Not all parents rush to have a second child immediately after the birth of their first child. That is why the issue of contraception after childbirth is most pressing.

In order for the female body to prepare for the next pregnancy, it requires certain time, and for mothers with small children in their arms, it is not always easy to endure a subsequent pregnancy without endangering their own health. Taking into account all of the above factors, the conclusion about the need to choose a competent contraceptive after birth period suggests itself. Let's try to figure out which contraceptive methods are most suitable for young mothers and do not harm babies.

When should you start having sex after childbirth?

Question about renewal sexual contacts After the birth of a baby, not only mothers, but also fathers worry. It is worth remembering that childbirth is a huge burden for a woman’s body, and even if it proceeded without complications, there is no need to rush into intimate contacts.

Doctors recommend abstaining from sexual activity for 6 weeks after childbirth; if any complications arise during delivery, this period can be extended. You can obtain more complete and reliable information about when you can begin intimate life after childbirth after an examination with a gynecologist, who, based on the examination, will decide on the initiation of sexual activity or temporary abstinence from it.

Is breastfeeding a guarantee against another pregnancy?

I would immediately like to dispel this myth, which young mothers often take as a basis when starting sex life. In fact, the hormone, which is produced in the body of a nursing mother, prevents the onset of menstruation and the production of an egg. But there are often cases when menstruation can begin in a woman who is intensively breastfeeding her baby, immediately after the end of postpartum discharge.

Each organism is unique, which is why you should not rely entirely on this method under any circumstances! Even if a woman has established lactation, then, as a rule, the menstrual cycle resumes within six months, but if a young mother does not feed her baby, then ovulation can resume within a month!

It happens that a woman who has recently given birth to a child becomes pregnant even before the first birth. menstrual bleeding.

Resumption of sexual relations after childbirth, according to experts, occurs in most women, but, as a rule, about half of them do not even think about using any method of contraception. That is why women who have recently given birth to babies are included in the group high risk unplanned pregnancy.

If you are not planning on having similar babies and carefully monitor your health, many doctors do not recommend getting pregnant again for 2-3 years after the first birth. This is explained by the weakening of the female body, the risk of complications during a second pregnancy, the need to restore the body and other factors. You need to pick up as much as possible suitable method contraception. Only the right method of protection can reliably and effectively protect you.

Choosing a method of contraception after childbirth

Of course, the ideal choice would be to select postpartum contraception before the baby is born. If for some reason you were unable to do this, you can get the necessary information from a doctor in the maternity ward, immediately after giving birth. A specialist will tell you about the pros and cons of a particular method and recommend what is right for you. When choosing a contraceptive method, you should not rely on the advice of friends or acquaintances; remember that only a doctor can give you the right advice!

If you are breastfeeding, be sure to indicate this in a conversation with your gynecologist, since not all methods of contraception are compatible with breastfeeding; some pills can affect lactation or block it altogether.

A woman who does not breastfeed her baby for any reason, should start taking contraceptives immediately after starting intimate relationships. If there are no contraindications to a particular method, then a woman is free to choose the method of contraception that is most convenient and comfortable for her, but only after consulting a doctor.

Regarding nursing mothers, then everything is a little more complicated: the frequency of feeding the baby and the time that has passed since delivery must be taken into account. When choosing a contraceptive for women whose children are breastfed, the main thing is that the method of protection does not have negative influence neither on the health of the baby, nor on the process of milk production.

If the child is completely breastfed, then oral contraceptives are not recommended for six months. If feedings are irregular or early complementary feeding is introduced, then the woman must contact a gynecologist no later than a month after giving birth, so that the specialist can select and prescribe the correct drug.

There is one more important rule, which women should not forget about: different methods of contraception have varying degrees effectiveness, some involve restrictions in use, and not all contraceptives can be used in the first weeks after the birth of a child.

A woman who has recently given birth to a child should be psychologically attuned in advance to the fact that now contraception should be approached especially carefully, and in order to increase the degree of protection against unwanted pregnancy, it is often necessary to combine certain methods, achieving the highest possible protection and reliability.

It is also worth remembering the so-called “safety net” if for some reason you doubt the effectiveness of the product you have chosen. Tell me how to combine correctly protective equipment and what to do if the reliability of protection decreases can only be done by a competent gynecologist, who should be visited as early as possible after the onset of sexual activity after childbirth.

What methods of contraception after childbirth are the most effective, and how to make the right choice?

Of course, 100% method of preventing the onset unwanted pregnancy is sexual abstinence or, in other words, abstinence. But, often, for many couples this method of contraception is not suitable even for a short period of time, so they look for alternative method with a high degree of protection.

1. Lactational amenorrhea method – what is this? In order to understand how this method of contraception works, let's understand its mechanisms. So, having given birth to a child, a special hormone is produced in the body of a young mother - prolactin, which is responsible for lactation and at the same time suppresses ovulation. It is lactational amenorrhea that causes the absence of menstruation in women in the first months, when a young mother is actively breastfeeding her baby.

In this case, prolactin provides contraceptive effect. It is worth noting that the level of the hormone in a woman’s body decreases significantly if the time between feeding the baby is more than 4 hours, and, consequently, the contraceptive effect is reduced.

Putting a baby to the breast immediately after delivery is one of the most well-known methods of natural protection of the mother from the onset of subsequent unwanted pregnancy. In addition, breastfeeding promotes rapid recovery female genital organs after childbirth.

The lactational amenorrhea method involves constantly feeding the baby throughout the day, that is, both day and night, at intervals of no more than 3-4 hours. This method is considered most effective when a young mother feeds her baby on demand (15 to 20 times a day). However, expressing milk is not considered feeding, and the degree of protection this method is significantly reduced.

This method of protection can be used for six months if all the above rules are observed, however, even it does not provide a 100% guarantee and there is a risk of getting pregnant even if you feed the baby correctly and on time.

The advantages of this method are undeniable: it is very easy to use, has no contraindications, has a positive effect on the recovery process of the mother’s body after childbirth (contraction of the uterus, reduces the risk of postpartum hemorrhage etc.), and, of course, this method of contraception is very beneficial for the health of the baby who has already been born.

Despite many advantages, this method also has certain disadvantages. The lactational amenorrhea method will not protect you from sexually transmitted diseases, it is not suitable for working women and requires strict feeding of the child on demand, and this method of protection can only be used for 6 months (if the woman’s menstruation has not returned earlier).

2. Oral contraceptives. There are several options for oral contraceptives, some contain only progestins and are called “mili-pili”. These tablets contain synthetic hormones, due to which the viscosity of the cervical mucosa is reduced, and the sperm is not able to enter the uterine cavity. Thus, the embryo does not implant.

Women can use such drugs as early as 6 weeks after delivery, and non-breastfeeding mothers can take these tablets a month after childbirth or from the moment menstrual bleeding begins. At correct intake of the drug in combination with breastfeeding, this method of contraception provides a guarantee of about 98%.

Separately, it is worth noting that taking these oral contraceptives does not affect the quantity and quality of breast milk of a nursing woman.

And, of course, it’s worth saying a few words about the disadvantages of these drugs. In the first cycles of treatment, discharge similar to menstrual discharge may be observed. This is due to the body’s adaptation to the drug and should not be a cause for concern. If your periods have stopped or something has bothered you since taking the pills, you should immediately visit a gynecologist.

The peculiarity of taking oral contraceptives is that they must be taken constantly, without skipping, at a certain time. They are not recommended to be combined with certain drugs; you can get more detailed information about this from the instructions for the drug or from the doctor who prescribed the medicine.

Fertility usually returns to normal immediately after stopping the drug, so if you decide to continue taking oral contraceptives after stopping breastfeeding, then you are better off choosing combined contraceptives. They begin to be taken from the moment menstruation begins after breastfeeding is stopped. The effectiveness of these pills is close to 100%, that is, if taken correctly, it is almost impossible to get pregnant.

Combined drugs are similar in their method of administration and the ability of the body to restore conception after their withdrawal to drugs containing progestins.

It is worth noting long-acting progestogens. These drugs long acting, which are administered to breastfeeding women after 6 weeks after birth and to non-breastfeeding women after 4 weeks. They provide very high protection against unwanted pregnancy, also do not affect lactation and breast milk, and do not have a negative impact on the health of the woman and child.

These drugs are prescribed and administered only by a doctor; after their administration, they must be used for 14 days additional methods protection.

3. Intrauterine devices. If a woman does not experience any complications during childbirth, this method of contraception can be introduced immediately. Otherwise, an intrauterine device can be placed six weeks after birth. The protection efficiency is about 98%, which is quite a high figure.

Today, many women prefer intrauterine devices as a reliable and effective remedy against unwanted pregnancy. It is worth noting that those women who have an intrauterine device installed need to visit a gynecologist at least once every six months. This method of contraception can provide effective protection for a period of 5 to 7 years, after which the contraceptive is removed or replaced.

The disadvantages of this type of contraception are that after installation of the IUD, pain in the lower abdomen may occur when feeding the baby. Menstruation in the first months after installing this contraceptive may be more heavy and painful than before. Sometimes the spiral may fall out, so a woman should carefully monitor its location. The advantage of the IUD is that the contraceptive effect occurs immediately after its installation.

The installation of this method of contraception is not recommended for women who have diseases of the female genital organs or are sexually active with several sexual partners.

4. Barrier methods of contraception. The most popular barrier method of preventing unwanted pregnancy is the condom. You can start using it immediately from the moment you resume sexual activity. According to statistics, a condom provides a guarantee of about 90%, and when used correctly, reliability increases to 97%. This method of contraception is easy to use and accessible to everyone. It does not affect lactation, and, importantly, protects partners from various sexually transmitted infections.

The disadvantages of a condom are that it can slip off, break, and at the same time the risk of pregnancy increases significantly. That is why you should strictly follow the instructions for using a condom.

4-5 weeks after birth, you can use a cap (diaphragm) as protection against unwanted pregnancy; it is suitable only when the female genital organs have returned to their usual size. The effectiveness of this barrier method directly depends on the correct application. During breastfeeding, the effectiveness of protection is about 90%. The advantages of the method are that it does not affect milk production and can protect against some infections.

A gynecologist should select a cap for a woman and teach her how to use it correctly; after the baby is born, the size of the cap may change, so consultation with a specialist is also necessary here. It is better to use caps as a method of contraception in conjunction with spermicides, which we will discuss below.

Spermicides are various creams, suppositories, tablets, ointments that disrupt sperm motility or lead to their death. Application this tool contraception should be combined with some other method.

5. Sterilization. It is an irreversible method of contraception, after which pregnancy is impossible. When carrying out sterilization, women undergo tubal ligation, and men undergo ligation of the vas deferens.

The decision to sterilize must be thoughtful and informed. In Russia, sterilization is carried out for women at least 35 years old or those who already have two children. It is worth noting that the legislation does not say anything about male sterilization, and it is worth noting separately that this operation in men does not affect potency.

6. Natural methods to help prevent pregnancy. They can be used if a woman knows how to calculate fertile and “safe” days. Typically this is done by measuring basal temperature and constructing an appropriate graph to determine ovulation.

This method is not suitable for a woman after childbirth, because the menstrual cycle has not yet formed, and nursing mothers should not rely on it at all. You can also use special ovulation tests to calculate days when pregnancy is unlikely. This method cannot be called the most effective and is best used in combination with another means of protection.

Many couples resort to another method of preventing unwanted pregnancy - interrupted sexual intercourse. This method not only does not provide a high degree of protection, but also interferes with the normal course of sexual intercourse between the couple, which often causes quarrels, disagreements, and irritability among spouses. And many scientists claim that interrupted sexual intercourse has a negative impact on men’s health.

So, in this article we looked at the most common methods of contraception after childbirth. Currently, there are a great many ways to protect yourself from unwanted pregnancy after childbirth, and, as we have found, many of them are harmless to the baby and do not affect the breastfeeding process.

Which one should you choose? It's up to you to decide! The main thing is that before deciding to choose a method of contraception, you need to consult with a gynecologist who will give you the right advice, select the appropriate contraceptive and help you make a decision.

Let yours intimate life brings only joy!

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Content

Many people believe that it is impossible to get pregnant while breastfeeding. Indeed, the chance of conception is much less, however, the possibility of fertilization of the egg is not completely excluded. Therefore, for all women who have recently given birth, the issue of contraception after childbirth becomes relevant. More details about the features and methods of protection later in the article.

Features of contraception in the postpartum period

If a girl categorically refuses to use contraception after childbirth, she should know under what conditions the possibility of pregnancy is practically zero. There are several such conditions:

1. Breastfeeding begins immediately after birth.
2. The child should be breastfed only without complementary foods or formula.
3. Breastfeeding should be as frequent as possible: at least every 3 hours during the day, and at night at intervals of 6 hours.
4. Lack of menstruation.
5. No more than six months have passed since the birth.

Even compliance with all these conditions does not provide a 100% guarantee. And early pregnancy prevents breastfeeding. In addition, there is a high likelihood of complications developing.

The simplest option for contraception after pregnancy is the use of condoms. It not only prevents unwanted re-pregnancy, but also protects against infectious diseases. But sometimes using a condom is not suitable for partners. There may be many reasons for this: discomfort due to vaginal dryness, dulling of natural sensations. Therefore, more attention should be paid to contraception for women after childbirth.

Modern methods of contraception for women after childbirth

Contraceptives that a girl uses after childbirth must have several properties:

• effectively protect against re-fertilization of the egg;
• have some activity against sexually transmitted infections;
• be absolutely safe for women and children;
• do not have a significant effect on hormonal levels.

The vast majority have these properties. modern species contraception for women after childbirth.

Birth control pills after childbirth

The action of the tablets is based on changes in the level of hormones in the blood. This prevents the follicle from maturing in the ovary and the release of the egg. Also, under the influence of these drugs, the structure of the layer of the uterus (endometrium), which is located closer to its cavity, changes, due to which the egg cannot attach to the wall of this organ.

A feature of postpartum hormonal contraceptives is that they must contain only the hormone progesterone, without estrogen. Then the drug will not harm breastfeeding.

When can you take birth control pills after giving birth?

Doctors allow me to start drinking birth control pills 4 weeks after birth for non-breastfeeding mothers, and at least 6 weeks for breastfeeding mothers.

How to take birth control pills after childbirth

Oral contraceptives must be taken strictly on schedule. The woman drinks them every day, almost at the same time. A difference of one hour is acceptable. Daily dose– one tablet.

Warning! Breaks are not allowed!

It is necessary to adhere to these rules, since to prevent pregnancy a constant increased amount of the hormone in the body must be maintained.

Which birth control pills are best to take after childbirth?

Among all the abundance of contraception, preference should be given to drugs called “mini-pills”. These medicines include:

• "Femulen";
• "Continuin";
• "Exluton";
• "Charozetta."

Their peculiarity is that they contain only a hormone called gestagen, or progesterone. It does not change the composition of breast milk, and is also not transmitted to the baby during breastfeeding. The amount of hormone in the “mini-pill” is less than in standard progestin tablets, which causes their lower effectiveness.

Advice! For best effect“mini-pills” and barrier methods of contraception should be combined.

“Mini-pills” are made specifically for mothers who are breastfeeding. They are also suitable for women during menopause (over 45 years of age). Taking medication in non-breastfeeding girls reproductive age leads to gross violations menstrual cycle.

Despite their high effectiveness, the use of oral contraceptives after childbirth has a number of disadvantages:

• do not provide protection against infectious diseases;
• the need to take pills strictly on schedule;
• may cause unwanted adverse reactions: nausea and vomiting;
• can affect the frequency and abundance of menstruation;
• Skipping even one dose of medication significantly reduces the effectiveness of the drug.

Intrauterine device

Another effective method of contraception is the intrauterine device (IUD). It does not affect the amount of progesterone in any way, and therefore does not cause the development of unpleasant side effects or distort the menstrual cycle.

If there were natural childbirth, without complications, you can install the spiral after 6 weeks.

The main contraindication to inserting an IUD after childbirth is delivery by cesarean section. After this surgical intervention, a scar remains on the uterus. Constantly impacting it from the inside with a foreign object, such as an intrauterine device, can lead to rupture of this scar. The use of IUDs is also contraindicated in other pathological conditions:

• endometriosis – growth of the endometrium in places where it should not normally be;
• endometritis - inflammation of the inner lining of the uterine wall;
• severe heart and vascular diseases.

If a woman decides to use an IUD as a contraceptive after childbirth, its installation and removal should be entrusted to a gynecologist. You also need to go to preventive examination twice a year, since wearing a spiral increases the risk of inflammation of the genital organs.

Barrier methods of contraception after childbirth

There are several barrier methods of contraception for women after childbirth:

• diaphragm;
• cap.

Installing a cap or diaphragm does not affect breastfeeding in any way. The peculiarity of contraception after childbirth using these methods is that you should choose a larger size due to expansion birth canal. For the first time, the installation of the diaphragm and cap should be carried out by a gynecologist. You can start using them 6 weeks after birth.

Chemical contraceptives

Spermicides are drugs that have the ability to destroy sperm. They also have activity against pathogens of infectious diseases. They are considered one of the least effective contraceptives in preventing pregnancy. Therefore, it is better to use them in combination with tablet drugs.

Injectable contraceptives

Injections are another form of contraception with gestagens, which are recommended for use after childbirth. This drug is called Depo-Provera. It is administered intramuscularly every two months. Just like taking pills, injections should be regular. This is the only way to achieve high efficiency of the method.

Injectable or tablet contraceptives, together with barrier methods, are recommended for use as contraception after cesarean section. These drugs do not irritate the uterus from the inside, and therefore cannot lead to its rupture.

Obstetricians and gynecologists recommend that women use protection even during breastfeeding. In this case, it is advisable to use two methods simultaneously. This will increase effectiveness in protecting against recurrent pregnancy and prevent sexual transmission of infections.

Contraception latest generation doctors call subcutaneous implants, which are installed on the inner surface of the shoulder. They contain a gestagen, which is constantly released in small doses. A one-time installation of such an implant prevents the development of pregnancy for three years.

Conclusion

Contraception after childbirth should be a matter of utmost importance for a new mother. Early repeat pregnancy– a risk for both the already born baby and the mother and unborn child. Therefore, regarding contraception after childbirth, a woman should consult with her obstetrician-gynecologist already during pregnancy in order to choose the optimal contraception option.

One and a half months after the birth of the baby, ovulatory processes are restored in 15% of non-breastfeeding and 5% of nursing mothers. And this means that by the third month conception is possible. How to protect yourself during this period without harming the health of mother and baby.

How to choose?

It is believed that it is undesirable to become pregnant in the first one and a half to two years after childbirth. Female body has not yet recovered enough to carry a pregnancy, and abortion can cause dangerous complications in sexual and hormonal systems, and a sentence - for reproductive.

Therefore, the selection of optimal contraception should be carried out carefully, seriously, with mandatory consultation with a specialist. After all, when a woman is breastfeeding, the method should not affect lactation and the health of the infant.

Usually in this case, women are advised to combine and protect themselves in several ways.

Natural ways

The choice of method that can be recommended to a woman depends on what type of feeding the baby is on, and whether there are contraindications for a particular method of contraception. Natural protection completely eliminates negative factors. Its effectiveness is low and requires certain rules to be followed.

Abstinence

1. Only by the end of the second month the uterus is completely restored and cleansed.
2. At the organ increased sensitivity to infection.
3. Penetration into the injured perineum brings pain.

With difficult births, cesarean sections, ruptures and incisions, the period it takes for the organ to fully adapt doubles.

Often, young mothers themselves do not want to resume sexual activity immediately after giving birth. They temporarily do not need it: priorities have changed, complexes have appeared due to a changed body, depression and chronic fatigue.

Complete abstinence during this period provides 100% contraception and allows the mother to recover, does not affect lactation processes. This method is used as an intermediate method, and in the future married couples he doesn't fit.

Lactational amenorrhea

Breastfeeding blocks the synthesis of the hormone estrogen, which stimulates ovulation, and increases prolactin levels.

This means that if the egg does not mature, then conception is impossible.

But in order for this method of protection to work, certain conditions are important:

1. Mode natural feeding must be free - at the baby’s first request.
2. The breaks between breastfeeding are no more than 4 hours a day. daytime and six - at night.

The method is suitable for the first six months, before the menstrual cycle resumes.

Pros of lactational amenorrhea:

• No negative impact on the health of mother and baby is excluded.
• No contraindications.

• Will not protect against infection and sexually transmitted infections.
• If the intervals between feedings are more than 4 hours, supplementary feeding is introduced to the baby, he is 4 months old, introduce other contraceptives.

If a woman begins spotting, any duration and intensity, this indicates that reproductive function has been restored.

Calendar methods

Also applies to natural means protection for women. Their essence is to periodically, on certain calculated days on which you can conceive, to abstain from sexual intercourse. Contraception after childbirth using the calendar method is used only when the menstrual cycle is completely restored.

1. With an established cycle, ovulation occurs in the middle. If 28 days pass from the first day of one period to the first day of the next, the middle of the cycle (ovulation) occurs on the 14th day. In this case, it is better to abstain from sexual intercourse for 5 days before and the same number after or use additional methods.
2. By rectal temperature in the morning, lying in bed. If on ordinary days it is no higher than 36.9 °C, then with ovulation and before menstruation it is 37.1 °C.
3. According to the properties of saliva. Cervical mucus and saliva during ovulation contain an increased amount of salts. With the help of a magnifying glass and special glasses, saliva is examined, and if it looks like a fern leaf in a dried state, ovulation has begun.

Postpartum contraception using calendar methods is not used immediately and is considered effective only when the menstrual cycle is fully established.

Non-hormonal methods

This group of protection includes intrauterine and barrier agents. They prevent the penetration of sperm into the vagina and cervix, and according to their method of action, they can be mechanical (condom, vaginal diaphragm, cap), chemical (spermicides).

Intrauterine contraceptives

The spiral is allowed to be inserted healthy woman on the second day after birth. If, due to contraindications, such a procedure was not performed, an intrauterine device is placed after birth at 8 weeks.

If there is a coil in the uterine cavity, it protrudes foreign body and prevents the fertilized egg from implanting and attaching.

Advantages of the method:

• It is considered one of the most effective.
• Does not affect the lactation process.
• Without negative impact on the health of mother and child.
• Provides long-term (5 years) contraception.

Disadvantages of the intrauterine contraceptive:

• Placing and removing the coil is an exclusively medical procedure.
• Not allowed for women who have multiple sexual partners.
• Contraindicated in inflammatory and infectious diseases genitourinary system.
• In rare cases, periods become heavier and more painful.

A woman with an intrauterine device is required to visit a gynecologist once every six months. After 5 years the product must be removed.

Condom

Contraception after childbirth using condoms is the most popular, affordable and effective way, without negative effects on the body and lactation. Often in the postpartum period, women complain of vaginal dryness, and condoms with lubricants eliminate this unpleasant symptom.

In addition, this type of barrier contraceptive protects against any kind of infection of the dilated cervical canal, prevents cervical cancer, and is easy to use.

Spermicides

Chemical method of protection includes the use local funds with spermicides. Basic active ingredients nonoxynol and benzalkonium chloride reduce motility and destroy sperm. Additional components allow the drug to distribute evenly into the vagina.

Dosage forms of drugs:

1. Suppositories (Pharmatex, Erotex, Sterilin, Patentex, Conceptrol).
2. Cream, capsules (Pharmatex).
3. Film (ABF).

The effect of the drugs begins within a few minutes and lasts about 6 hours.

Chemical methods of contraception after childbirth are suitable for women of any age and are approved for the lactation period. They are available and can be purchased over the counter.

Spermicides do not contain hormonal components; they are allowed to be used for a long time and combined (supplemented) with other contraception in the postpartum period. Efficiency chemical method protection – about 95%.

The group of barrier methods also includes diaphragms, caps and sponges, which, after deep insertion, close the vaginal lumen and protect cervical canal from the entry of sperm. But today these funds are unpopular. Installing the diaphragm and caps requires some experience and skill.

Barrier methods do not pose serious medical risks. From side effects possible irritation and allergic reactions.

Hormonal contraception

Can I take birth control pills after giving birth? Yes. If a woman is determined to use this method of contraception, then monocomponent gestagen-based products are indicated.

Other combination oral medications, which contain multiple hormones, negatively affect milk quality, physical and mental health baby.

Mini-drink

Hormonal tablets with gestagens are indicated to a greater extent for nursing mothers. In those who have weaned their child from the breast, their effectiveness is reduced due to the onset of a full menstrual cycle.

Pros of admission:

• If you take birth control pills regularly, without breaks, the effectiveness reaches 97%.
• The function of conception remains uninhibited.
• They do not affect the duration of the lactation period.

Disadvantages of the mini-pill:

• The contraceptive effect is significantly reduced by violating the rules of administration, combination with antibiotics, antidepressants.
• In the middle of the cycle, bleeding is possible.

Mini-pills (Chirozetta, Ovretta, Micronor, Exluton) contain little gestagen. But this is enough for ovulation to be inhibited and changes in the endometrium and cervical mucus to occur.

Prolonged gestagens

Long-acting drugs - injectable contraceptives with hormonal implants - are prescribed no earlier than six weeks after birth. Their effectiveness reaches 99%, and the benefits are like a mini-pill. The list of long-acting contraceptives with gestagen includes:

• Depo-Provera. Injectable drug. It is administered intramuscularly, forming a depot. With slow resorption, it provides protection for 12 weeks.
• Norplant is a subcutaneous implant contraceptive. One injection into the forearm provides and maintains a contraceptive effect for 5 years.

Prolonged gestagens between injections require strict adherence intervals, and after cancellation, the function of conception is restored in the first six months.

Combination oral drugs

In the postpartum period, contraception with two-component drugs is allowed in two situations: breastfeeding has ended, or there was no breastfeeding at all.

Oral contraceptive pills are a modern, effective, reliable and safe approach to birth control. In addition, this type of drug is widely used for the treatment and prevention of many gynecological pathologies.

1. Microdosed (Novinet, Logest)
2. Low-dose (Regulon, Miniziston, Yarina).
3. Highly dosed (Non-Ovlon, Anteovin).

The drugs have a list of contraindications, so they must be prescribed by a doctor after a thorough examination.

The pills are taken daily and regular use provides 100% contraception.

Postcoital drugs

This type of protection is indicated only for occasional sexual relations and as an “ambulance” in case of a damaged condom and missed pills. Postcoital contraception includes:

1. Oral contraceptives in large dosages.
2. Medicine with high content gestagen Postinor.
3. Mifepristone is a drug that interrupts ovulation and causes menstrual bleeding.

A group of postcoital medications can cause uterine bleeding and are therefore prescribed only by a doctor.

The drugs should not be taken during lactation, as they change the amount and composition of milk.

Hormonal intrauterine contraception

This type of protection is allowed for the postpartum and lactation period. Acting locally, the system (Mirena) gives a minimal concentration of hormones in milk and does not affect the quantitative and qualitative characteristics.

The essence of the method:

• Introduction into the uterine cavity of a special system with gestagen and levonor-gestrel.
• The composition, acting locally, affects the characteristics of cervical mucus with the endometrium and inhibits sperm.
• This method is equal in efficiency surgical sterilization, and has been working for 5 years.
• “Set it and forget it” – reliable and convenient way, especially for those busy caring for small child mom.

The system has one more advantage. It reduces volume, shortens the duration of menstruation, prevents inflammation and ectopic pregnancy. Hormonal intrauterine contraception is prescribed as a treatment for menorrhagia, uterine bleeding, benign neoplasms, desmenorrhea.

After childbirth, a woman’s body is weakened and requires maximum attention and care. Even if sexual intercourse is impossible for some time, a man should not forget about tenderness, affection and understanding during this difficult but unforgettable period in family life.

• barrier contraceptives (condom);
• intrauterine devices (IUD Copper T);
• oral contraceptives (birth control pills with low content hormone);
• injected hormones.

If you want to grow your family, you should use condoms to space your children. But condoms must be used properly and during all sexual acts, without exception, on the “dangerous” and “safe” days of a woman’s cycle.

Intrauterine devices can only be used 6 weeks after birth, even if you had a caesarean section. The advantage of the IUD is that it is highly effective, provides a long contraceptive period and will free your partner from feeling anxious during sexual intercourse. Before and after installation of the Copper T IUD, after 1, 3, 6 months, patients need to undergo control gynecological examinations. The patient herself should monthly monitor the presence of IUD threads in the vagina after menstruation.

The use of injected hormones gives high frequency breakthrough bleeding.

You should not plan your next child earlier than in 2 years. You can resort to methods of permanent contraception - salpingectomy (Salpingectomy - removal of the fallopian tube (method female sterilization)) or vasectomy (Vasectomy - excision of the vas deferens (male sterilization method)).

Restoration of the functional activity of the ovaries and the possibility of a new pregnancy after childbirth depend on many factors: hereditary predisposition, breastfeeding, diet, the presence of stress factors, etc. According to modern ideas it is believed that everyone next child should be born no earlier than 2 years after the completion of feeding the previous baby. During this period of time there is full recovery woman's body. Therefore, simultaneously with the onset of sexual activity, the question arises about a rational method of preventing pregnancy (contraception).

Pregnancy, which occurs a short period of time after a previous birth, leads to a weakening of the woman’s body, occurs with many complications, and ends in the birth of a weakened child. In addition, the onset of a new pregnancy stops the formation of milk in a woman and disrupts the feeding of the first child.

At the same time, an abortion performed in the first months after childbirth is also very harmful to a woman’s body and leads to hormonal disorders, inflammatory processes of the genital organs, increases the risk of the formation of uterine fibroids, breast tumors, and the subsequent occurrence spontaneous miscarriages and premature birth.

To avoid these complications, a woman should receive full information about the methods of contraception allowed after childbirth and choose the most suitable one for yourself. In obstetrics and gynecology, the effectiveness of a contraceptive method is assessed using the Pearl index: the number of pregnancies that occurred when using this contraceptive method during the year among 100 women. The higher the Pearl index, the less reliable the contraceptive method used.

Contraceptive methods that can be used by a woman during breastfeeding

1. Natural contraception, associated with breastfeeding and the development of lactational amenorrhea. This method is based on the fact that during full breastfeeding, a woman’s body produces substances that prevent the restoration of the normal menstrual cycle, egg maturation, and ovulation, and, accordingly, pregnancy cannot occur during this period. According to research, 98% of breastfeeding women are not able to become pregnant within six months after giving birth, while in women who refuse breastfeeding for one reason or another, fertility (the ability to become pregnant) is restored no later than 2 months after childbirth. However, the main condition for the development of lactational amenorrhea is the regular attachment of the baby to the breast (daily every 4 hours). Modern women often do not have the opportunity to regularly breastfeed the child (they have to go to work, there is not enough milk, etc.), in this case the effectiveness natural method is greatly reduced and the risk of pregnancy increases sharply.

2. Surgical sterilization. This method can be used in both men and women. Its principle is to create a mechanical obstacle in the head passages of a man or woman for the movement of germ cells. In men, the vas deferens are ligated (or cut) (after sperm is collected to store it in a special bank in case the couple wants to have another child). In women, surgical tubal ligation is performed. This sterilization method is performed on women if they have reached the age of 32 (if they have 1 child) or have 2 or more healthy children. When using this method, an almost 100% contraceptive result is achieved (there is no need to worry about contraception throughout your life). Surgical intervention is done once. Such sterilization is absolutely irreversible. If a woman decides to give birth to another child, then this becomes possible only with the help in vitro fertilization. Contraindications to female surgical sterilization are the presence of acute inflammatory diseases of the genital organs, severe vascular and heart diseases, respiratory system, diabetes mellitus, pelvic organ tumors (malignant and benign), obesity, umbilical hernia, adhesive disease.

3. Intrauterine contraception. Usage intrauterine devices widespread in our time, including among postpartum women. In the postpartum period, you can use both non-hormonal IUDs and IUDs containing a hormone (progesterone).

This good way contraception for women who already have the desired number of children and a permanent partner ( main drawback spiral is that it does not protect against possible infection). It is contraindicated in the presence of fibroids or heavy menstruation, but it is allowed after cesarean section. However, this type of contraception is not used immediately after childbirth. There must be a period of at least 2 months between birth and installation of the IUD.

When installing and using an intrauterine device, complications may arise:

• after the restoration of the menstrual cycle, heavy and prolonged menstruation may occur;
• perforation of the uterus may occur (the coil makes a hole in the wall of the uterus and exits through this hole into the abdominal cavity);
• the risk of inflammatory processes in the genital organs increases;
• pain occurs in the lower abdomen during sexual intercourse.

The main manifestations of these complications are pain in the lower abdomen, the appearance of unusual discharge from the genital tract, bloody discharge not associated with menstruation, very prolonged and heavy menstruation, delayed menstruation, unexplained increase in body temperature. The appearance of at least one of these symptoms is an indication for an urgent visit to the gynecologist.

Intrauterine contraceptives vary in shape. They are spiral-shaped, ring-shaped and T-shaped.

4. Interrupted sexual intercourse. The principle of this method is the completion of sexual intercourse by ejaculation outside the woman’s genital tract, i.e. when using this method, sperm does not enter the vagina, so pregnancy does not occur. This method is widely used by many couples, although it does not have sufficient contraceptive effectiveness and has some adverse effects on the body of both partners.

Disadvantages of the method:

• the method does not have a sufficient contraceptive effect, the Pearl index reaches 30 (i.e., out of 100 women using this method during the year, 30 became pregnant) - this is the most high rate of all contraceptive methods;
• with regular use of this method, a woman experiences congestion in the pelvic organs (since more than half of sexual intercourse using this method does not lead to orgasm). Stagnation of blood and lymph in the pelvic area causes dysfunction of the genital organs, the occurrence of uterine fibroids, dysfunctional uterine bleeding, infertility, and frigidity;
• a man using this method of contraception increases the risk of developing neuroses, adenoma prostate gland, impotence, premature ejaculation;
• This method of contraception also does not protect against sexually transmitted infections.

5. Barrier contraception. The main advantage of barrier contraceptives is their lack of impact on the body of a nursing woman, on the quality and quantity of breast milk. Currently, the recommended products include condoms, diaphragms and spermicides.

Condom- a cover made of elastic material (latex), which is put on the penis in a state of erection. It creates a mechanical obstacle to the sperm's path to the woman's reproductive tract. The contraceptive effectiveness of condoms is not very high, the Pearl index is 13-20. When using them, allergic reactions to latex (the substance from which condoms are made), rupture during intense sexual intercourse or an incorrectly selected condom size, a decrease in the intensity of sensations during sexual intercourse are possible (this disadvantage is eliminated by using special condoms - with antennae, pimples, etc. .d.).

Can be used after childbirth spermicides containing benzalkonium chloride or boric acid.

A condom is a contraceptive that is not recommended immediately after childbirth. You can also use local contraceptives (suppositories), which have a lubricating effect, which makes sexual intercourse easier: it should be placed inside the vagina approximately 10 minutes before sexual intercourse, you should refrain from using the personal toilet 2 hours before and after (otherwise this will stop the spermicidal effect of the drug ).

6. Hormonal contraception. As a postpartum hormonal contraception Nursing mothers can only use drugs containing gestagens (substances similar in nature to the hormone of the second phase of the menstrual cycle and the pregnancy hormone progesterone). When using these drugs, a small amount of the hormone passes into breast milk, but does not have any harmful effect on the child’s body. In addition, these drugs do not affect the production, quantity and quality human milk(unlike other types of hormonal contraceptives). These hormonal drugs are available in the form of tablets (mini-pills), subcutaneous implants, and solutions for injection. Start taking hormonal contraceptives it is necessary 3-6 weeks after birth.

Mini-drinks. Modern mini-pills contain microdoses of the hormone; they do not contain estrogen (the second hormone used in combined contraceptives), which reduces the likelihood of developing side effects from taking the drug.

The contraceptive effect of the mini-pill is based on a combination of the following effects:

• gestagens change the hormonal status of a woman’s body, disrupting the process of development of the egg and its release from the ovary (ovulation);
• gestagens change the condition of the uterine mucosa, which makes it impossible for a fertilized egg to penetrate into it (implantation);
• gestagens change the properties of the mucus plug located in the cervical canal, making it thicker and more viscous. Such characteristics of mucus do not allow sperm to penetrate into the uterine cavity.

Contraceptive effectiveness mini-pill is quite high (compared to the contraceptive effectiveness of barrier, intrauterine contraceptives), and the Pearl index is 3.

Advantages of the mini-pill over other options for postpartum contraception:

• regular use of tablets eliminates the need to take care of contraception before each sexual intercourse;
the ability to conceive is restored within a month after stopping the drug.

Disadvantages of the mini-pill:

• the use of the mini-pill leads to disruption of the menstrual cycle: changes in the duration and abundance of menstrual flow, in some women menstruation stops completely, in others, intermenstrual spotting or bleeding appears;
• the risk of developing ovarian cysts and ectopic pregnancies increases slightly;
• Some women experience increased sensitivity to sun rays, exposure to the sun can lead to the appearance of open places body brown spots(disappearing after taking the drug).

Recommendations for use: mini-pills should be taken continuously - daily, at the same time; if the drug is delayed for 3 hours or more, the contraceptive effect in this cycle is sharply reduced.

Sometimes the use of the drug may cause nausea and other discomfort. To avoid this, it is recommended to take the mini-pill with meals or before bed. Side effects disappear after a few months of taking the drug.

When using the first package of mini-pill, you must use others within 3 weeks. contraceptive methods(for example, barrier), since the contraceptive effect does not occur immediately, but develops gradually.

You should start taking the mini-pill no earlier than 3 weeks after childbirth or on the first day of the first menstrual cycle after childbirth.

If the next pill dose was missed, vomiting or severe diarrhea, you must carefully read the instructions for the drug and follow the recommendations (usually it is recommended to take extra tablet and use other contraceptive methods during sexual intercourse until the end of the menstrual cycle).

When using the mini-pill, you must visit a gynecologist once every 6 months (if there are no complaints).

If you have complaints (too much menstruation, prolonged absence of menstruation, abdominal pain, icteric discoloration of the skin, etc.), you should immediately consult a doctor.

It is not recommended to wear the mini-pill while using contact lenses(this may cause visual impairment).

Side effects possible when using the mini-pill:

• migraine-type headaches;
• fungal colpitis;
• blurred vision when using contact lenses;
• allergic reactions to the drug such as urticaria (itching, skin rash);
• increased oily skin, appearance acne(usually these unpleasant phenomena disappear after 3 months);
• nausea, vomiting, engorgement of the mammary glands (without the appearance of tumor formations), dizziness (usually also disappear after 3 months from the start of taking the drug), flushing, increased irritability and fatigue;
• weight gain, increased appetite;
• weakening of sexual desire.

Contraindications to the use of the mini-pill:

• liver and kidney diseases with organ dysfunction;
• pregnancy;
• ovarian cyst;
• bleeding from the genitals, the cause of which is not clear.

Breastfeeding mothers should not use combined hormonal drugs or emergency contraception.

7. Contraception using injectable drugs. The only injectable contraceptive used in Russia is medroxyprogesterone. It is a progestin (like the mini-pill). The drug is injected deep into the muscle, where a depot is created, which is gradually consumed over 3 months. The drug gradually enters the blood from the muscle and produces a long-lasting contraceptive effect. Medroxyprogesterone is a highly effective contraceptive, the Pearl index is 1. This substance has a more pronounced contraceptive effect compared to mini-pills and barrier contraceptives. The contraceptive effect of medroxyprogesterone is based on such effects as:

• a change in the hormonal status of a woman’s body, leading to disruption of the development of the egg and its release from the ovary (ovulation);
• a change in the condition of the uterine mucosa, which makes it impossible for a fertilized egg to penetrate into it (implantation);
• a change in the properties of the mucous plug located in the cervical canal (it becomes thicker and more viscous, which does not allow sperm to penetrate into the uterine cavity).

Advantages of the method:

• the drug is administered once every 3 months, which relieves the woman of worries about contraception for a long time;
• Compared to the mini-pill, the injectable contraceptive reduces the risk of ovarian cysts and ectopic pregnancy;
• the drug does not affect the production of breast milk;
• the drug does not affect metabolism, blood clotting, or blood pressure.

Disadvantages of the method:

• the use of medroxyprogesterone often leads to disruption of the menstrual cycle, the appearance of intermenstrual bleeding and spotting;
• sometimes women using injectable contraception experience an increase in body weight, changes in mood, decreased libido (sex drive), engorgement of the mammary glands, and swelling;
• restoration of fertility (ability to conceive) occurs 1.5 years after discontinuation of the drug.

Contraindications to the use of medroxyprogesterone are the same as when using the mini-pill.

• within 2 weeks after the first injection, it is necessary to use additional methods of contraception (for example, barrier);
• administration of this substance is carried out only in medical institutions by a specially trained specialist, the injection site should not be rubbed or massaged.

8. Implantation contraceptives. Contraceptive implants are small capsules containing hormonal substance(from the group of gestagens allowed for nursing women). They are injected under the skin inner surface left shoulder in a hospital, in an operating room, by a specially trained doctor. The contraceptive effectiveness of this method of contraception is very high, amounting to approximately 1 pregnancy per year among a group of 100 women using it. In addition to high contraceptive activity, the drug has the following advantages:

• is administered once every 3 years and throughout this time has a continuous contraceptive effect(some drugs in this group are administered once every 5 years);
• the active substance is released from the implant gradually, in very small doses, so this method of contraception practically does not lead to the development of side effects;
• just like mini-pills and methoxyprogesterone, implants do not affect the production, quality and quantity of breast milk;
• the contraceptive effect develops within a day after insertion of the implant;
• the drug has therapeutic effect in women with menstrual irregularities, endometriosis, uterine fibroids;
• Fertility (ability to conceive) is restored within 1 month after removal of the implant.

The implant should be installed no earlier than 8 weeks after birth (or on the first day of the menstrual cycle). The drug is removed by a doctor 3 years after installation (or after another time depending on the drug).

Side effects encountered when using implants:

• menstrual irregularities;
• increased skin greasiness and acne;
• nausea, mood changes, pain and engorgement of the mammary glands, weight gain;
• possible inflammation at the implant site.

When using an implant, you must visit a gynecologist 2 times a year.

Contraindications to the use of implants are the same as when using a mini-pill.

9. If a woman does not breastfeed her baby, then, in addition to the methods described, she can use combined hormonal contraceptives.

10. Oral contraceptives. They can also be used immediately after birth.

Classic oral contraceptives (pills containing estrogen and progestrogen) are contraindicated during lactation. If there are no contraindications, then this method of contraception is possible starting from the 3rd week after birth (not earlier, in order to avoid increasing the risk of phlebitis) until the menstrual cycle resumes.

Mini-pills (based on a low dose of progestrogen) are allowed during feeding, although they reduce the amount of milk secreted; their use is possible starting from the 10th day after birth. They have two drawbacks: strict adherence to the time of taking the drug (deviation by several hours removes their effect) and periodic minor bleeding.

Implant (Implanon). It is a progestinogen administered subcutaneously. It is allowed both during feeding and in its absence. It is a flexible stick the size of a match that is placed on inside hands. The effect of one implant lasts on average 3 years. It can be administered in the coming days after birth.

11. Plaster. It contains a combination of estrogen and progestogen and has the same indications as the classic pill. But its use has one drawback: a woman may forget to change it (a new patch is applied once a week, the course lasts 3 weeks, after which a break of one week is taken). The advantage is that it replaces pills.

Methods of contraception contraindicated after childbirth

These include contraceptive caps and other types of female condoms, since the vagina and cervix on which they are placed have not yet returned to their original shape. Observations of temperature indicators (Ogino method) are impossible before the first ovulation, so this method is also not recommended. Sterilization by tying the fallopian tubes in France is carried out only by adults who have expressed their desire of their own free will and supported it with a written request. Mandatory term, which is given for reflection, is 4 months. The doctor informs the patient about possible risks and the irreversibility of the procedure. It is usually performed using laparoscopy.

A miracle happened. The baby you've been waiting for for nine long months has finally arrived. Now you, parents, are completely immersed in caring for him. At first, both of you are terribly tired, night feedings are exhausting, and you can’t even think about resuming sexual relations. Yes and extra pounds appeared, the figure is not the same as before pregnancy. No, you need to wait a little, especially since the doctor recommends not having sex for the first 4-6 weeks... But nature takes its toll, and your sexual relations will soon resume. Contraception is probably the last thing on your mind right now. Is it worth taking care of her at all, isn’t breastfeeding enough?

It’s worth it if you want to avoid an unplanned pregnancy in the first months after giving birth, because, contrary to popular belief, this is not so uncommon. Studies have shown that in women who breastfeed, menstruation resumes on average after 2-6 months, depending on the intensity of feeding, and in non-breastfeeding women - 4-6 weeks after birth. If you do not have lactation or breastfeed irregularly, then ovulation, and therefore the ability to conceive, can resume as early as 25, and on average 45 days after birth. And since ovulation occurs 14 days before your period, you may already be fertile without knowing it.

Consequently, pregnancy can occur even before the first menstruation appears, therefore, in order to begin to protect yourself, you should not wait for the restoration of the menstrual cycle, the start of complementary feeding and a reduction in the frequency of breastfeeding.

According to surveys, two-thirds of Russian women resume sexual relations within a month after childbirth, and within 4-6 months - almost all (98%). At the same time, doctors are greatly alarmed by the fact that after giving birth, 20-40% of sexually active Russian women do not use any methods of contraception. Meanwhile, the probability of pregnancy in the absence of reliable contraception in nursing mothers 6-8 months after birth it reaches 10%, and in non-breastfeeding mothers it reaches 50-60%. Thus, women who have recently given birth in Russia should be considered a high-risk group for unplanned pregnancy.

And pregnancy during this period is generally extremely undesirable. Doctors believe that the minimum interval between births should be about 3 years. Why? Despite the fact that organ involution reproductive system(returning them to their previous state) ends 4-6 weeks after birth, complete restoration of the body takes at least 1.5-2 years. Breastfeeding also places a significant burden on a woman’s body. But after this, a woman still needs to replenish her supply important microelements, for example, iron, calcium, etc. Studies have shown that when pregnancy occurs earlier than 2 years after birth, the risk of developing complications during pregnancy (preeclampsia, anemia, intrauterine growth retardation), childbirth and the postpartum period doubles.

Thus, we inevitably come to the conclusion that in the postpartum period and for 2 years after childbirth, a woman needs effective, reliable and safe contraception.

Choosing a contraceptive method after childbirth

Ideally, you should get advice and choose a suitable method of contraception after childbirth during pregnancy. If you don't have time to give birth, consult your doctor maternity hospital. If you still cannot decide on a contraceptive method or you have doubts and questions, then before resuming sexual relations (even while breastfeeding), you should definitely seek advice from a gynecologist, for example antenatal clinic or a family planning and reproduction center. The purpose of this article is to give a general idea of ​​contraceptive methods during the postpartum period and how these methods are combined and how compatible they are with breastfeeding, but you should only determine which of these methods is right for you in consultation with your doctor.

A non-breastfeeding woman should start using contraceptives from the moment she resumes sexual relations. Moreover, if not special contraindications, she can choose any of the modern arsenal contraception.

The method of contraception for a nursing woman depends on the feeding regimen and the time elapsed after childbirth. In addition, the contraceptive should not adversely affect the child’s health or milk secretion. If you are exclusively breastfeeding, the start of contraception can be delayed by 6 months. If feeding is infrequent or early start complementary feeding (all this is typical for residents developed countries) a contraceptive method should be selected during a mandatory postpartum visit to the doctor no later than 6 weeks after birth.

And one more important note: the various methods of contraception, which will be discussed below, have different effectiveness, some of them involve serious limitations in use, and not all can be used in the first weeks after childbirth. Tune in advance to the fact that in this important and responsible period of your life, when next pregnancy in any case, it is better to wait; different methods of contraception will often have to be combined, either by increasing the effectiveness of a method that is ideal for you, but not reliable enough, or by “hedging your bets” in circumstances where the effectiveness of a reliable method for some reason is reduced. And in determining the need and principles of combination various methods, as well as in selecting the most suitable remedy for your couple, again only a doctor will help.

Methods of contraception after childbirth

Abstinence

Abstinence (sexual abstinence) has 100% contraceptive effectiveness, but most couples are not satisfied with this method even for a short time.

Lactational amenorrhea method (LAM)

Mechanism of action and characteristics. After childbirth, a woman’s body produces the hormone prolactin, which stimulates milk production by the mammary glands and at the same time suppresses ovulation, resulting in lactational amenorrhea (absence of menstruation during breastfeeding). This effect of prolactin on a woman’s body determines the contraceptive effect of breastfeeding. Each act of breastfeeding stimulates the secretion of prolactin, but if the break between feedings is too long (more than 3-4 hours), the level of prolactin gradually drops. Breastfeeding started immediately after birth is effective method natural contraception and at the same time provides the child with the most good nutrition. In addition, sucking stimulates the production of oxytocin, a hormone that promotes not only the contraction of the muscles of the areola of the mammary gland (due to which milk is released from the nipples), but also the contraction of the uterus, which leads to speedy recovery its size and shape after childbirth.

MLA involves exclusive or near-exclusive breastfeeding, both during the day and at night. The effectiveness of MLA is maximum if feeding does not occur according to a schedule, but at the child’s first request (even at night), sometimes several times an hour, on average from 12 to 20 times a day, of which 2-4 times at night. The break between feedings should not exceed 4 hours during the day and 6 at night. In this case, each time it is necessary to give the baby the breast, and not express milk. The contraceptive effectiveness of MLA remains at an acceptable level if the share of complementary feeding is no more than 15%.

Terms of application. The first 6 months after childbirth proper feeding chest.

Efficiency. 98%.

Advantages

• Easy to use.
• Gives a contraceptive effect immediately from the start of use.
• Does not affect sexual intercourse.
• Promotes uterine contraction, reducing the risk of postpartum complications (bleeding) and leading to a speedy recovery of the body.
• Does not require medical supervision.
• Beneficial for the child (breastfeeding provides the child with the most adequate nutrition, promotes the development of immunity, and reduces the risk of infection).

Flaws

• Requires strict adherence to the above breastfeeding rules.
• Not suitable for working women.
• Short-term use (6 months).
• Does not protect against sexually transmitted diseases.

Hormonal methods

ORAL CONTRACEPTIVES (OK)

OCs containing only progestins (“mini-pills”)

The tablets contain progestins - synthetic hormones, the contraceptive effect of which is to reduce the amount and increase the viscosity of cervical mucus (which prevents the passage of sperm into the uterus), change the structure of the mucous membrane of the uterine body (this prevents embryo implantation) and suppress ovulation.

Start of use. Breastfeeding women can start taking pills 5-6 weeks after birth, non-breastfeeding women - from the 4th week after birth or with the onset of menstruation.

Efficiency. 98% when taking the pills correctly and regularly in combination with breastfeeding.

Advantages. They do not provide negative influence on the quantity, quality of milk and duration of lactation.

Flaws. In the first 2-3 cycles of use, intermenstrual bleeding is often observed, which is a consequence of the body’s adaptation to the drug. Some women may experience menstrual irregularities, including amenorrhea.

Features of application. OK prescribed by the doctor. They must be taken daily, without breaks, strictly at the same time. Violation of the time of taking or skipping pills, as well as the simultaneous use of certain antibiotics, anticonvulsants and sleeping pills medicines, vomiting or diarrhea reduce the contraceptive effect. The ability to conceive is usually restored immediately after stopping the drug. After stopping feeding, you should switch to combined OCs, which are more effective.

Combined OK

They contain the hormones gestagen and estrogens, which suppress the growth and maturation of follicles and ovulation, as well as preventing implantation.

Start of use. After stopping breastfeeding, combined OCs are started to be taken with the resumption of menstruation. If you have not breastfed at all, you can use this type of contraception from the 4th week after birth.

Efficiency. When taken correctly and regularly, the effectiveness approaches 100%.

Advantages. After stopping taking the pills, the ability to conceive is quickly restored.

Flaws. It is not advisable to use during breastfeeding (estrogens reduce milk secretion and the duration of lactation).

Features of application. Similar to the use of OCs containing only progestins.

PROGESTAGENS, LONG-ACTING

Highly effective long-acting products. These include, for example, the injectable drug “Depo-Provera” and the subcutaneous implant “Norplant”.

Start of use. The first administration of the drug to nursing women is no earlier than 6 weeks after birth, to non-breastfeeding women - from the 4th week after birth.

Efficiency. 99%.

Advantages. Do not affect the quantity and quality of milk, the duration of lactation, do not have harmful influence per child. One injection of Depo-Provera provides contraception for 12 weeks. "Norplant" provides protection against unwanted pregnancy for a period of 5 years. Removal of the implant is possible at any time.

Flaws. The disadvantages of OCs containing only progestins are similar (frequent intermenstrual bleeding and the onset of amenorrhea).

Features of application. Prescribed and administered by a doctor. In the first 2 weeks after administration, additional contraceptives should be used. It is necessary to strictly observe the intervals between administration of the drug. “Norplant” must be removed after 5 years, since after this period the effectiveness of the method sharply decreases. After discontinuation of the drug, restoration of a regular menstrual cycle and the ability to conceive usually occurs within 4-6 months.

Intrauterine contraceptives (spirals)

Start of use. In case of uncomplicated labor and no contraindications, an intrauterine device (IUD) can be inserted immediately after birth. This does not significantly increase the risk infectious complications, bleeding or perforation of the uterus. Optimal time introduction - 6 weeks after birth, which reduces the incidence of IUD loss.

Efficiency. 98%.

Advantages. Compatible with breastfeeding. Provides protection from pregnancy for up to 5 years. Gives a contraceptive effect immediately after administration. The IUD can be removed at any time. Restoring the ability to conceive after removal of the IUD occurs very quickly.

Flaws. Sometimes it causes discomfort in the lower abdomen resulting from contractions of the uterus during breastfeeding. For some women, in the first months after insertion of an IUD, menstruation may be heavier and more painful than usual. Sometimes the IUD comes out.

Features of application. The IUD is inserted by a doctor. It is not recommended for women who have suffered from inflammatory diseases of the uterus and appendages, both before pregnancy and in the postpartum period; as well as women who have multiple sexual partners, since in this case the risk of inflammatory diseases increases.

Barrier methods of contraception

CONDOM

Start of use. When resuming sexual activity after childbirth.

Efficiency. On average 86%, but with correct use and good quality reaches 97%.

Advantages. The method is easily accessible and easy to use, and does not affect lactation or the health of the child. Greatly protects against sexually transmitted infections.

Flaws. At misuse the condom may slip off or break. Use is associated with sexual intercourse.

Features of application. You should not combine the use of a condom with the use of fatty lubricants, which can cause the condom to rupture. Use a neutral lubricant with spermicide.

DIAPHRAGM (CAP)

Start of use. Not earlier than 4-5 weeks after birth - until the cervix and vagina shrink to normal sizes.

Efficiency. Depends on correct application. During breastfeeding, it increases to 85-97% due to a decrease in the ability to conceive at this time.

Advantages. Does not affect lactation and baby's health. Provides partial protection against some sexually transmitted infections.

Flaws. Use is associated with sexual intercourse.

Features of application. Select a diaphragm for a woman and teach her how to use this method of contraception medical worker. After giving birth, you need to clarify the size of the cap; it may have changed. Used together with spermicides. The diaphragm should be removed no earlier than 6 hours after sexual intercourse and no later than 24 hours after its insertion.

SPERMICIDES

This method of chemical contraception is the local use of creams, tablets, suppositories, gels containing spermicides - substances that destroy cell membrane spermatozoa and leading to their death or impaired motility.

Start of use. When resuming sexual activity after childbirth. While breastfeeding, they can be used independently; in the absence of lactation, they should be combined with other means of contraception, in particular with a condom.

Efficiency. At correct use 75-94%. The contraceptive effect occurs a few minutes after administration and lasts from 1 to 6 hours depending on the type of drug.

Advantages. In addition to those described for the condom, it provides additional lubrication.

Sterilization

Sterilization is a method of irreversible contraception in which ligation or clamping of the fallopian tubes (in women) or ligation of the vas deferens (in men) is performed surgically.

FEMALE STERILIZATION

Start of use. Performed immediately after uncomplicated childbirth local anesthesia laparoscopic access or by minilaparotomy, as well as during cesarean section.

Efficiency. 100%

Advantages. The effect occurs immediately after the operation.

Flaws. Irreversibility. Low likelihood of postoperative complications.

Features of application. The method is acceptable only for those who are absolutely sure that they do not want to have more children. The decision to use the method should not be made under pressure from circumstances or emotional stress.

MALE STERILIZATION (VASECTOMY)

Under local anesthesia, a small incision is made in the scrotum and the vas deferens are ligated (similarly fallopian tubes). Sexual desire, erection and ejaculation are not disturbed in any way, only the ejaculate does not contain sperm.

Efficiency. 100% if you follow the rule: you should use a condom for the first 3 months after surgery. The effectiveness of a vasectomy can be confirmed by the absence of sperm in the ejaculate, detected using a spermogram.

Disadvantages and application features. Similar to female sterilization.

Natural Family Planning Methods

Based on abstinence from sexual intercourse on days favorable for conception.

Start of use. Only after establishing a regular menstrual cycle.

Efficiency. No more than 50% if all rules are followed.

Advantages. No side effects. Spouses bear joint responsibility.

Flaws. To determine favorable and unfavorable days requires special training of the couple by medical staff, careful record keeping, self-control and self-discipline. It is not recommended immediately after childbirth, as it is difficult to determine the timing of ovulation and first menstruation.