After your baby is born – Sex and contraception after birth

You can get pregnant again as early as 21 days (three weeks) after giving birth, including if you’re breastfeeding or your periods haven’t started yet. That’s because the ovaries can still release an egg.

Therefore, you need to have effective contraception after birth that’s working before day 21 if you’re going to be having penis in vagina sex.

Most contraception is safe to start straight after birth and we usually recommend starting it as soon as possible so that you are protected from pregnancy when you do decide to start having sex again. This also means that you have your contraception sorted well before you return to your busy life at home where it can be more challenging to find the time to talk about contraception with a healthcare professional.

There are a few exceptions where a method needs to be started a little later, such as coils and the diaphragm/cap. These are discussed in more detail in the contraception choices section.

The World Health Organisation recommends waiting 24 months but most organisations from higher-income countries feel that on review of the evidence, an interval of between 18-24 months is also safe.

Research suggests that starting a pregnancy within 6 months of giving birth can increase your chances of stillbirth, premature birth, low birth weight, congenital disorders, issues with the placenta, maternal anaemia and womb rupture.

Discussing your options for effective contraception until you do feel ready to conceive, and understanding the risks associated with the timing of your next pregnancy will help you make decisions about growing your family.

All contraceptive methods that do not contain oestrogen are safe to use straight after birth when breastfeeding. They do not pass into the breast milk in any unsafe levels for your baby and they will not affect your milk supply. Combined hormonal contraceptives that contain oestrogen can be safe from 6 weeks after birth when breastfeeding.

There are no rules about when to start having sex again. This is a very personal choice and depends on how you feel and when both you and your partner are ready. You will probably feel tired and sore, so don’t feel any pressure to rush into it until you’re feeling fully healed.

The hormonal changes can make the vulva and vagina drier which can cause discomfort. You may find that over the counter lubricants make sex more enjoyable. If penetrative sex hurts then stop, there’s lots of other ways that you can experience pleasure alone or with your partner/s that doesn’t involve penetration.

The combined oral contraceptive (COC) pill is known by many as 'the pill'. It’s traditionally been the pill that you take for 21 days and then have a 7 day break and a ‘bleed’. It prevents pregnancy by stopping the ovaries from releasing an egg. This method contains oestrogen so can be started after 3 weeks if you’re not breast feeding and after 6 weeks if you are breastfeeding.

It is not suitable for everyone, so a healthcare professional will need to ask you some questions to make sure it is suitable for you. It requires you remembering to take a pill each day and becomes less effective if you forget to take it or vomit. This method, unlike condoms, does not protect you from sexually transmitted infections (STIs). Use condoms alongside this method for protections from STIs.

With combined methods we know it’s also safe to use a 'tailored regime', where you shorten or skip your pill free interval all together to prevent having a bleed every month. If you’re interested in learning more about this, then speak to your healthcare professional when starting the method.

With perfect use of this method <1% of people become pregnant in the first year. With typical use of this method 9% of people become pregnant in the first year.

The pill can help with acne, heavy or painful periods, endometriosis and premenstrual symptoms. Sometimes people can experience hormonal side effects such as tender breasts, headaches, acne and mood changes but generally it’s very well tolerated.

The combined contraceptive patch contains two hormones just like the combined pill but comes in a patch form which is applied to the skin and changed every week. It prevents pregnancy by stopping the ovaries from releasing an egg. This method contains oestrogen so can be started after 3 weeks if you’re not breast feeding and after 6 weeks if you are breastfeeding.

It is not suitable for everyone and so a healthcare professional will need to ask you some questions to make sure it is suitable for you. It requires you remembering to change your patch each week for three weeks, then have a patch free week where you have a bleed. This method, unlike condoms, does not protect you from sexually transmitted infections (STIs). Use condoms alongside this method for protections from STIs.

With combined methods we know it’s also safe to use a tailored regime where you shorten or skip your patch free interval all together to prevent having a bleed every month. If you’re interested in learning more about this then speak to your healthcare professional about it when starting the method.

With perfect use of the patches <1% of people become pregnant in the first year. With typical use of this method 9% of people become pregnant in the first year.

The patch can help with acne, heavy or painful periods, endometriosis and premenstrual symptoms. Sometimes people can experience hormonal side effects such as tender breasts, headaches, acne and mood changes. The hormones on the patch can irritate the skin, but generally it’s very well tolerated.

The vaginal ring contains two hormones just like the combined pill but comes in a ring form which is inserted into the vagina for three weeks at a time. It prevents pregnancy by stopping the ovaries from releasing an egg. This method contains oestrogen so can be started after 3 weeks if you’re not breast feeding and after 6 weeks if you are breastfeeding.

It is not suitable for everyone and so a healthcare professional will need to ask you some questions to make sure it is suitable for you. It requires you remembering to remove your vaginal ring after three weeks, then you can have a ring free week where you have a bleed before inserting a new ring. This method, unlike condoms, does not protect you from sexually transmitted infections (STIs). Use condoms alongside this method for protections from STIs.

With combined methods we know it’s also safe to use a 'tailored regime' where you shorten or skip your ring free interval all together to prevent having a bleed every month. If you’re interested in learning more about this then speak to your healthcare professional when starting the method.

With perfect use of the ring <1% of people become pregnant in the first year. With typical use of this method 9% of people become pregnant in the first year.

The ring can help with acne, heavy or painful periods, endometriosis and premenstrual symptoms. Sometimes people can experience hormonal side effects such as tender breasts, headaches, acne and mood changes. The hormones on the ring can irritate the vagina but this is not very common and generally it’s very well tolerated.

The progesterone only pill (POP) is known by many as the 'mini-pill'. It’s the contraceptive pill that, in most cases, you take everyday, unlike the combined pill where you traditionally have a pill free break and a ‘bleed’. It prevents pregnancy by thickening the mucus at the neck of the womb preventing sperm from passing through and some of the types of pills also stop you ovulating.

This method if safe to start straight away even if you are breast feeding, and has fewer contraindications compared to the combined methods. It requires you remembering to take a pill each day and becomes less effective if you forget to take it or vomit. This method, unlike condoms, does not protect you from sexually transmitted infections (STIs). Use condoms alongside this method for protections from STIs.

With perfect use of this method <1% of people become pregnant in the first year. With typical use of this method 8% of people become pregnant in the first year.

The mini-pill can help with heavy or painful periods, endometriosis and premenstrual symptoms. Often it will stop your regular periods all together and instead you may experience some irregular periods or some spotting which is the most common side effect. Sometimes people can experience hormonal side effects such as tender breasts, headaches, acne and mood changes but generally it’s very well tolerated.

The hormonal IUD (coil) is a ‘T’ shaped contraceptive device that sits inside the womb. The most well known hormonal IUD is the 'Mirena  coil' but there are also other types containing different amounts of hormones such as the 'Kyleena' and the 'Jaydess'. They prevent pregnancy by thickening the mucus at the neck of the womb which prevents sperm from passing through and can also stop ovulation.

This method if safe to be inserted within the first 48 hours after birth or after 4 weeks and is totally safe with breastfeeding. It can last as contraception for up to 8 years and does not require you to remember to take something each day.

Currently in Worcestershire we only fit coils after 4 weeks. If you want this method then you will be offered a ‘bridging’ method of contraception to protect you from pregnancy until it’s safe to insert a coil. Insertions can sometimes be uncomfortable but we have lots of options for pain relief, including local anaesthesia. This method, unlike condoms, does not protect you from sexually transmitted infections (STIs). Use condoms alongside this method for protection from STIs.

With perfect and typical use of this method <1% of people become pregnant in the first year.

The hormonal IUS (coil) has the benefit of making your periods lighter and less painful and in many people it stops their periods all together. It can also help with endometriosis and premenstrual symptoms. You may experience some irregular periods or some spotting, this is the most common side effect but this often settles with time.

Sometimes people can experience hormonal side effects such as tender breasts, headaches, acne and mood changes. As the hormones are released locally into the womb and not directly into the blood stream, these hormonal side effects are usually very minimal compared to other methods.

The implant is a small matchstick sized contraceptive device, which is inserted under the skin in the upper arm releasing progestogen slowly over time. It prevents pregnancy by thickening the mucus at the neck of the womb preventing sperm from passing through. It also prevents ovulation. This method if safe to start straight away even if you are breast feeding and has fewer contraindications compared to the combined methods.

Once inserted it lasts for three years for contraception and it does not require you to remember to take something each day. This method, unlike condoms, does not protect you from sexually transmitted infections (STIs). Use condoms alongside this method for protections from STIs.

With perfect and typical use of this method, only 0.05% of people become pregnant in the first year. This is the most effective contraceptive method available.

The implant can help with heavy or painful periods, endometriosis and premenstrual symptoms. Often it will stop regular periods all together and instead you may experience some irregular periods or some spotting, which is the most common side effect.

If you struggle with irregular bleeding/spotting on this method, speak to your doctor as there are things you can try to stop this. Sometimes people can experience hormonal side effects such as tender breasts, headaches, acne and mood changes but generally it’s very well tolerated and the side effects settle with time.

The injection, also known as the 'depo injection' or 'depo-provera' is a contraception injection that is given once every three months. It contains progestogen and prevents pregnancy by thickening the mucus at the neck of the womb preventing sperm from passing through and stopping ovulation. This method if safe to start immediately after childbirth even if you are breast feeding and has fewer contraindications compared to the combined methods.

Each injection lasts for three months and it does not require you to remember to take something each day. Once the injection has been given it cannot be removed if you experience side effects. This method, unlike condoms, does not protect you from sexually transmitted infections (STIs). Use condoms alongside this method for protections from STIs.

With perfect use of this method <1% of people become pregnant in the first year. With typical use around 3% become pregnant in the first year.

There is also a contraceptive injection called 'Sayana press' which allows you to self-administer an injection under the skin (like an insulin injection) and lasts for 13 weeks. If you are interested in giving the injection to yourself, then ask your healthcare practitioner about this option.

The injection can help with heavy or painful periods, endometriosis and premenstrual symptoms. Often it will stop your regular periods all together and instead you may experience some irregular periods or spotting, this is the most common side effect.

If you do struggle with irregular bleeding/spotting on this method, speak to your doctor as there are things you can try to stop this. Sometimes people can experience hormonal side effects such as tender breasts, headaches, acne and mood changes but generally it’s very well tolerated.

The copper IUD (coil) is a ‘T’ shaped contraceptive device that sits inside the womb. It prevents pregnancy by stopping sperm from fertilising an egg and by creating an environment that is toxic to sperm. This method if safe to be inserted within the first 48 hours after birth or after 4 weeks, and is totally safe with breastfeeding. It can last as contraception for up to 10 years and does not require you to take something each day.

Currently at our unit we only fit coils after 4 weeks so if you want this method then you will be offered a ‘bridging’ method of contraception to prevent pregnancy until it’s safe to insert a coil. Insertions can sometimes be uncomfortable but we have lots of options for pain relief, including local anaesthesia.

This method, unlike condoms, does not protect you from sexual. This method, unlike condoms, does not protect you from sexually transmitted infections (STIs). Use condoms alongside this method for protection from STIs.

With perfect and typical use of this method <1% of people become pregnant in the first year.

The copper IUD (coil) has the benefit of being a non-hormonal method of contraception. You may find that your periods become slightly heavier and more painful, this is the most common side effect. If you already have heavy and painful periods this may not be the best option for you. If your periods are already light and manageable then you may tolerate this method well.

Condoms are a barrier method of contraception that prevent both pregnancy and the transmission of sexually transmitted infections (STIs) by creating a physical barrier that stops the exchange of bodily fluids. You use this method every time you have sex and it doesn’t contain any hormones. You can get external condoms that fit over a penis or sex toys used for penetration. You can also get internal condoms which go inside the vagina.

With perfect use of this method 2% of people become pregnant in the first year and with typical use of this method 18% become pregnant in the first year.

Condoms are good at protecting from STIs and offer a contraception option that contains no hormones, but they do have a relatively high failure rate compared with other options. The safest method would be to use another contraceptive method alongside condoms to protect from infections.

If you do use condoms as your method of contraception, then be sure to inspect the condom after each use for breaks and contact a healthcare practitioner or a local pharmacy as soon as you can if you have forgotten to use a condom or experienced a break as you may need emergency contraception. If you have a latex allergy, be sure to get latex free condoms and never use oil-based lubricants with your condom as it degrades the material and causes them to break.

Diaphragms and caps are a barrier method of contraception that prevent pregnancy by providing a physical barrier that stops sperm. A spermicidal jelly can be applied to the device which kills sperm. The diaphragm looks like a flexible, plastic cup, very similar to menstrual cups/discs. You cover it in spermicidal jelly and insert it into the vagina until it is sitting around the neck of the womb before having sex.

You then leave it in for 6 hours after sex before removing it. Because of changes to your body during pregnancy, you must wait for 6 weeks after birth until it’s safe to use diaphragms/caps.

If you are keen to use this method, then you will be offered a ‘bridging’ method of contraception to protect you from pregnancy until it’s safe to use. It doesn’t contain any hormones and only works if you use it each time you have sex. This barrier method, unlike condoms, does not protect you from sexually transmitted infections (STIs). Use condoms alongside this method for protection again STIs.

With perfect use of this method 6% of people become pregnant in the first year and with typical use of this method 12% become pregnant in the first year.

Diaphragms/caps are a good non-hormonal contraception option. We highly recommend going to a sexual health clinic where they specialise in contraception to access this method so that they can assess that you are able to fit it correctly and confidently.

Fertility tracking is a method of contraception that uses menstrual cycle tracking and various markers such as body temperature and cervical mucus thickness to calculate when you are most fertile.

During this time you should abstain or use condoms when having sex to prevent pregnancy. It requires you to track these markers every single day. If you are still having sex without a condom at certain points in your cycle then this method will not protect you from sexually transmitted infections (STIs). Only using condoms each time you have sex will protect from STIs.

With perfect use of this method 5% of people become pregnant in the first year and with typical use of this method 25% become pregnant in the first year.

Fertility tracking offers a contraception option that contains no hormones, but it does have a very high failure rate compared with all other options. If you have an irregular menstrual cycle then you will not be able to use a fertility tracking method. It is important for the health of mum and baby that someone doesn’t get pregnant again too soon after giving birth.

Because of this reason we don’t routinely recommend this method as a stand-alone method of contraception after giving birth. If you are thinking of using this method though, it is important that you discuss it with a healthcare practitioner so they can check that it’s appropriate for you and your cycle and explain to you how best to do it.  

The lactational amenorrhoeic method (LAM) is a method of contraception specifically for people who have just given birth. It is only effective as a method of contraception if you are less than 6 months after giving birth, you are exclusively breastfeeding and you are having no periods. If these criteria are met then you are at a reduced risk of becoming pregnant. As soon as you don’t meet all three of these criteria, this can no longer be used as a method of contraception.

We know that as the frequency of breastfeeding decreases, the risk of pregnancy increases with LAM and so there is a relatively high failure rate with this method (though exact percentages are difficult to determine).

This is why we recommend that the safest way to protect against pregnancy is to use another contraceptive method alongside LAM. This could be condoms or another method. LAM alone does not protect you from sexually transmitted infections (STIs). Only using condoms each time you have sex will protect from STIs.

LAM offers a non-hormonal contraception method for people after giving birth but there is very strict criteria for it to be effective and many people don’t meet these criteria. If you do meet the criteria, you will still need to think about another contraceptive method to start by 6 months post birth. LAM cannot be used as contraception after this point or if you start having periods before 6 months or begin to wean your baby.

If you want to use the LAM method then discuss this with your healthcare practitioner so that they can check that you are eligible, and plan with you about what you will use as contraception when you no longer meet the LAM criteria.

If you stay on our postnatal ward after delivery someone should discuss your post birth contraception options with you before you leave.

If you know that you would like a contraceptive implant then let your midwife in the hospital know right away and they can make a referral to the local sexual health clinic to try and get it fitted prior to you being discharged (see below section on WISH for further details).

If you're interested in having any other contraception then read on about all the places you can go to, to access your chosen method. Unfortunately we don't yet provide contraception directly from our ward on discharge but this is something we are looking at trying to do.

WISH is our local sexual health service who specialise in sexual health care and contraception. They offer fast tracked contraception appointments for anyone who has recently given birth and you can self-refer for this by calling the below numbers and telling them you have recently had a baby. They can provide all the different methods of contraception.

• 0300 1231 731 for Worcester
• 01527 488588 for Redditch
• 01562 514512 for Kidderminster

If you are staying on the postnatal ward after your delivery and you know that you would like a contraceptive implant then let your midwife in the hospital know right away and they can make a referral to WISH to fit the device. Our aim is to fit your implant before you are discharged but if there isn’t capacity then you will be discharged with an appointment time to get it fitted as soon as possible.

Check out the WISH website at: www.hacw.nhs.uk/knowyourstuff/

You can access most methods of contraception via your GP. We recommend seeing your GP about contraception before your routine postnatal check unless you plan to abstain until then. That’s because your fertility returns before this check up, from as early as day 21 post birth.

If you struggle to get in to see your GP, then please explore accessing contraception through any of the other avenues discussed here.

You can access contraceptive pills without a prescription through most pharmacies.

To find out which pharmacies near you offer this service go to: www.nhs.uk/nhs-services/pharmacies/find-a-pharmacy-offering-contraceptive-pill-without-prescription/

SHOUTREACH is a WhatsApp messaging service for young people aged 21 or under in Worcestershire.

If you are struggling to attend a sexual health clinic due to school, college or travel, WhatsApp the team via 07925893838 and they will arrange a call back within two working days (Monday - Friday) to discuss your concerns and where you can access support, advice or treatment. This includes accessing contraception.

Please note this service is available to people aged 21 or under only. Those over this age who need of sexual health advice are encouraged to access the Worcestershire Integrated Sexual Health (WISH) website for information on local clinics.