Mom

BIRTH CONTROL AFTER THE BABY

By Beth Weinhouse

If you've just had a child, you may find it hard to believe, but eventually you are going to be interested in having sex again. In fact, obstetricians say -- and scientific studies back them up -- that most American couples resume having sexual intercourse within several weeks of having a baby. (It's a fair bet that much of this post-partum sex is at the male partner's instigation, since the most fervent desire new mothers have when they get into bed is for only one thing: sleep.) Whether or not you want more children eventually, you probably don't want them right away. That means you have to think about contraception.

Gynecologists say the right time to think about after-baby birth control is while you're still pregnant. Having a plan in place gives you one less thing to worry about when you're preoccupied with caring for a newborn. Your first post-partum checkup, at four to six weeks, is another opportunity to speak to your doctor about contraception. While you may very well want to return to a method you were using happily before you got pregnant, there are some new factors to consider:

• Condoms Because they don't need to be fitted and don't require a prescription, condoms are especially easy for new parents to use. But because vaginal dryness is common in the weeks after birth -- and even longer for nursing mothers -- you may feel more comfortable using a lubricated condom or a personal lubricant.
  
  
• Diaphragms If you were happy with the diaphragm before you became pregnant, by all means go back to it... but not to the same one you'd been using prior to pregnancy. You should be re-fitted for a diaphragm (or fitted for the first time if you've never used one before) at your four- to six-week postpartum checkup, when the uterus and cervix have returned to the size they will remain (which is usually a bit larger than before pregnancy).
  
  
• Cervical Caps Doctors aren't certain why, but cervical caps are somewhat less effective in women who've given birth; it may have to do with a changed cervical shape after delivery. This method may not be the wisest choice for moms.
  
  
• Oral Contraceptives Most birth control pills are combinations of two hormones: estrogen and progestin. Women who are not breastfeeding can begin or resume taking the Pill at the time of their first postpartum checkup (sooner may increase the risk of blood clots). Some doctors prefer to wait in non-nursing women until they've had their first postpartum period. Most nursing mothers prefer to wait until their babies are weaned before taking combination pills.
  
  Progestin-only pills (and other progestin-only contraceptives, such as Norplant implants or Depo-Provera injections) can be started immediately after giving birth in non-nursing mothers. There is some controversy over how safe these methods are for women who are breastfeeding.
  
  
• IUDS For a variety of reasons -- both legal and medical -- most doctors will not prescribe IUDs for women who have never had a child. IUDs got a bad reputation when one model, the Dalkon Shield, was held responsible for pelvic infections and ectopic pregnancies, but experts swear the new models are safe and effective. However, once you've given birth, this contraceptive method becomes newly available to you. Some physicians will insert an IUD immediately after delivery, others prefer to wait for six to eight weeks. While not a hindrance to nursing, the IUD can cause mild uterine cramping during breastfeeding. Talk to your gynecologist about whether this method would now be right for you.

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