You can use any methods of protection against pregnancy that suit you. Breastfeeding women need to select those that do not pass into breast milk and do not affect its production.
Lactation
Is in a natural way protecting a woman from conceiving again while she is caring for a helpless baby. When a baby suckles at the breast, it stimulates the mother's body to secrete prolactin, the hormone that produces milk. Prolactin, in turn, suppresses ovulation, so for breastfeeding women, the resumption of the menstrual cycle can take from several months to several years, depending on the duration of breastfeeding and personal characteristics. This effect persists if the break between feedings is no more than 3-4 hours, otherwise prolactin levels begin to fall. But even so, the chance of conception for breastfeeding women 6-8 months after birth is 10%, and with the introduction this probability increases.
Condoms
A very popular and effective method of barrier contraception. Protects against unwanted pregnancy and STDs (sexually transmitted diseases). Condoms do not affect quality in any way mother's milk. Until the postpartum discharge ends, you can only have sex with a condom, since the body is extremely vulnerable to infections.
In the story, look at new types of contraception:
Diaphragm (vaginal cap)
It is a dome made of thin rubber with an elastic ring at the base. It is installed in the vagina before sexual intercourse and prevents sperm from penetrating the cervix. Does not affect lactation. For greater effectiveness, it must be used together with a spermicidal lubricant. Do not use if there is erosion or inflammation in the uterus.
Oral contraceptives
Creams, suppositories, gels, vaginal tablets with spermicides
Spermicides – chemicals, destroying sperm or depriving them of motility. Do not interfere with lactation. The main disadvantage is that they are not effective enough; they must be used in combination with condoms or a diaphragm.
Intrauterine device
It is administered by a gynecologist for up to five years. It is better to place it 6 weeks after birth, when the uterus has sufficiently recovered, although it is permissible to do this immediately after the birth of the baby. The IUD has no effect on breast milk and reliably protects against pregnancy, but does not protect against infections. Not recommended for women who have suffered from inflammatory diseases of the uterus and appendages.
Female or male sterilization
A radical solution to the problem of protection. Dressing fallopian tubes can be done immediately after birth. Or suggest that your husband undergo a vasectomy - ligation of the vas deferens. This method has one drawback - irreversibility. It is suitable for those who are firmly convinced that they no longer want to have children.
Unfortunately, there is an opinion that in the first months/year after the birth of a baby, conception is impossible, especially if the child is breastfed, and therefore almost half of couples who have just become parents neglect contraception. Result - . Conception can occur even before the arrival of the first menstruation - after all, ovulation occurs approximately 2 weeks before it and it is easy to miss the moment of return of fertility.
Conceiving too soon after childbirth is undesirable, even if you are not against a second child. Carrying children is very taxing on the body, and new pregnancy can be difficult for a woman and adversely affect the development of the fetus. Doctors say that pregnancy occurring in the first two years after birth is twice as likely to have complications. Therefore, even after natural birth, not to mention a caesarean section, it is worth taking care of high-quality contraception.
The period after childbirth when a woman breastfeeds her baby is called lactational amenorrhea. It's natural physiological method contraception, therefore it is considered the safest.
However, it is effective only if the woman exclusively breastfeeds the baby, and the baby asks her for no less than 5-6 once a day.
As soon as the baby turns 6 months old, this method becomes ineffective and requires additional funds protection against unwanted pregnancy.
Contraception after childbirth is necessary, because the female body needs at least a year to recover and achieve a new pregnancy.
Immediately after giving birth, a woman begins to bleed, which can last for about a month. During this period, sexual relations should be completely excluded.
I don’t want sex, friction instead of pleasure brings pure pain, as if the penis is covered with sandpaper.
Don't forget about psychological problems.
During the gestation period, a woman can gain 20-30 extra pounds, and during lactation it is almost impossible to get rid of them.
In addition, the young mother has absolutely no time for herself, she feels unattractive, fat, and this does not help increase her libido. A man, after a long period of abstinence, may insist on intimacy without understanding his wife’s excuses. This behavior can provoke in a woman postpartum depression appearing in the background hormonal changes and aggravated by psychological problems.
Conclusion: ideally, you can start sexual activity no earlier than a month after giving birth, and preferably after a month and a half.
There is an opinion that from the moment of termination postpartum hemorrhage Before the onset of the first menstruation, conception should not occur in a nursing mother due to lactational amenorrhea. And, thanks to breastfeeding, you can extend this period by almost several years. Actually this is not true.
Pregnancy can occur just two weeks before the first postpartum menstruation, and a woman can only find out about the possibility of conception by measuring basal temperature in the morning. Its increase indicates ovulation.
However, irregular hours, fatigue and constant care for the baby prevent a woman from monitoring changes in her body. Therefore, if a woman does not plan to give birth to a second child after the first, if she had a caesarean section, if she is weakened and does not feel well, she should take care of additional contraception, and not rely on the methods of our grandmothers and great-grandmothers who lived in other environmental conditions and didn’t experience as much stress.
In principle, a healthy woman can become pregnant a month after giving birth, if everything went well, she feeds her newborn not only with breast milk, and her postpartum bleeding has stopped.
In general, doctors advise you to wait at least six months.
During this period, all internal microtraumas will heal, the woman will get stronger and recover for a new pregnancy, and the older baby will not have a great need for breast milk. However, any hormonal disorders may prevent pregnancy. And, even if a woman wants to achieve a new conception, disturbances in the functioning of the hypothalamus will not allow her to achieve her plans.
From time immemorial the most in an efficient way Mandatory breastfeeding of the newborn was considered protection against pregnancy. This condition of the female body is called lactational amenorrhea.
Lactational amenorrhea is that prolactin, released during active breastfeeding, blocks the production of the hormone estrogen, which stimulates ovulation and, accordingly, in this case, conception cannot occur.
The slightest decrease in the frequency of feeding leads to a decrease in prolactin levels, and, therefore, increases the possibility of a new pregnancy.
One should also take into account the fact that for the first six weeks after giving birth, a woman should completely exclude sexual relations.
It turns out that you can use a natural method of contraception in the postpartum period for no more than 5 months, until menstruation returns.
In any case, the time will come when you will again need to think about additional methods of contraception.
Hormonal fluctuations in a woman’s body significantly reduce the effectiveness of other natural methods protection against unwanted pregnancy. Hence, the method of measuring basal temperature, the calendar method, and changes in the composition of cervical mucus can be considered ineffective.
Barrier methods of contraception are the safest and most effective for nursing mothers.
However, you can only use a cap, condom or diaphragm after postpartum period, which lasts approximately 1.5 months after birth. Only then the uterus and vagina regain their previous size.
The advantage of barrier methods of contraception is that they can be used as needed. The inconvenience is that you will have to prepare for the sexual act itself almost half a day in advance. There can be no talk of spontaneity and playfulness. But the effectiveness of the barrier method is quite high. The use of spermicides (creams, gels, sponges, suppositories that kill sperm) additionally protects against sexually transmitted infections.
The condom (male and female) is almost 100% effective, however, women during lactation experience vaginal dryness, as well as allergic reactions to latex, so it can only be used in tandem with lubricants and lubricants.
The intrauterine device is the most reliable method of contraception for both breastfeeding and non-breastfeeding women. Its effectiveness reaches 99%.
There are hormone-containing intrauterine devices, for example Mirena, which release the hormone levonorgestrel in small doses.
The IUD can be inserted no earlier than 1.5 months after normal childbirth and no earlier than 6 months after caesarean section.
Regarding hormonal drugs, then nursing women should immediately refuse combination drugs, but it is better to prefer contraceptives containing the hormones gestagen and progestin.
They do not affect the composition and quality of mother’s milk in any way, and hormones will not affect the mother’s health either. Contraceptive properties hormonal drugs reach 99% , but there are significant drawbacks.
The pills must be taken at the same time every day, and any deviation from the schedule can negate the entire contraceptive effect.
And due to caring for the baby, the new mother does not even have time to eat normally. Therefore, when taking hormonal contraceptives You need to set an alarm on your phone to remind you to take your pills at the same time every day.
Another disadvantage is the incompatibility of hormonal contraceptives with antibiotics, as well as the side effect of vaginal discharge and menstrual cycle disruption. In general, hormonal contraception should only be used as prescribed by a doctor.
The safest and effective method protection against unwanted pregnancy is the installation of an intrauterine device. Moreover, it is suitable for both non-lactating and nursing mothers. In the latter case, a woman may experience some discomfort in the lower abdomen, since the uterus contracts slightly during breastfeeding. Some IUDs, such as the Mirena, contain the hormone progestin, which is slowly released over the course of a year and blocks the attachment of a fertilized egg to the walls of the uterus.
In general, the IUD is practically safe, and it is installed a month and a half after birth.
Emergency contraception is different from regular contraception hormonal contraception increased levels of hormones. For example, Postinor, the most common “emergency” remedy, contains huge amount the hormone levonorgestrel, due to which the egg does not leave the ovary, and the fertilized one cannot attach to the wall of the uterus.
After giving birth, a woman experiences a real hormonal storm, and an extra dose of hormones can cause serious disruption in the body’s functioning.
The menstrual cycle, which has not yet been adjusted, may shift, and in special cases(if the pills are taken incorrectly or the dosage is incorrect), taking Postinor during lactation will stop the formation of milk or even lead to the appearance of any gynecological pathology.
The same applies to all drugs emergency contraception: Escapella, Ginepriston, Genale, etc.
Conclusion: In general, radical methods of birth control should be abandoned in the first year after childbirth.
If a woman who has given birth cares about her health and the health of her baby, then contraception after childbirth should be selected carefully and seriously. You can't take this for granted "maybe", because an unplanned pregnancy in a woman who has not recovered after the birth of her baby will lead to the birth of a premature or weakened child. Conceiving immediately after a cesarean section is fraught dire consequences. Complete abstinence is better than long-term treatment. After all, an abortion for a woman who has recently given birth is actually a death sentence for her reproductive system.
The long-awaited time has come when you can say, not without pride, that you are now a real mother. And these are not just words! After all, in the playpen he quietly groans in his sleep - the most precious treasure in the world! My favorite! The most magnificent! Bringing with it new feelings, new joy, new anxiety, new troubles...
With the birth of a baby, mommy’s worries increase significantly. You must not only take care of the baby, but also put yourself in order after a difficult ordeal. To be beautiful, charming, sexy. So that the husband will eventually move from the sofa to the marital bed and again look with adoration at the thin figure... Just do not forget, with all these worries, about what is no less important - contraception.
They have more fun growing up. But is your strength enough for two toddlers in a row? Can your body withstand such ups and downs without a break? Pregnancy that occurs immediately after childbirth will most likely not be easy or prosperous. And an artificial interruption will cause mental and physical trauma to the young mother. So we, together with the doctors, advise maintaining an interval of 3-4 years. During this time, the body will “rest”, but will not “forget” the previous birth.
We understand that during 9 months of pregnancy you have relaxed, become lazy... Leave your pregnant whims behind. Your body is already fully armed and ready to raise a new doll within itself. So what if you’re tired... And even if after giving birth you for a long time If you don’t have your period, you can still get pregnant at any time. Moreover, you will not notice this pregnancy right away. That is why experts recommend using protection during the first sexual intercourse after the baby is born. But don’t rush straight to the pharmacy in search of the usual box.
Now, dear mothers, you need to be especially careful when choosing contraceptives. Are you breastfeeding? Then your “safety” drug must meet all the requirements of a nursing mother. More precisely: it does not affect milk production, is safe for the baby and effective for you. Today there are many methods of contraception. We will describe the most common ones, and the choice is yours.
They are the most common and accessible contraceptive. However, improper use of a condom or the use of low-quality latex in its production can lead to unwanted pregnancy. Therefore, many couples combine a condom with chemical protection products (vaginal suppositories or gels). The only side effect may be an allergic reaction to the material or lubricant of the condom. At correct use The reliability of the method is 98%.
Protection, so to speak, “from time to time.” The drugs act in different ways: they either deprive sperm of motility or kill them. But this method is considered not very reliable if it is not “supported” by some other means. At frequent use may cause irritation of the vaginal mucosa.
Refers to “barrier” methods of protection. The diaphragm is a membrane that is inserted deep into the vagina. The cap is a cylinder that fits over the cervix. Both devices protect the cervical canal (the canal leading to the uterine cavity) from the penetration of sperm. The size is selected individually by the doctor. It is advisable to select the size no earlier than 6 weeks after birth. The drug is administered half an hour before sexual intercourse and then removed. Efficiency depends on correct use. But in lately This method is not particularly popular.
For nursing mother prerequisite– the pills should not contain the hormone estrogen. If a woman is not breastfeeding, then any pill will suit her. Choose low-dose drugs; they contain two hormones, but in minimal quantities. Tablets can be monophasic (equal amount of hormones in all tablets), biphasic or triphasic (hormones are distributed in two to three stages, imitating the natural processes occurring in female body). Oral contraceptives are 98 – 99% reliable if you take the pills at the same time every day.
The injection preparation contains only gestagen and is a highly effective contraceptive for correct use. Breastfeeding women are given an injection 6 weeks after birth, non-breastfeeding women - 4 weeks. Protection will be provided for 12 weeks, then the injection will need to be repeated. At first there may be spotting between periods, some change in body weight, etc. If you choose this method, then follow the timing of the repeated injection to maintain effectiveness.
Two months after birth, the IUD can be inserted (with earlier insertion there is a risk of it falling out). IUDs are divided into hormone-producing ones (they release a small amount of gestagen hormones) and regular ones. This method plays the role of a kind of “barrier” and refers to mechanical methods protection. The spiral changes the mucus of the uterine pharynx, which makes it difficult for sperm to penetrate. The product is administered by a gynecologist, who also checks the “correctness” of her position from time to time. After a certain period of time (depending on the type of IUD), the doctor removes the contraceptive or replaces it with a new one. The reliability of the method is high – 99%. But there are some side effects, for example, painful or heavier periods.
Some couples use it. But here there are more minuses than pluses. Complete hassle and high percentage"glitches". Out of one hundred women who use abortion as a means of contraception, eighteen become pregnant. Think about it: while having sex, you will have to be on guard all the time. And doctors claim that the lubricant that is released in men when aroused also contains sperm. Where is the guarantee that they will not meet the egg? Long-term use of this method leads to neuroses and anorgasmia in women and weakened erections in gentlemen.
6 silicone capsules that are injected under the skin during inner side shoulder The hormone (gestagen) contained in them is released in impulses for 5 years. Then the contraceptive effectiveness of the drug decreases sharply and it must be removed. Only a doctor can insert and remove capsules. In the first months after administration, intermenstrual bleeding is possible, which goes away without taking any additional measures. Changes in body weight, dizziness, etc. are also sometimes observed. The reliability of the method is 99%.
The method is irreversible, but provides a 100% guarantee. Spouses need to weigh the pros and cons and consider various options that life can throw at you. There is no turning back and a woman (or man), after sterilization, will never be able to have children.
But no matter which method you choose, be sure to consult your doctor. It is important to understand that contraception is not just a way to avoid pregnancy, but a way to preserve the remnants of nerves and health. Moreover, the health of not only the woman, but also her future children. Therefore, treat this issue with due responsibility.
Novikova Tatyana
Consultant: Aigul Tursunova, gynecologist
Kangaroo Magazine No. 34
The selection of a method of contraception after childbirth should be taken very seriously. After all, pregnancy can occur even before arrival next menstruation, come as a complete surprise to the young mother and lead to serious emotional and physical stress. And to fully restore a woman’s body and carry the next pregnancy normally, it is recommended to wait at least two years.
Within 3-4 weeks after birth, the uterus returns to its previous size. The tissues of the vagina and perineum after spontaneous childbirth take a little longer to recover than after birth by cesarean section, and the condition of the mucous membrane depends on the level of female sex hormones. In lactating women, the pituitary gland produces a large amount of prolactin, which suppresses the maturation of follicles and the production of female hormones in the ovaries, so estrogen levels are low, ovulation does not occur (lactational anovulation), and, accordingly, menstruation is absent (lactational amenorrhea). Therefore, theoretically, the likelihood of pregnancy for a nursing young mother is very low.
If you are actively breastfeeding, you can rely on lactation anovulation until the baby is 4–5 months old, but only if certain rules are followed. The effectiveness of the lactational amenorrhea method is about 98% only if a woman feeds “on demand,” including at night, that is, daytime breaks are no more than 3–3.5 hours, and one night break is up to 5–6 hours. If the number of feedings decreases for any reason, the effectiveness of the method decreases and becomes unpredictable, that is, you can no longer rely on it. If subsequently the number of feedings increases again, the effectiveness of the method remains questionable and a doctor’s consultation is required to decide on the possibility of further use of this contraception option.
You should also pay attention to bloody discharge from the genital tract. Postpartum discharge(lochia) can last up to 2 months. After this period, the resumption of bleeding can be regarded as menstruation and, accordingly, the restoration (although perhaps incomplete) of the woman’s ability to conceive. In this case, you need to choose another method of birth control. Given all this, lactation is a temptingly simple and convenient method of contraception, but not entirely reliable.
As for non-lactating women, by the end of the postpartum period (6–8 weeks after birth), in the absence of the inhibitory effect of prolactin, the synthesis of female hormones and the process of follicle maturation are gradually restored. Therefore, for young mothers who do not breastfeed at all or feed little (the child is mixed-fed), the first menstruation begins 2-3 months after birth. Accordingly, at this time their ability to conceive is restored, although, of course, the body’s reserve for bearing the next pregnancy is not yet restored.
Contraceptives used during the postpartum period and during breastfeeding must meet certain requirements. First of all, they must be highly efficient and reliable. In addition, when choosing a method of contraception, nursing mothers should definitely take into account the effect of drugs on lactation. Their selection of funds is determined by the age of the child and the activity of lactation (whether the child is completely breastfed or mixed-fed). For women who do not breastfeed at all, contraception has no specific features compared to healthy women appropriate age. It is important to note the time when you need to start using birth control when you resume sexual activity after childbirth. In the absence of lactation or with mixed feeding, contraception will be required immediately upon the onset of sexual activity.
Barrier contraception is a group of drugs whose action is based on the mechanical impossibility of sperm penetration into the cervix. This is first of all a condom, which has no contraindications for use (except for individual intolerance), is highly effective when used correctly, protects against sexually transmitted diseases, does not have any effect on breast milk, can be used immediately after childbirth, but has your shortcomings. The main disadvantage of condoms is that their use is necessary immediately before sexual intercourse and requires a certain discipline and strict adherence to instructions for use.
Barrier methods also include cervical caps and vaginal diaphragms, which are practically not used in our country.
A common method of contraception that can be used in the postpartum period and also belongs to the barrier method is spermicidal preparations. They come in a variety of forms: suppositories, vaginal creams, sponges, etc. Active ingredient these drugs contain benzalkonium chloride or nonoxynol, they inactivate sperm in the vagina and thus prevent sperm from penetrating into the uterus; they are practically not absorbed into the blood and do not penetrate into milk. These products can be recommended to a greater extent for nursing mothers. This is due to two factors. Firstly, their effectiveness is not very high: about 25–30 pregnancies per 100 women occur per year (Pearl index is the number of pregnancies per 100 women per year), but given that during lactation a woman’s fertility is slightly reduced, this is enough to protect against unwanted pregnancy. Secondly, when using spermicides, foam is formed, which provides additional comfort when the mucous membrane is dry, which is often observed in women after childbirth.
Contraindications for the use of these drugs are individual intolerance and allergic reactions, acute inflammatory diseases of the genital organs. The disadvantage of spermicides is that they must be used some time before sexual intercourse, strictly following the instructions for use.
After giving birth, women can start using intrauterine contraceptives - intrauterine devices (IUDs). The mechanism of action is based on increased contractile activity of the uterus and excessive peristalsis of the fallopian tubes due to the presence foreign body. This causes the egg to enter the uterus prematurely, so fertilization does not occur. Also, a foreign body causes certain changes in the inner shell uterus, so-called aseptic inflammation, so the fertilized egg does not have the opportunity to implant. If the intrauterine device contains copper or silver, then these substances have a spermicidal effect (sperm lose their ability to fertilize).
The IUD is inserted by the doctor into the uterine cavity on the 2-3rd day of menstruation, while the “whiskers” of the spiral remain in the vagina (strong thin threads that indicate that the IUD is in the uterus and which can subsequently be used to remove it). After childbirth, it is recommended to insert an IUD after 6 months or during the first menstruation, and before that use barrier contraception or the lactational amenorrhea method. The IUD is also removed by a doctor, preferably also during menstruation, no later than 3–5 years after insertion.
The method has undeniable advantages: after installing the IUD, you don’t have to worry about contraception and unplanned pregnancy several years ( different manufacturers It is recommended to replace the IUD at intervals of 3–5 years). After installing the IUD, the effect occurs immediately, the effectiveness of the method is very high: the Pearl index is 0.9–2.0 (that is, 1–2 women out of 100 may become pregnant during the year when using the IUD). But there are also a number of serious disadvantages.
The main problem that arises when using an IUD is more high level inflammatory diseases genitals. This complication, in fact, is associated with the mechanism of action of the contraceptive, that is, with the presence of a foreign body, which facilitates the penetration of infection into the uterus (infection along the antennae of the spiral located in the vagina can rise into the uterine cavity). With the use of an IUD, menstruation may become more painful and heavy. Due to changes in fallopian tube peristalsis, women using IUDs are 4 times more likely to have ectopic pregnancies. This occurs mainly after removal of the intrauterine device; in rare cases, an ectopic pregnancy can occur when using an IUD, since the embryo cannot attach to the uterus. It is noted that the longer the IUD is used (more than 3 years), the higher the risk ectopic pregnancy due to the fact that the cilia that push the fertilized egg into the uterus disappear in the mucous membrane of the fallopian tubes. In addition, if there is cicatricial deformation of the cervix (as a result of its rupture during childbirth), there is a high probability of the IUD falling out during menstruation.
Taking this into account, the method has contraindications and limitations. First of all, the use of an IUD is contraindicated for chronic inflammatory diseases of the genital organs. Relative contraindication is the presence of an ectopic pregnancy in the past. According to WHO recommendations, this method of contraception is more suitable for older women (after 35–40 years) with children. Before starting to use this method, it is necessary to consult a doctor, be examined for inflammatory diseases of the genital organs, and have an ultrasound of the pelvic organs. While using an IUD, you should visit a gynecologist once every 6–9 months.
Hormonal contraception is the most reliable, safe and convenient method of protection. The Pearl index is 0.01–0.05, which is the most high rate for reversible contraception methods. The reversibility of contraception means the complete independent restoration of the ability to conceive and bear a child after stopping the use of one or another method of birth control.
Hormonal contraception divided into several main groups. The most widely used are combined estrogen-progestin oral contraceptives. These drugs contain synthetic analogs of two female hormones that are produced in the body in the first and second phases of the menstrual cycle (estrogens and gestagens).
New generations of combined hormonal contraceptives have been developed. These agents, in essence, are practically no different from combined hormonal pills, in addition to the method of entry of the substance into the body - absorption active substance occurs through the skin (patch) or through the vaginal mucosa (ring). With these methods, the contraceptive effect is achieved with lower doses of drugs. In general, these drugs have all the same indications and contraindications as combination tablets.
A group of drugs that contain only a gestagenic component, similar to the female hormone progesterone, is called mini-pills.
The mechanism of action of hormonal contraceptives has been studied in great detail and differs somewhat for combined and purely gestagenic drugs. Both groups of drugs increase mucus viscosity cervical canal, which prevents the penetration of sperm, slow down the peristalsis of the fallopian tubes and the passage of the egg through them, and contribute to changes in the structure and thinning of the inner lining of the uterus. This leads to the fact that the egg cannot meet the sperm in the fallopian tube at the moment when it is ready for fertilization. Further, if fertilization does occur, implantation of the egg into the uterus is impossible due to a sharp thinning and change in the structure of the uterine mucosa. Combined contraceptives, in addition, to a greater extent than purely gestagenic ones, they have central action– affect the regulatory centers of the brain and prevent their stimulating effect on the ovaries. Without receiving any signals, the synthesis of female hormones in the ovaries is inhibited, dominant follicle(the one from which the egg will be released after ovulation) does not mature, ovulation does not occur.
Thus, the contraceptive reliability of purely progestogen drugs is slightly lower than that of combined drugs. First of all, it should be noted that since the estrogen component of combination drugs reduces breast milk production, this group of contraceptives is not recommended for breastfeeding women. Their use is possible only for mothers whose children are on artificial feeding. Pure progestogen mini-pills and hormonal IUD do not have such an effect, and gestagens enter milk in extremely small quantities, which cannot have any effect on the child’s body, so these drugs can be recommended for nursing mothers.
You can start using any hormonal contraceptives only after consulting your doctor and necessary examination, which allows you to identify contraindications to the use of hormonal contraceptives in a woman, as well as select the most suitable drug.
For nursing mothers who use the lactational anovulation method, mini-pills are recommended, and you can start taking them on any day, but only as long as all feeding rules are followed and the lactational amenorrhea method is considered reliable. For maximum confidence in the contraceptive effect, it is advisable to start taking it no later than 6-8 weeks after birth. If the number of feedings has decreased and lactation is no longer a completely reliable method of contraception, then you should use barrier contraception until menstruation begins, and then from the first day of menstruation you can start taking mini-pills.
Tablets are taken one per day, strictly at the same time, without breaks, next package should begin immediately after the end of the previous one. Accurate adherence to the rules for taking the mini-pill is very important to ensure a contraceptive effect, because the validity of one tablet is exactly 24 hours. Young mothers whose baby is mixed-fed should start taking the mini-pill either 3-4 weeks after birth or later, after waiting for the first menstruation, and before that use barrier contraception. You can continue taking it until lactation completely stops, or longer if the drug is well tolerated.
When using hormonal contraception, be sure to visit a gynecologist at least once a year. After the abolition of such protective measures, the ability to conceive is restored mainly in the first or second menstrual cycle.
In conclusion, I would like to recommend that young mothers be attentive to their body after the birth of the baby, because adequate and full recovery after childbirth is the key to your reproductive health and the birth of healthy children in the future.
Separately, a brief word should be said about irreversible methods of contraception. For men, this is a vasectomy, that is, ligation of the vas deferens, which prevents sperm from entering the ejaculate while maintaining hormonal and sexual function. For women, this is a “ligation” of the fallopian tubes, also with complete preservation of hormonal and sexual function. The operation is performed laparoscopically (that is, through small, no more than 1 cm, incisions in the skin), under anesthesia; in this case, a section of the tube is excised or cauterized and the meeting of the egg and sperm becomes impossible. The irreversibility of the methods implies that subsequent pregnancy naturally will be impossible, so its use requires serious and balanced reasons.
There are purely gestagenic contraceptive drugs long acting. These include injectables and subcutaneous capsules, but due to large quantity side effects these funds are not currently used in developed countries. Of this group of drugs, you should pay attention only to the intrauterine hormonal system, which is a T-shaped intrauterine device, on the vertical part of which there is a cylinder where levonorgestrel (a hormonal drug, an analogue of the hormone progesterone) is located. Due to the low hormone content and absorption at the uterine level, this drug has a minimal number of side effects, and due to the combination of hormonal and intrauterine contraceptive action, it is highly effective (Pearl index less than 0.1).
Contraception after childbirth
It is known that by the 10th day after childbirth the cervical canal is completely restored, and at 7-8 weeks the restoration of the mucous membrane (endometrium) of the uterus ends. 6 weeks after birth, 15% of non-breastfeeding and 5% of breastfeeding women ovulate. Thus, a woman can become pregnant by 3 months after birth.
At the same time, pregnancy during the first 1.5-2 years after childbirth is extremely undesirable for most women: your body has not yet fully recovered to carry the next pregnancy. In addition, pregnancy can occur with various complications and risks for the child, and abortion during this period is extremely dangerous due to the development of severe complications from the reproductive system. Thus, the use of contraception in the postpartum period provides the mother with required time to restore your health and provide normal care for your newborn baby.
Recommended methods of contraception in the postpartum period depend on whether the baby is breastfed, mixed or bottle-fed, and whether the mother has contraindications to this or that type of contraception.
It has been established that hormonal contraceptive preparations containing estrogens and gestagens ( combined oral contraceptives) have a negative effect on the quantity and quality of milk and can shorten the period of breastfeeding, so they should not be taken until breastfeeding has stopped. If, nevertheless, the mother is determined to use hormonal contraceptives, then contraceptive medications containing only gestagens can be used.
Lactational amenorrhea method
The method is due to the fact that for 6 months a woman who breastfeeds her baby only (without a night break) and if she does not have menstruation, remains 98% infertile. The advantages of this method include accessibility to all breastfeeding women and absolute freeness. However, for women whose children are mixed-fed, this method is ineffective and is not a reliable method of contraception.
Gestagen-containing contraceptives (mini-pills)
It is noted that hormonal drugs containing only gestagens, in contrast to combined oral contraceptives, which contain both gestagens and estrogens, do not affect breast-feeding and do not affect the physical and mental development kids. The results of numerous studies have also shown that drugs containing only gestagens are more effective for nursing mothers than for non-breastfeeding mothers, since the latter's acceptability of these drugs is reduced due to an increase in the frequency of spotting from the genital tract.
Mini-pills - contain only microdoses of gestagens (30-500 mcg).
Mini-pills affect the mucus of the cervical canal, reducing its amount in the middle of the cycle and maintaining its high viscosity, which makes it difficult for sperm to pass through. The viscosity of the mucus appears 2 hours after taking the tablet. Under the influence of the mini-pill, changes in the endometrium occur that are unfavorable for implantation; the movement of the egg through the fallopian tube slows down due to a decrease in the contractile activity of the fallopian tubes. In the ovaries, mini-pills inhibit ovulation by 55-65%.
Contraindications: heavy vascular diseases brain and heart, liver dysfunction (liver cirrhosis, viral hepatitis, liver tumors), uterine bleeding with unknown reason, the presence of ovarian cysts, breast cancer, thrombo-embolic diseases.
Side effects: menstrual irregularities (possible uterine bleeding in the middle of the cycle; shortening of the menstrual cycle); nausea, vomiting; depression; weight gain; decreased sex drive; headache, dizziness; engorgement of the mammary glands; increased risk of developing functional cysts ovarian and ectopic pregnancy.
Advantage of the method: low hormone content, low risk cardiovascular disorders, no effect on carbohydrate metabolism and the blood coagulation system, therapeutic effect with some cycle disorders, premenstrual syndrome, pain during ovulation in the middle of the menstrual cycle, inflammatory diseases of the internal genital organs; fast recovery ability to conceive (within 3 months after discontinuation of the drug); used during lactation; possible use smoking women over 35 years old.
Disadvantages of the method: The drug should be taken at the same time every day. Otherwise, efficiency decreases sharply.
Attention! Hormonal contraceptives do not protect against sexually transmitted diseases.
Intrauterine devices (IUD)
This method meets all the requirements for pregnancy-preventing agents used in the postpartum period: it does not affect lactation; is reversible; does not have overall influence on the body; easy to use; available; highly effective.
The IUD increases the tone of the uterus and, therefore, promotes the expulsion of the embryo early stages, increases motor activity fallopian tubes and thereby prevents the development of a fertilized egg and implantation.
There are simple IUDs and copper IUDs.
Contraindications for IUD insertion are acute and chronic inflammatory diseases of the genital organs, pregnancy, malignant and benign tumors genital organs, abnormalities in the development of the reproductive system.
Complications when inserting an IUD: pain in lower sections abdomen, slight spotting that usually goes away within 2 to 4 weeks. The development of inflammatory diseases, spontaneous expulsion of the IUD, heavy and painful periods is possible.
The spiral is introduced no earlier than 6 weeks after birth. This is due to the fact that in the period from 1 - 2 days to 6 weeks after birth there is high frequency spiral falling out.
The IUD does not protect against sexually transmitted diseases!
Recently, the use of hormonal intrauterine systems has become increasingly widespread - systems that combine the advantages of traditional IUDs and hormonal contraceptives and have healing effect for some female diseases.
Hormonal intrauterine system
The intrauterine system is one of the most effective and acceptable reversible methods of preventing unwanted pregnancy. The essence of this method is that the gestagen levonor-gestrel is gradually released from the system introduced into the uterine cavity. It has a local effect on cervical mucus, endometrium and sperm motility, which provides a reliable contraceptive effect that is comparable to surgical sterilization. Moreover, this effect lasts for 5 years - set it and forget it! This is especially convenient for young mothers who simply do not have time to remember about contraception every day, since caring for a baby takes a lot of effort and time.
Mirena can be used during breastfeeding.
Thanks to local action system hormone concentration in breast milk- extremely low.
Does not affect the growth and development of a child during breastfeeding.
Does not affect the quantity and quality of breast milk.
Other advantages of the intrauterine system include a reduction in the volume and duration of menstrual blood loss (in 82-96% of patients); therapeutic effect in idiopathic menorrhagia, dysfunctional uterine bleeding, uterine fibroids small sizes, adenomyosis, dysmenorrhea, premenstrual syndrome. Unlike traditional IUDs, the intrauterine system also significantly reduces the risk of pelvic inflammatory disease and ectopic pregnancy.
The system provides menstrual comfort- menstruation becomes less abundant and almost painless.
In the first months, intermenstrual bleeding may be observed, which later becomes more rare and scarce. For some women, they may stop altogether. You should not be afraid of this, because this is the reaction of the uterus to the local administration of the hormone.
During this period, you should not limit yourself to sports; you can visit the pool and have sex. You should lead a normal lifestyle, and Mirena® will be your reliable assistant. After discontinuing use of the Mirena system, the menstrual cycle and the ability to become pregnant are quickly restored.
Barrier methods of contraception
Their main advantage is the absence of a systemic effect on the partners’ bodies. Among these methods, the condom is the most widely used. As a rule, modern condoms consist of latex and come with or without lubricant. Do not lubricate the condom with oils or saliva, as this may compromise its seal.
Benefits of using condoms:
Relatively low cost;
- ease of use;
- high efficiency when used correctly;
- no effect on metabolism in the body;
- prevention of sexually transmitted diseases;
- reducing the risk of developing cervical cancer;
Disadvantages of condoms:
If the quality of the condom is poor or it is stored beyond the expiration date, as well as if used incorrectly, the condom may rupture;
- decreased sensation during sexual intercourse in both men and women;
- development of irritation phenomena in the area of the external genitalia and vagina of women due to dryness of the vaginal mucosa or hypersensitivity to the constituent components of the condom;
You can use diaphragms, but when choosing them you should remember that they require strict adherence to the rules of storage and use. This method is rarely used. The diaphragm is inserted into the vagina before sexual intercourse. Its dome should cover the cervix.
Contraindications to the use of diaphragms:
Sexual infantilism;
- prolapse of the walls of the vagina and uterus, decreased tone of the pelvic floor muscles;
- poorly healing perineal tears;
- very capacious vagina;
- pathology of the cervix;
- inflammatory processes genitals.
It is better to use a condom and diaphragm in combination with chemical methods of contraception- spermicides that destroy sperm. Spermicides are produced in the form of creams, jellies, foam aerosols, suppositories, tablets, films.
Spermicides are injected into top part vagina 10-15 minutes before sexual intercourse. For one sexual act, a single use of the drug is sufficient. With each subsequent sexual intercourse, additional administration of spermicide is necessary.
Benefits of spermicides: ease of use, providing some protection against some sexually transmitted diseases.
The main disadvantage of spermicides- low contraceptive effectiveness, therefore it is recommended to use spermicides in combination with barrier methods contraception. Possible development allergic reactions, itching and burning of the genitals.
Voluntary surgical sterilization(DHS)
It is the most effective and irreversible method of birth control for both men and women and at the same time is a safe and economical method of contraception. However, it is most often used in women over 40 years of age and if there are more than 2 children in the family (for more information about the method, see Pregnancy and childbirth in women over 35 years of age).
Low-dose and micro-dose combined (containing estrogens and gestagens) hormonal contraceptives
They can be used if a woman is not breastfeeding her baby. These drugs contain small amounts of the hormone estrogen, which is associated with almost all of the adverse effects of combined hormonal contraception. At the same time, these are very effective drugs in terms of preventing pregnancy.
You can start taking combined hormonal medications 2 months after giving birth.
The mechanism of their action is to suppress ovulation, slow down the movement of the fallopian tubes, influence the endometrium, and increase the viscosity of the mucus of the cervical canal. Modern low- and micro-dose combined oral contraceptives do not have a pronounced effect on the metabolism in the body.
Contraindications to the use of combined oral contraceptives: pregnancy, breastfeeding, serious illnesses cardiovascular system, cerebral vessels; liver pathology ( acute diseases liver, severe liver dysfunction, benign and malignant tumors liver); acute thrombophlebitis, thrombosis or thromboembolism, or their presence in the past, the presence of genetic and acquired thrombophilia; bleeding from the genital tract of unknown origin.
Contraindications taking into account age over 35 years: hypertension, 3rd degree obesity, increased blood lipid and cholesterol levels, smoking more than 15 cigarettes per day, diabetes mellitus, migraine, epilepsy, depression, liver pathology ( cholelithiasis, itching and jaundice during pregnancy in the past, chronic diseases liver), tuberculosis, uterine fibroids.
The most unreliable methods of contraception include interrupted coitus and calendar method.
Calendar (or biological) method
Based on definition dangerous days for conception depending on the duration of the menstrual cycle. In the postpartum period, especially in the first six months, it is unreliable, since the menstrual cycle is only established after childbirth. In addition, pregnancy can occur in the first menstrual cycle after childbirth, even in the absence of menstruation. This method is not suitable for women suffering from ovarian dysfunction. In this regard, it cannot be recommended as a reliable method of contraception.
Most likely days of conception
Coitus interruptus
Has a lot negative aspects: It often leads to sexual dysfunction in both men and women. In addition, some of the sperm can end up on the woman’s external genitalia, and from there into the vagina and uterus.
If we talk about the degree of reliability of a particular method of preventing unwanted pregnancy, then it is determined by the so-called Pearl index- the number of unwanted pregnancies among 100 women using this method of contraception during the year.
