Birth Control

Hopefully, you have discussed birth control options prior to this point. Ideally, you should know what method of contraception you will use long before you need it again. Breastfeeding does offer some contraceptive effect, but not a reliable one. (WHAT FOLLOWS IS A BRIEF AND INCOMPLETE REVIEW OF BIRTH CONTROL METHODS. PLEASE DISCUSS THIS TOPIC IN DETAIL WITH YOUR DOCTOR OR MIDWIFE.)

Before you select a birth control method, you should ask yourself two questions. What degree of protection from unplanned pregnancy do I need? And, how much inconvenience (in the form of side effects) am I willing to put up with?

There is no perfect form of birth control……other than complete abstinence. No reversible form of birth control is perfect at preventing pregnancy, and all have some potential side effects or inconvenience factors. A method’s ability to prevent pregnancy is called its effectiveness. And there are two types of effectiveness- “theoretical” effectiveness, and “user” effectiveness. The theoretical effectiveness rate is the number of unplanned pregnancies (per hundred women per year) IF THE METHOD IS USED PERFECTLY. The user effectiveness rate includes the HUMAN-ERROR factor. Here is the list of the modern forms of reversible birth control in order (roughly) of their “user” effectiveness (number of pregnancies per 100 women-users per year):


  • injectable and implantable forms of progestin (0.2)

  • the combination birth control pill (2)

  • the mini-pill (4)

  • the IUD (4)

  • the condom with a spermicide (5); without a spermicide (16)

  • the female condom (?)
  • the cervical cap (10)

  • the diaphragm and a spermicide (18)

  • the sponge (20)

  • spermicidal foam, cream, jelly (20)

  • natural family planning/the ovulation/cervical mucus method (25)

  • withdrawal (20)

  • wishful thinking (90)

Injectable and Implantable Progestins

Progestins are man-made forms of the sex hormone, progesterone. In the form of implants and injections, progestins are very effective contraceptives. In the U.S., the injectable form is DepoProvera, and the implants are called Norplant. Depoprovera may be given immediately after childbirth. Norplant must be inserted by a clinician trained to do so, and usually requires a special clinic appointment (it takes about 30 minutes). Once inserted Norplant is good for five years.

The most common negative side effect is bleeding and spotting. For many women, this side effect persists for months, and is the major reason some women stop using it. With DepoProvera, for those women who stick with it, most will have no periods at all in the second year of use (and most of them perceive this as a positive side effect). The Depoprovera injection is given once every 3 months.

Injectable Combination Hormones

A rather new injectable contraceptive, known as Lunelle in the U.S., is a combination of both an estrogen and a progestin. This combination of hormones is similar to the combination Birth Control Pill. Lunelle is given by injection once a month. The side effects are similar to the Pill.

Oral Contraceptives….The Birth Control Pill

Birth control pills (for both breastfeeding and bottlefeeding mothers) may be started 2-3 weeks after you have your baby. There are basically 2 types of birth control pills. The “combination” pill and the “mini-pill”. Both types are quite effective at preventing pregnancy, but the combination pill is slightly more effective. The combination pill includes two hormones, an estrogen and a progestin. The mini-pill has only a progestin.

Both pills can be used by breastfeeding mothers, although there are no long-term studies on adults who were breastfed while their mothers were using the pill. If a combination pill is used by a breastfeeding woman, it should contain no more than 35 mcg of estrogen (the most common form). Pills containing more than 35 mcg may diminish a woman’s milk supply.

Some of the more common negative side effects include bleeding/spotting between periods, nausea, and headache. Some of the more common positve side effects include decreased rates of ovarian and endometrial cancer, and decreased menstrual cramps.

Newer Hormonal Methods

A couple of new methods have recently hit the market. These new methods include a vaginal ring and a patch. Both the ring and the patch include hormones similar to those in the birth control pills. The ring is inserted by the woman (or her partner) and remains high in the vagina (around the cervix) for a month. The patch is applied to the skin and is also good for a month. Both provide protection from unplanned pregnancy about as successfully as the birth control pill.

The IUD

The intrauterine device is a small piece of plastic which is inserted into the space inside the uterus. Some earlier forms of the IUD were made of metal (and a circular stainless steel ring is still in use in China). A string attached to the lower end of the IUD protrudes through the opening in the cervix and hangs down into the vagina (just an inch or so).

The IUD got a deservedly “bad rap” in the 1960s and 1970s. When inserted in women who have never had babies and who are at risk of sexually transmitted disease, the infection rates (and the possibility of infertility) were inexcusably high. One early form of the IUD, which had a multi-filament (braided) tail, inadvertantly drew micro-organisms up into the uterine cavity.

The IUD of the 21st century is an effective, safe, easy-to-use birth control method for women in monogamous relationships who have had at least one baby. In the U.S., there are currently 2 forms of the IUD. The copper-wound may stay in for up to 10 years. The other is good for about 5 years and includes a small amount of progestin hormone which reduces the cramping and bleeding associated with a woman’s period.

If you decide to have an IUD inserted after you have your baby, don’t have intercourse until the IUD is inserted. See if your clinician will insert it at the 6-week postpartum visit. Have a discussion about IUDs with your clinician well before your baby is born, so that you both are clear when it can be inserted.

The Barrier Methods

The “barrier” methods include condoms, diaphragms, sponges, films, and the chemical barriers, “spermicides”. As their name implies, they present a barrier to sperm meeting egg. In a similar fashion, they can serve as barriers to sexually transmitted disease.

Obviously, to be of any use, barrier methods have to be used. Often, a woman states that “her” choice of a birth control method will be “condoms”. Yet, if her male partner does not put one on (and put one on every time they have sex), the “user” effectiveness rate is quite high. Often, in the heat of the moment, barrier methods are left in the bathroom, the bedside drawer, the purse or the glove compartment…….they don’t work very well in those places. When used perfectly, the effectiveness rates are quite good, especially for the condom and the diaphragm, and especially if used in combination with a spermicide.

Natural Family Planning

“Natural Family Planning” is a phrase used by some Catholic organizations to describe a system of contraception based on the hopefully predictable rhythms of the menstrual cycle. Many women with very regular menstrual cycles have used this method (in combination with periodic abstinence) to avoid unplanned pregnancy.

The method is based on prediction of ovulation and avoidance of intercourse near that time. For women with long histories of predictable periods, ovulation can be predicted within a day or two by keeping track of the menstrual cycle on a special menstrual calendar. Because the mucus of the cervix becomes clear and watery (like egg-white) around the time of ovulation, by checking her cervical mucus a woman may increase her chances of correctly determining ovulation. During this time, she can abstain from sex, or use a barrier method.

Many Catholic organizations offer a course in “NFP”. Their course, written materials and calendars are excellent.

Sterilization…..The Tubal Ligation and The Vasectomy

All the above birth control methods are REVERSIBLE. If you want to get pregnant, just stop using them and they stop working. However, if you are certain that you never/ever want to be pregnant again, you or your male partner should discuss a method of sterilization. More people in this world rely on sterilization for birth control than any other form of contraception.

The most common form of sterilization for women is tubal ligation. In men, it’s the vasectomy. Both tubal ligation and vasectomy are safe and incredibly effective. And you can throw away all the hardware. If you want to have sex (and have a consenting partner), just roll over and do it. Nothing to worry about, put on, put in, or apply.

If you are 100%-no-doubt-about-it-certain that you never-ever-under-any-circumstances want to get pregnant again….get your tubes tied……or have your man get his tubes tied. The benefits….unbridled sex whenever the mood strikes without fear of pregnancy.

A lot of men are big babies when it comes to cutting anything close to their penises. Try to convince him of all the good, spontaneous, unfettered sex that lies ahead. If he’ll get a vasectomy, do that…..the complication rates are lower than for female tubal ligation (although complication rates for both are very low……..these procedures are relatively easy for trained physicians). However, if you know he’ll never do it, consider having your “tubes tied” a day or two after the birth of your baby. Most women are already in the hospital, the enlarged uterus makes the tubes easier to find, and the little scar can be hidden in the belly button.

There is a new device on the market which may someday change the way tubal “ligation” is accomplished. This new idea incorporates the use of small metal springs which are placed into both tubes by going through the cervical canal (through the vagina like a Pap smear). In this way the tubes are not actually ligated (cut). The springs cause an inflammatory reaction which occludes (or blocks) the tubes. The advantage of these springs are two-fold. The procedure involves no surgery or cutting of tissue. The procedure can also be done without general or spinal anesthesia. The device is known as Essure in the U.S. You may want to ask your physician about this if you are certain that you do not want any more pregnancies.

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