Dear Doctor,

I gave birth to my first child two months ago. I want to start birth control but I’m not sure of which method to use. What’s the best birth control method and what are the side effects?

Pamela

Dear Pamela,

Menstrual cycle, pregnancy, delivery, all phases in the life cycle of a woman of reproductive age group, occur due to the balance and changing levels of the two hormones, estrogen and progesterone. After delivery, a hormone called prolactin determines the phase of breastfeeding and also protects against a pregnancy. But this protection is absolute only till four to six weeks. Any sexual activity after this period does carry a risk of pregnancy.

The best method for contraception at this stage is the "barrier method”. This includes condoms and a diaphragm. They interfere with the sperms reaching the egg, thus preventing conception. They do not interfere with hormones; hence breastfeeding is not affected. Moreover, there are no side effects and it also protects against HIV and other sexually transmitted diseases. A male condom is a thin tube-like sheath which fits over the penis. The only drawback is the risk of a condom getting ruptured at the time of erection, thus being ineffective. This risk is lower with good quality latex condoms. A condom prevents pregnancy at that point of time, but has no protective effects against pregnancy due to future sexual activity. A female condom is a thin polyurethane pouch that is inserted in the vagina before intercourse.

The diaphragm is a shallow dome-shaped device that is partially filled with spermicidal gel and inserted in the vagina before sex. The cervical cap is yet another device which protects against unwanted pregnancy. It is a silicone cup shaped like a hat. It is partially filled with spermicide and inserted in the vagina before sex. These devices have to be of correct fitting, otherwise, there is risk of failure. A health care worker can help in finding one of good fitting.

Hormonal contraceptives can be used, but are not a good idea, just early after delivery. Estrogen containing pills carry risk of clotting, to which a woman is already prone at this stage. The mixed pills or progesterone containing pills or injections are effective but do carry risk of side effects like swelling over feet, withdrawal bleeding, and etcetera. The biggest risk of hormonal contraceptives is that lactation can be affected and subsequent conception can become difficult. There is no protection against STDs with this method of contraception.

An IUD (intrauterine device) is a small t-shaped device that can be inserted by a health worker. They provide long term contraception and are safe, if inserted with due aseptic precautions.

If the couple is determined, they can practice premature withdrawal, where the male partner withdraws before ejaculation. But the timing has to be very accurate; otherwise there is risk of failure and pregnancy.

Dr.Rachna Pande is a specialist in internal medicine.