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The combined oral contraceptive pill in the postnatal period

A mother who is breast-feeding should not use the combined pill.

The estrogen component of the pill will have the effect of drying out the milk. The hormone is also passed into the milk and may have unwanted effects on the baby. The combined pill is not used unless the woman gives up breast-feeding first.

Contraception for a mother not breast-feeding

A woman who is not breast-feeding has the freedom of the entire spectrum. Her concern should therefore be about the convenience, effectiveness and ultimately her personal preference. The consideration of milk production or effects on the baby is not in the equation.

The combined pill, the intrauterine device and the progestogen injection are the most effective.

When to start using a contraceptive when not breast-feeding

If a woman is not breast-feeding and is sexually active in the immediate postnatal period, the possibility of conceiving is ever-present. Ovulation may occur as early as four to six weeks after delivery. As soon as she resumes being sexually active, whenever this might be, she should ensure she has a reliable contraceptive in place.

Sterilization as a contraceptive option

While only until a few years back, sterilization immediately after delivery was very popular, it is very infrequently done nowadays. There are a number of disadvantages associated with immediate postnatal sterilization.

· The chances of regretting the decision are significantly higher if it is done at this time.

· Secondly, it is less safe as a surgical procedure as there is a higher chance of thrombosis complications.

· Probably most significantly for the majority, is the fact that the failure rate of sterilization at this time is considerably higher than at other times.

Recommended is what is known as "interval sterilization", where the procedure is performed several weeks after delivery. In the meantime, other temporary methods of contraception may be used. Unfortunately, even the 6 to 12 weeks interval is occasionally too long and some women find themselves pregnant before being sterilized.

Contraindication to sterilization

A decision on sterilization is an intensely personal thing. It is also a profound decision, by virtue of its permanent nature. Ultimately, a woman has to make the final decision, as long as she knows the facts. In this regard, doctors have a duty to advise where they feel the decision may be unwise and likely to be regretted later. This is their only role.

Of course, some women take offence in being told that what they are proposing to have may not be good, or at least the timing of it is not right. This should never make doctors shy away from their responsibility of giving what they consider to be their best advice. Hostile reception of a doctor's advice is part and parcel of the job. And the interval is partly meant to allow the woman time to think things through.

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