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Postpartum Counseling

(Updated July 2013)

Contraceptive Options for US Women in the Postpartum Period Table

Contraceptive Options for US Women in the Postpartum Period
Method Advantages Consider
Most effective (99% or more effective)
Transcervical sterilization (Essure®) Permanent. May be placed in an office setting. Delayed efficacy. Follow-up procedure (hysterosalpingogram) required to confirm efficacy. Non-reversible.
Tubal ligation Permanently eliminates concerns about birth control. Surgical procedure. Non-reversible in most cases. Can be done laparoscopically.
Intrauterine contraception (Copper T IUD [ParaGard®] or LNG 52 IUS [Mirena®] or LNG 13.5 IUS [Skyla™])

Copper T IUD lasts 10 -12 years. It can be used by nursing women.

LNG 13.5 IUS lasts up to 3 years

Lower risk of expulsion if insertion delayed until 6 weeks postpartum.
Not recommended for women currently at risk of STIs or pelvic inflammatory disease.
Very effective (91% - 99% effective)
Oral contraceptives (OCs): combination Does not interfere with sexual activity. Helps ease menstrual cramps and regulate menstrual periods; may be used continuously to suppress periods. Reduces risk of ovarian and endometrial cancer. Estrogen-containing OCs are not generally recommended for women who are breastfeeding. If not nursing, women can begin using 3-4 weeks postpartum.
Oral contraceptives: progestin-only Suitable for breastfeeding women. Does not interfere with sexual activity. May cause irregular menstrual bleeding. Breastfeeding women can initiate 6 weeks postpartum.
Injection (DMPA) Contains synthetic progesterone. Suitable for nursing mothers. Injections 4 times/year. Irregular menstrual cycles and weight gain possible. Fertility may take up to 1 year to return.
Patch Provides 1 week of protection.
Easy to apply.
Contains estrogen and therefore not recommended for breastfeeding women.
Vaginal ring Once-a-month vaginal insertion. Can be used continuously to suppress menstruation. Small percentage of users report discomfort; some women are uncomfortable with vaginal method.
Effective (81% - 90% effective)
Condom Lubricated condoms can ease pain with sex if vaginal dryness is a problem. Provide STI protection. Female condom allows woman to control use of barrier method. Condoms may tear during intercourse. Some people are allergic to latex, in which case polyurethane condoms are recommended.
Diaphragm (with spermicide) Good option for women who prefer a barrier method to hormones. Refitting after childbirth required but should be delayed for 6 weeks postpartum. Not suitable for women allergic to latex. May increase risk of bladder infection. Should be refitted/replaced at least every 2 years.
Moderately effective (80% effective)
Cervical cap (with spermicide) An option for women who prefer a barrier method to hormones. Refitting after childbirth required but should be delayed for 6 weeks postpartum. Not suitable for women who are allergic to latex. Should be refitted/replaced every 2 years.
Spermicides Non-hormonal contraception that is highly portable and discreet. Protection against some STIs. Includes foam, creams, gels, vaginal suppositories, and film. Use with a condom boosts effectiveness. Spermicides do not protect against HIV.
Sponge Non-hormonal contraception that provides a barrier to sperm and contains spermicide. Delay use until 6 weeks postpartum to reduce risk of toxic shock syndrome. Does not protect against HIV.