Birth Control

Non-hormonal methods of contraception are compatible with breastfeeding though no method is 100% effective against pregnancy regardless of whether you are breastfeeding or not. Examples include:

Barrier methods (condom, diaphragm, cervical cap, sponge )
Non-hormonal IUD (coil)
Spermicides
LAM (Lactational Amenorrhea Method)
Natural Family Planning

Some hormonal methods of contraception may affect milk supply especially in the early months after birth. Examples include:

Contraceptive pill, including combination and progesterone only
Contraceptive implants, injections and patches
Hormonal IUD (coil)
Vaginal ring

Combination contraceptives

Combination contraceptives contain both progestin (the synthetic version of progesterone) and estrogen and come in a number of forms, including:

Combined oral contraceptive pill
Combination transdermal (skin) patch
Combination contraceptive vaginal ring

Contraceptives which contain estrogen have been linked to reduced milk supply and early cessation of breastfeeding even when started after milk supply is well established and baby is older. Not all mothers who take contraceptives containing estrogen experience lower milk supply, but many do. It is only recommended to use contraceptives containing estrogen with caution, particularly those mothers who have had challenges with their milk supply.

Progestin-only contraceptives

Progestin–only contraceptives are preferred for breastfeeding if a hormonal method is desired or needed. Most mothers do not experience any problems with their milk supply when using progestin-only forms of contraception when started after the 6th-8th week postpartum. However, there are a number of anecdotal reports that some women experience issues with their milk supply when using progestin-only methods of contraception.

Progestin-only contraceptives come in several different forms:

Progestin-only pill (POP) also called the ‘mini-pill’
Progestin injection
Progestin releasing IUD
Progestin implant

A number of progestin-only methods are designed to deliver a dose that continues to have effect for months and, in the case of implants and IUDs, even years. Because of this you might want to trial the effects of progestin-only pills before trying a method with a long lasting effect – if you find your supply is affected you can simply stop taking the pills.

Please note that the progestin-only pill is not considered safe for all mothers to take. Your healthcare provider can help you with relevant information.

Milk supply issues

You may notice a drop in your milk supply after starting to take hormonal birth control pills (particularly those containing estrogen). If you are using a form of hormonal contraceptive and your baby’s weight gain or growth slows or stops, or you observe a drop in your milk supply, you might like to discontinue using it to see if your baby’s growth and/or your supply improves. There is usually a safe and reliable alternative you can use to protect yourself from unwanted pregnancy.

Effects on baby

A small amount of the synthetic hormones in contraceptives will enter your milk, there is no evidence that this is dangerous to your baby. Some babies younger than six weeks may have difficulty metabolising the hormones and for this reason it is not recommended to start using a hormonal contraceptive until your baby is older.

Some mothers report fussiness in their babies after starting to take hormonal contraceptives, many of these mothers also report an improvement when they change their method of birth control.

Lactational Amenorrhea Method (LAM)

The return to fertility is individual for each mother and it is possible to get pregnant while breastfeeding. However, exclusive breastfeeding can sometimes be used as a reliable form of contraception in the first six months after birth, if your periods haven’t returned yet. This is called Lactational Amenorrhea Method (LAM).

In order to use the LAM, you must be able to answer “yes” to ALL three of these questions:

Is my baby less than six months old?
Is my baby fully or nearly fully breastfed, and breastfeeding frequently both day and night? (‘Nearly fully breastfed’ means that the baby may receive ‘taste-sized’ portions of solids occasionally.)
Have I had no vaginal bleeding (not even spotting) since six weeks after my baby was born?

If you can answer ‘yes’ to ALL of these questions, your chances of becoming pregnant are less than 2%, making LAM about as effective as using condoms. It is worth considering that when a condom fails you are extremely likely to know about it and have the opportunity to take immediate action, whereas when LAM fails you are likely to find out only at a point in time when your options are reduced.

References

Goulding Alison N., Wouk Kathryn, and Stuebe Alison M., Contraception and Breastfeeding at 4 Months Postpartum Among Women Intending to Breastfeed. Breastfeeding Medicine. January 2018, 13(1): 75-80.
U.S. Selected Practice Recommendations for Contraceptive Use, 2016, K. Curtis et al, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion
ABM Clinical Protocol #13: Contraception During Breastfeeding. Breastfeeding Medicine. 2015 https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/13-contraception-and-breastfeeding-protocol-english.pdf