Birth control after baby ― Which suits you best?

Wondering what form of protection to use after baby arrives? Here’s your complete guide to contraceptives.

By Jassmin Peter-Berntzen

Posted: 18 Dec 2016 Updated: 09 Dec 2020

Hormonal Methods

1) THE PILL
Effectiveness 95 to 99 per cent.
How it works There are two types, points out SmartParents expert Dr Christopher Chong, a consultant obstetrician, gynaecologist and urogynaecologist at Gleneagles Hospital. The traditional ones ― which contain oestrogen and progesterone ― need to be taken for 21 consecutive days, then you stop for a week and wait for your period. The other is the progesterone only mini-pill you take continuously, so you don’t get your period. “The last four pills have no medication in them,” Dr Chong notes. The hormones in the pill prevent ovulation from taking place and also thicken the cervical mucus to prevent sperm from joining with an egg.
It’s good because… It has a proven low failure rate ― less than 1 per cent of women will get pregnant if they take the pill as instructed. Plus, it helps women lose weight and improve their complexion, while reducing pre-menstrual symptoms, such as cramps, and also lightens a heavy flow. “If you take it for more than a year, it will also reduce risk of womb and ovarian cancer by 50 per cent,” Dr Chong adds. Because of the low dose, it doesn’t affect fertility and you can try for a baby soon after stopping. However, you might experience mild side effects such as nausea, breast tenderness, mood swings and sometimes chloasma (dark patches on your face).
It’s not for you if… You have a history of deep vein thrombosis, as it could exacerbate the condition, or if you’re forgetful ― miss a few pills and it’s no long as effective. You might also want to give it a miss if you have liver disease, a thyroid problem and on epilepsy medication that could affect how the pill metabolises in the liver, which means the normal dosage may not be sufficient to achieve the usual protection success rates.

Chronic smokers are also discouraged from going on the pill as the medication may have lethal effects when combined with nicotine. The oestrogen in the pill stresses the blood vessels, while nicotine increases your blood pressure and accelerates the heart rate. This increases your risk of having a heart attack, blood clots or a stroke.

Plus, a new study also links the pill to depression, although Dr Chong reckons insufficient studies have been done to confirm this theory. “It’s still generally safe and has low side effects. The studies may not be statistically significant as most textbooks do not indicate this.”

2) THE PATCH
Effectiveness 95 to 99 per cent.
How it works It’s a thin, beige, plastic patch that you stick on your skin for three weeks in a row, then remove it on the fourth week so that your menses willcome. It’s small enough to be used inconspicuously, usually in your bum or upper thigh area. Just like the pill, it releases oestrogen and progesterone to prevent ovulation while thickening cervical mucus.
It’s good because… It has proven low failure rates and is convenient ― you slap it on and don’t have to do anything for three weeks. Similar to the pill, the dosage will also not affect fertility later on.
It’s not for you if… You have sensitive skin as it could react to it. If you tend to perspire a lot or easily, you might have to give this a pass, says Dr Chong, as the patch could keep sliding off.

Do you know what the most effective birth control is? Read on to find out!

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3) IMPLANTS
Effectiveness 99 per cent.
How it works A thin, flexible plastic implant ― about the size of a matchstick ― is gently inserted under your skin, usually you underarm area. It releases etonogestrel (a form of progesterone) slowly into your bloodstream for the next three years, after which you will have to get a new one.
It’s good because… You’re all set for three years and can have all the monkey sex you want without worrying about getting knocked up.
It’s not for you if… You’re worried about the onslaught of mild, but common side effects. According to Dr Chong, these include spotting, acne, mood swings and migraines. During your first year, you might also not get your menses for an extended period of time, which might make you worry that you could be pregnant. Subsequently, your bleeding patterns may also be erratic. Many women also report water retention leading to weight gain. And while it doesn’t wreak havoc on your fertility, it may take a longer time for you to start ovulating again as compared to other hormonal methods since you have to wait for your period patterns to return to normal.

4) IUCD (Intra-Uterine Contraceptive Device)
Effectiveness 99.9 per cent.
How it works A small “T-shaped” device is inserted into the uterus through the cervix. It’s available in two forms, says Dr Chong, “One with just copper and the other with progesterone.” Both work the same way ― they prevent pregnancy by changing the way sperm move, so it doesn’t get near an egg. Sperm doesn’t like copper, so it won’t go anywhere near it, while the one with medication works the same way as other hormonal methods by preventing ovulation and thickening mucus.
It’s good because… It’s hailed as one of the most effective birth control methods out there and can last up to five years. The medicated version also helps to lighten your period if you’re one of those unlucky ones who suffers from a major flow every month, although you might experience the same kind of side-effects as the implant.
It’s not for you if… You’re allergic to copper or have recurrent lower-genital tract infections such as cervicitis (inflammation of the cervix). There’s also a slim chance that the IUCD migrates to another part of your body and causes an infection, which can block your fallopian tubes and give rise to subsequent fertility issues. “An IUCD can also erode into the muscle of the womb, making it difficult to remove and may result in surgery,” adds Dr Chong.

Barrier Methods

1) CONDOMS
Effectiveness 98 per cent.
How it works You roll out the thin latex sheath over the penis. During intercourse, the sperm is deposited in the condom which is later thrown away. “Make sure you squeeze away the air at the tip of the condom when rolling it down over the penis to reduce risk of breakage,” Dr Chong warns.
It’s good because… It’s not costly, is hormone free and convenient. You only use it when you need to. It’s also covered with spermicidal lubricant for extra protection against pregnancy and also prevents sexually-transmitted diseases. Condoms come in various colours, sensations (extra sensitive, ribbed, ultra-thin), flavours (chocolate, strawberry, mint and banana) and there are even glow-in-the-dark ones!
It’s not for you if… You’re allergic to rubber and are worried that it might break during intercourse, which is more common than many think. Sizes are limited, so some men may also not find a good fit. Some condoms also have a strong latex odour.

For women, a ligation can be done right after delivery (should you decide this would be your last baby) or via a keyhole surgery any other time.

2) DIAPHRAGM
Effectiveness 86 to 94 per cent.
How it works This soft, rubber dome-shaped barrier is inserted into the vagina before it comes into contact with the penis. It covers the cervix so as to prevent sperm from entering the uterus and will have to be removed after intercourse. Spermicide is added to most diaphragms to kill any sperm that breaches the barrier.
It’s good because… It’s convenient, can be carried around easily and is used only when needed. Plus, it also doesn’t have any hormones and can be reused.
It’s not for you if… You’re allergic to latex as it might not only irritate skin, it also poses a toxic shock risk because it’s inside you. Common toxic shock symptoms include nausea, vomiting, headaches and muscle ache. It must be cleaned after every use, but there’s always a chance that some bacteria remains, resulting in urinary-tract infections. Plus, there’s also always a risk that you might have inserted it the wrong way, which could hinder sexual pleasure and result in zero protection.

3) STERILISATION (VASECTOMY AND TUBAL LIGATION)
Effectiveness 99.85 per cent (vasectomy) and 99.5 per cent (ligation).
How it works A vasectomy, also known as male sterilisation, happens when the vas deferens ― a narrow, muscular tube that connects the testicles to the urethra ― is clamped, cut or sealed in a 30-minute procedure. This prevents sperm from mixing with the semen during ejaculation. Sperm continues to be produced, but is reabsorbed by the body. For women, a ligation can be done right after delivery (should you decide that this is your last baby) or via keyhole surgery any other time. Your fallopian tubes are blocked, tied or cut to ensure that any eggs won’t travel to the ovaries to be fertilised.
It’s good because… Both procedures are irreversible, so it’s a permanent solution. “The failure rates are 1 in 400 to 1 in 1,000,” Dr Chong notes.
It’s not for you if… “You aren’t done having a family or end up re-marrying and want to have more kids,” he says. And since it’s a surgical procedure after all, it has risks. If a tubal ligation is not executed successfully, there’s a high risk that you’ll experience an ectopic pregnancy ― which can be life threatening as the egg grows outside of the tube.

Considering natural methods of preventing pregnancy? Click through for our top three picks.

Natural Methods

1) WITHDRAWAL
Effectiveness Extremely unreliable.
How it works Although it’s been around for eons, this method is not one backed by science and for good reason: It takes a lot of experience and self-control for the man to uill his penis out of the vagina before he ejaculates, in order to limit the chance of any sperm reaching the egg. The woman also needs to trust that her husband will do the right thing in good time.
It’s good because… You don’t have to rely on any birth-control devices or medication.
It’s not for you if… You are worried about failure rate, because it’s very high. It’s a common misconception that sperm is only present during ejaculation. “The secretions during sex may actually have more sperm than during ejaculation,” points out Dr Chong. No healthcare provider will recommend this unsafe method of pregnancy prevention.

Your baby’s suckling plays a huge role is suppressing ovulation, so every missed breastfeeding session makes you more likely to risk falling pregnant.

2) RHYTHM PLANNING
Effectiveness About 75 per cent. An estimated 13 per cent of women who use this method fall pregnant in the first year.
How it works Also known as the calendar method, you’ll need to track your menstrual history carefully to predict which days you’ll ovulate (usually between days 13 and 15). If you want to conceive, have sex during those days. If you want to be baby-free, avoid having sex altogether or use a barrier method.
It’s good because… It’s convenient and does not involve any medication or birth-control devices.
It’s not for you if… You want a reliable contraception method. “People using the natural family-planning method are called parents,” jokes Dr Chong.

3) LACTATIONAL AMENORRHEA
Effectiveness 98 per cent during the first six months if done properly.
How does it work Since breastfeeding interferes with the release of the hormones needed to trigger ovulation, you are less likely to get pregnant as long as you’re nursing bub exclusively. This is also why women who breastfeed round-the-clock take a long time to start menstruating again.
It’s good because… If you’re breastfeeding, any birth control containing hormones are a big no-no, as it can affect your milk supply. So, if you’re not into the barrier methods, this may be your only option.
It’s not for you if… You’re looking for an iron-clad long-term solution. Also, if you are supplementing with formula or pumping. Your baby’s suckling plays a huge role is suppressing ovulation, so every missed breastfeeding session makes you more likely to risk falling pregnant. By the way, once you start menstruating, it’s a clear indication that you’ve started to ovulate and are therefore, fertile.