If you’ve just given birth, you probably feel like you’re being pulled in a million different directions. You might be breastfeeding, you’re probably not getting a lot of sleep, you’re physically recovering from delivery. You’ve got a lot on your mind! But there’s one thing you may want to think about even before you have your baby: birth control.
You may be thinking, "Sex? No thanks!" now, but you might be surprised at how quickly you find yourself in the mood after baby’s born (and if you don't, that's okay and normal too). And while planning what birth control to use ahead of time may seem less than sexy, it’ll be helpful if you’re not hoping to get pregnant again immediately (which is definitely possible, contrary to what you may have heard, but not advisable).
When can you start using birth control after pregnancy?
It depends on what method you’re using. Some, such as an IUD, you can use immediately. In fact, you can even schedule your IUD insertion for delivery day, whether you deliver vaginally or via C-section.
With others, such as combined hormonal methods like the pill or the patch, you have to wait at least three or four weeks before you start due to the higher risk of blood clots immediately following birth (the estrogen in these methods can bump that risk up a bit).
You may also want to think about breastfeeding. If you know you want to nurse, your practitioner will probably caution you against taking anything with estrogen such as the pill because it could impact your milk supply.
What kinds of birth control are safe after pregnancy?
All of them, once you wait out the first three or four weeks, unless you opt for an IUD that can be inserted immediately.
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That said, the right birth control method for you may differ from that of your best friend or your sister. It really comes down to lifestyle and preference. Do you love the idea of a set-it-and-forget-it IUD? Are you really good at remembering to take the pill every day? Once you figure out your preferences, finding the right contraception for you should be pretty easy.
What kinds of birth control should you use while breastfeeding?
Look for a progestin-only form of birth control if you're breastfeeding. Why? While estrogen-based birth control isn’t dangerous, it may decrease your milk supply, so if you’re nursing talk to your practitioner about:
The shot
The implant
Condoms
The mini-pill
Paragard
A hormonal IUD (Mirena, Skyla, Liletta or Kyleena)
Steer clear of the combined hormone pill, the patch or the ring.
Does breastfeeding as birth control work?
The short answer: No, breastfeeding is not a reliable form of birth control.
The longer answer: While it is true that you may not get your period if you’re breastfeeding, you can still ovulate, and if you’re ovulating, you can get pregnant.
When you breastfeed exclusively — defined as nursing at least every four hours during the daytime and at least every six hours at night, for the first six months postpartum and before the return of your period — you typically no longer ovulate, and your chances of getting pregnant are much lower. Only about 2 out of 100 women who breastfeed according to these exact criteria get pregnant.
But if you know you want to space your children out over a specific period of time, or you simply know you’re closing up shop for good (no more buns in this oven!), you'll definitely want to use some form of birth control.
This is especially true once your baby is ready to start solid food (around 4 to 6 months), as you’ll likely get your period again. It's also true if you start supplementing with formula or don't stick to all the criteria of exclusive breastfeeding.
Types of birth control: Which one is right for you?
So how do you know what type of birth control is right for you after giving birth? Here's the lowdown on the various kinds of birth control to help you decide.
Hormonal birth control
The pill. The pill is pretty much synonymous with "birth control," and is far and away the most popular option. There are two kinds of pills: combination pills, which contain a mix of estrogen and progestin, and the mini-pill, which is a progestin-only form (more on that one below). The combination pill comes with a week’s supply of inactive pills — a.k.a. placebo pills — which is why you still have a period every month. While the pill is safe for most women, it’s not the best option for you if you’re nursing, since the boost in estrogen could potentially decrease your milk supply.
The patch (OrthoEvra or Xulane). Another one that includes both estrogen and progestin, the patch falls somewhere in between the pill and more permanent methods. You apply it once a week for three weeks while leaving it off the fourth week so you can get your period. The patch may be a great option for you if you’re not into the idea of something permanent but are afraid you’ll forget to take a daily pill, and you know you don’t plan to nurse. However, you still have to apply it on the same day each week — and if you forget, you won’t be protected against pregnancy, meaning you’ll need to use a backup option.
The ring (NuvaRing). The ring delivers hormones that thicken your cervical mucus, making it hard for sperm to reach an egg, but it’s a little lower in hormones than the pill and the patch. It’s good for three weeks, so you only have to remember to insert it once a month.
The implant (Nexplanon). A progestin-only option, making it a good choice for nursing moms, Nexplanon is a flexible plastic rod that’s inserted into your arm and offers three years of fix-it-and-forget-it protection. (No need to remember anything, ever? Score!).
The mini-pill. This is a great option for nursing moms, because it’s progestin only. It works similarly to the combined-hormone pill; the only difference is that it doesn’t come with a week of placebo pills.
The shot (Depo-Provera). The shot, which is effective for three months at a time and can be administered right after you give birth, may be a good option for you if you’re pretty sure you don't want to get pregnant again any time soon. But you have to remember to visit the doc four times a year to make sure you stay protected. It's also worth noting that your cycle may not immediately return to normal after going off Depo-Provera. In fact, it can take up to 10 months, meaning that if you know you want to get pregnant again immediately after stopping birth control, the shot may not be for you.
The hormonal IUD (Skyla, Mirena, Liletta and Kyleena). All four hormonal IUDs work by releasing small amounts of progestin into your uterus to thicken your cervical mucus and make it harder for sperm to reach an egg. They’re effective for between three and seven years, and are pretty set-it-and-forget-it — meaning once it's inserted, your work is done.
Non-hormonal birth control
The copper IUD (Paragard). If you're looking for one-and-done birth control, it doesn't get much easier than the Paragard. This IUD is made of copper, which triggers inflammation that’s unfriendly to sperm but is safe for you to prevent pregnancy, and it’s effective for up to 10 years. But a common side effect is heavier, longer periods and spotting in between periods (though for many women that diminishes over time), so if that idea doesn’t sound great to you, you may want to opt for a different form of birth control.
Barrier methods
Male and female condoms. Condoms are inexpensive, easy to use and offer immediate protection. They're also non-hormonal, meaning you don’t have to wait to use them.
Diaphragm. A diaphragm is a fitted cup that you use in conjunction with spermicide and insert to prevent pregnancy. They’re fitted to your cervix — so you’ll need to get re-fitted after pregnancy, as your cervix can change after giving birth.
Cervical cap. This one works similarly to the diaphragm. It’s a small cup, typically made of silicone, that comes in several sizes and is fitted specifically to your cervix. Also like the diaphragm, it’s only effective if you use spermicide.
Permanent options
Tubal ligation. Also known as "getting your tubes tied." Much like an IUD, you can schedule to have your tubes tied (or removed completely in a procedure called a salpingectomy) immediately following your delivery for maximum convenience, though you certainly don’t have to.
Should you use the same type of birth control you used before you got pregnant?
It depends — some methods are more effective and comfortable pre-pregnancy and some are incompatible with nursing.
For example, some women who love their diaphragm before giving birth feel afterward that the spermicide is uncomfortable or drying. Do you find it inconvenient that you have to be re-fitted after birth to make sure it fits you properly (hey, we don’t blame you)? Next, please!
It’s also possible your period will change after pregnancy, though whether it’s for the better or worse is variable. Some women find that their cramps are much less severe once they’ve had a baby, while others have the opposite experience.
If you’re one of the unlucky ones, you may want to opt for a hormonal IUD or the pill, which will lessen the severity of your symptoms (you might find your period disappears altogether). Skip the Paragard since heavy, longer periods are a common side effect at least for the first few months.
And of course if you're breastfeeding, your hormonal birth control options are limited to the mini-pill and others without estrogen.
When should you go off birth control if you want to start trying to get pregnant again?
With most of the above-mentioned methods, your fertility will return immediately, so you can stop using it as soon as you want to try for another baby.
There are only two exceptions: the shot, which can impact your cycle for between nine and 10 months (though even with the delay, rest assured that it won’t permanently impact your fertility), and tubal ligation, which is permanent.
When to call the doctor
Most of the risks associated with birth control are minor. However, your risk of developing a blood clot (deep vein thrombosis) is slightly higher immediately following birth, and combined hormonal methods of birth control — the pill, the patch and the ring — can increase that risk further, which is why you’ll need to wait between three and four weeks before starting any of those methods.
Your risk also increases if you’re over 35 or a smoker. If you experience any of the below symptoms, call your doctor or 911 right away:
Swelling in one or both legs
Shortness of breath
Tenderness or pain, or your leg is warm to the touch
Chest pain
Other symptoms to watch out for include the following:
With an IUD (hormonal or otherwise)
Expulsion — if your IUD makes its way out of your body on its own, you’re not protected from pregnancy
Sharp, severe abdominal pain that doesn’t improve
Bleeding while you urinate
Bad-smelling discharge, which could be a sign of infection
Pain during sex
You can’t feel your IUD strings, or they feel longer
With the pill, mini-pill, patch, ring, shot or implant
Persistent headaches that don’t improve
Constant nausea
Breakthrough bleeding or spotting between periods that doesn’t improve or go away
Yes 
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