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Contraception during breastfeeding, which one?

Contraception refers to the use of reversible or irreversible methods that have the purpose of controlling human reproduction generating a condition of momentary or permanent infertility without affecting the general health of the individual . Contraception during breastfeeding should be effective, without risks for the mother and her baby; in addition, it should not interfere with the production of breast milk in terms of quantity and quality.

Appropriate methods of contraception in breastfeeding

Method		Percentage of unwanted pregnancies during use	Use in lactation	Protects against STDs
	Typical use	Ideal use
Any	85	85	yes	no
Coitus interruptus	27	4	yes	no
Periodical abstinence, Billings, others	25	1-9	yes	no
Male condom	fifteen	2	yes	yes
Female condom	fifteen	5.1	yes	yes
Diaphragm	twenty	6	yes	no
Oral contraceptives	9	1	yes*	no
Minipildora	3	0.3	yes	no
IUD with Copper	0.8	0.6	yes	no
Medicated IUD: Mirena	0.1	0.1	yes	no
Implanon	0.01	0.01	yes	no
Jadelle	0.8	0.8	yes	no
Female sterilization	0.5	0.5	yes	no
Male sterilization	0.15	0.1	yes	no

(*) The use of estrogen-type hormones during lactation is relatively contraindicated during the first 6 weeks postpartum, after this time they can be used without problems although during the first days of use you can notice a reversible decrease in milk production. We must consider very well the nutritional impact of the potential alteration of breast milk in low-income patients versus the catastrophe of a new pregnancy. ETS: Sexually Transmitted Disease

The so-called Pearl Index estimates the effectiveness of contraceptive methods when it comes to preventing unwanted pregnancies. It is based on calculating the number of pregnancies that occur in 100 women using a contraceptive method during a year with the perfect use and typical use of the method

The ” Ideal or perfect use ” is defined as the correct and consistent use of the contraceptive method, without interruptions and without intervening factors that could affect the performance of the method.

The ” Typical Use ” is defined as the use that the individual gives to their contraceptive method and is susceptible to human error or method failure due to lack of information, limitations of the method, poor memory, errors of use, interference of other factors about the method, etc.

Adapted from: Trussell J. Contraceptive efficacy. In Hatcher RA, Trussell J. Stewart F, et al Contraceptive Technology: Seventeenth Revised Edition. New York NY: Ardent Media, 1998. Population Council http://www.popcouncil.org/biomed/jadellefaq.html

Immediate postpartum contraception

It is about the immediate use of some contraceptive method from the birth of the baby to guarantee the early avoidance of a new pregnancy in unreliable patients.
IUD: Some specialists place an intrauterine device 10 minutes after having removed the placenta. The expulsion rate is 24% (compared to 4% when placed at 6 weeks postpartum, at the end of the “quarantine”). I have never placed a device under these conditions, I always wait at the end of the quarantine
Minipill: oral contraceptives with exclusive progestin could be used from the first day of the baby’s birth. They are not associated with lactation inhibition or venous thrombosis. Prolonged genital spotting can be a problem.
Injectables: The injection of medroxyprogesterone (Depo-Provera) is safe during lactation and just like oral preparations can be started immediately. Prolonged genital spotting can be a problem.
Combined injectables and oral contraceptives: should not be used before 6 weeks postpartum due to the increased risk of deep vein thrombosis to which they are associated. We must also consider the potential adverse effect on the quantity and quality of breast milk available for breastfeeding when it is exclusive and in patients of low economic power where the feeding of the baby can be a problem.

Some considerations

Reversible contraception should be safe for the health of the user and should not compromise future fertility when it comes to reversible methods.

The patient who decides to opt for an irreversible method such as surgical procedures, must take into account that she will never be able to have children again naturally, that if she decides to revert the intervention she has the risk of not getting pregnant again or presenting complications such as ectopic pregnancy.

For many “repentant” women, the only solution for having other babies was in vitro fertilization or adoption.

Divorce / change of partner is the most frequent cause for requesting the reversal of a surgical sterilization. The current rates of divorce in the world are around 60%