Dear Doctor,
I delivered three weeks ago and I am not on any form of contraception. Am I at risk of unplanned pregnancy? When should I start using contraception, and which method is most suitable?
Sally
Dear Sally,
You have a very pertinent concern. Effective contraception after delivery should be initiated as soon as possible. This prevents the likelihood of an unplanned pregnancy, and allows adequate spacing prior to subsequent pregnancies. There are many disadvantages of conceiving shortly after a recent pregnancy, with poor health implications for you and your newborn.
Following delivery, the potential to conceive may return even before your periods resume. If you are breastfeeding, there is a natural protection mechanism that kicks in to prevent ovulation, but it’s not foolproof. The way out then is to start on a suitable contraceptive method, rather than keep yourself exposed to the risk of an unwanted pregnancy.
Ideally, you should have made decisions on suitable family planning methods towards the end of the pregnancy. The choices are varied, and you will always find a method that suits your specific circumstances. If breastfeeding, hormonal contraceptives containing estrogens (commonly called the ‘combined pill’) should be avoided as they interfere with milk production. Long term reversible methods, like the implant or the coil, are especially suitable and effective.
Your midwife or gynaecologist should be able to guide you on what method to choose. You will get a basic assessment of your prevailing health, and future reproduction plans. It may be that you are suitable for any of the methods available.
You will have a choice of short-term or longer-term methods. The longer-term methods give you more flexibility, as you don’t have to remember to take any pills daily, and they keep you protected for several years.
Contraception can be commenced as soon as you deliver, and before leaving the hospital. This is entirely safe, and has been shown to be an effective intervention for ongoing maternal and newborn health. Those who have already achieved their desired family sizes can even opt for permanent methods prior to being discharged after delivery. For your case, all you need is to make up your mind and start on contraception soonest possible. The longer you wait, the more you are putting yourself at risk of an unplanned pregnancy.
Modern contraceptives are very effective. But the effectiveness of short-term methods is limited by the user. We are talking of pills, injectables and patches. If you forget to take your pills, or to change a patch, or miss out on the injection when due, then your protection declines. You should find a way of reminding yourself when the next pill or injection is due. There are plenty of Apps that you can use. If you are the forgetful type, go for the long-term methods.
Once a new pregnancy is desired, all you need is to discontinue using contraception.
- Dr Alfred Murage is a consultant obstetrician and gynaecologist