, that you wear on your skin for 7 days at a time before changing it. It can be started from 6 weeks’ after birth in women and birthing people who are breastfeeding, or any time after birth if not breastfeeding, if there are no other risk factors for venous thromboembolism (blood clots). It is important that all women and birthing people who are considering the patch have a risk assessment for venous thromboembolism (blood clots), prior to starting the combined hormonal patch. This can be done in hospital, and your GP can issue repeat prescriptions as necessary.
• Vaginal hormonal ring (oestrogen and progesterone): is a small, soft, flexible plastic ring approximately 5cm that you insert into your vagina and leave it there for 3 weeks at a time. Once the ring is in place, you should not be able to feel it, and do not need to remove it for sex. It can be started from 6 weeks after birth in women and birthing people who are breastfeeding, or any time after birth if not breastfeeding, if there are no other risk factors for venous thromboembolism (blood clots). It is important that all women and birthing people who are considering the vaginal ring have a risk assessment for venous thromboembolism (blood clots), prior to starting the vaginal hormonal ring. This can be done in hospital, and your GP can issue repeat prescriptions as necessary.
• Lactational amenorrhoea method (LAM): involves exclusively breastfeeding day and night (no other liquids given in addition to breastfeeds), no long intervals between feeds night or day (ie. More than 4 hours during day and more than 6 hours at night), do not have periods (amenorrhoeic), and less than 6 months since giving birth. Women and birthing people should be aware that this method is only reliable if all the above criteria are met, and the risk of pregnancy is increased if the frequency of breastfeeding decreases including using bottles (with breastmilk or formula), use of dummies/pacifiers, when periods return, or when women and birthing people are more than 6 months since giving birth.
• Fertility awareness method (FAM): can be used by women and birthing people after birth, however, because this method relies on the detection of the signs and symptoms of fertility and ovulation, its use may be difficult after birth, prior to periods returning, and is an unreliable form of contraception. There are apps available that can assist with FAM, however these have not been shown to be a reliable form of contraception.

Please note, although the above contraception options are effective at preventing pregnancy, they do not offer protection from sexually transmitted infections. If you are having sex with a new partner, you should always use condoms as well.

Resources

• NHS inform: general information about different types of contraception (opens in a new tab)
• NHS contraception guide: choosing a method of contraception (opens in a new tab)
• Faculty of Sexual & Reproductive Healthcare: Clinical guideline contraception after pregnancy (opens in a new tab)
• College of sexual and reproductive healthcare (opens in a new tab)
• Contraception Choices (opens in a new tab)
• Faculty of Sexual & Reproductive Healthcare: UK Medical Eligibility Criteria (opens in a new tab)