You've just given birth, you're exhausted, and they're already talking to you about contraception. You haven't even recovered yet, and your midwife is asking you which method you want to use again. It's normal to feel overwhelmed, but the reality is simple, You can get pregnant again as early as 21 days after giving birth., even without having had your period return.
Without contraception, approximately 23% of women become pregnant within 18 months of giving birth. This article discussestaille When to resume contraception, which method to choose depending on whether you are breastfeeding or not, and debunks common misconceptions about breastfeeding as contraception. Because being informed means being able to make a calm decision.
💡 Direct Answers
Summary Table: Which Contraception, When?
Depending on whether you are breastfeeding or not, the recommendations change. Here is the official summary of permitted methods according to the postpartum period.
📌 To remember
The efficiency percentages correspond to typical use (i.e., in real life, with oversights, errors, etc.). In perfect use, all these figures increase, but no one is perfect in the long run.
Fertility Return: Faster Than You Think
The widespread belief that one cannot become pregnant immediately after giving birth is false and dangerous. Medical data is clear on this point.
The official deadline: 21 days
According to ANAES and WHO: Ovulation does not resume until 21 days after delivery, regardless of how the baby is fed. This means you are naturally protected for the first 3 weeks.
But from the 22nd day onwards: Ovulation can resume at any time, even if your period hasn't returned. Therefore, you can become pregnant even before your period returns.
⚠️ The trap of postpartum bleeding
Ovulation occurs BEFORE the first period. If you are expecting your return of menstruation to resume contraceptionYou run the risk of ovulating in the meantime. As a result, a pregnancy can start even before you have your period.
Without Breastfeeding: The Quick Return
If you are not breastfeeding, your cycle usually returns quickly. On average, ovulation returns between 25 and 45 days after childbirth, and menstruation returns between 45 and 69 days postpartum.
With breastfeeding: Variable but not guaranteed
Breastfeeding does indeed delay the return of ovulation thanks to prolactin (the hormone that blocks ovulation). However, this delay varies considerably from woman to woman. Some ovulate as early as two months despite exclusive breastfeeding, while others don't until 18 months. It's impossible to predict in advance.
Breastfeeding = Contraception? The LAM Method
We often hear that breastfeeding protects against pregnancy. This is true, but under such strict conditions that the majority of women unknowingly fail to meet them.
The MAMA method: strict instructions for use
LAM stands for "Lactational Amenorrhea Method". Effectiveness: 98% if the following 4 conditions are met simultaneously:
1. 100% Exclusive Breastfeeding No supplements (bottle, water, herbal tea, formula), no pacifier or soother.
2. Breastfeeding on demand day AND night 6 to 10 feedings per 24 hours minimum, with no intervals exceeding 4 hours during the day and 6 hours at night
3. Total absence of rules As soon as menstruation returns, the contraceptive effect disappears.
4. Baby under 6 months old Beyond that point, even with exclusive breastfeeding, effectiveness drops.
Why it's difficult to comply
- Your baby is starting to sleep through the night → interval of more than 6 hours → protection compromised
- Giving a pacifier or a little water during a heatwave → compromised protection
- Introducing diversification at 4-5 months → protection compromised
- You're pumping instead of breastfeeding → compromised protection
- Your period returns → protection is over, even if you are still breastfeeding
An international study of 346 women showed that the Lactational Amenorrhea Method (LAM), when correctly applied, had a pregnancy rate of only 0,7% at 6 months. However, as soon as complementary feeding is introduced, this rate rises to 2,9% at 6 months and 5,9% at 12 months. These figures remain comparable to the typical effectiveness of the pill, but all the conditions must be met.
The unanimous medical council
Even if you are exclusively breastfeeding, healthcare professionals recommend additional contraception starting 3 weeks postpartum if you don't want to risk another pregnancy. Breastfeeding can be used as a natural method, but it is safer to combine it with another method (IUD, implant, condom).
Contraception Without Breastfeeding: All the Options
If you are not breastfeeding (or if you have chosen mixed feeding with bottles), you have access to almost all contraceptive methods. The only restrictions concern the waiting period after childbirth.
IUD (Intrauterine Device): The Long-Term Option
The IUD (intrauterine device, formerly called a coil) comes in two versions:
- Copper IUD Hormone-free, effective for 5 to 10 years, periods sometimes heavier
- Hormonal IUD Releases progesterone locally, effective for 5 years, periods often lighter or absent
timing: Insertion is recommended from 4 weeks postpartum, often during the 6-week visit. Technically possible within 48 hours of delivery, but rarely practiced in France (higher risk of expulsion).
Contraceptive Implant: Insertion and Forgetting
A small, flexible rod, 4 cm long, inserted under the skin of the arm, it releases progestins continuously for 3 years. No risk of forgetting, very effective, but may cause irregular bleeding (spotting) in the first few months.
timing: It can be inserted as early as 21 days after delivery. Some maternity wards offer it before discharge.
Progestin-only pill (estrogen-free)
Contains only a progestin (no estrogen). To be taken every day at the same time, without interruption (28 tablets). Only a 3-hour grace period for missed doses (or 12 hours for the desogestrel pill).
timing: It should be started 3 weeks after delivery. Some doctors prescribe it as soon as the patient leaves the maternity ward with instructions to start on day 21.
Combined Pill (Estroprogestative)
Your "classic" birth control pill from before pregnancy. Contains estrogen + progestin. Please note: Estrogens increase the risk of thrombosis (phlebitis, pulmonary embolism) in the weeks following childbirth.
timing: Never before 6 weeks postpartum. Ideally, wait until your period returns for added safety.
Condoms: The Immediate Solution
For men or women, these can be used as soon as you resume sexual activity. They are the only method that also protects against STIs. They can be combined with other methods for added protection.
Contraception While Breastfeeding: Restrictions
Breastfeeding changes things because certain hormones pass into breast milk and can affect lactation or (theoretically) the baby. Therefore, the recommendations are stricter.
The golden rule: No estrogen for 6 months
Contraceptives containing estrogen (combined pill, patch, vaginal ring) are not recommended during the first 6 months of breastfeeding, according to the WHO and the French National Authority for Health (HAS). The reason: they can decrease milk production in some women.
Exception : If breastfeeding is well established and milk production is abundant, some doctors are willing to prescribe a combined pill after 6-8 weeks. This should be discussed on a case-by-case basis.
Breastfeeding-Friendly Methods
✅ Without restriction
- Copper IUD No hormones, no impact on breastfeeding
- Condoms Male or female, no impact
- Spermicides Suitable for use from 6 weeks of age
⚠️ Acceptable from 3 weeks old
- Progestin-only pill Minimal passage into milk
- Progestin implant Likewise, very limited impact
- Hormonal IUD Local action, very few hormones in the blood
Do progestins really affect breastfeeding?
Studies show that progestins alone (progestin-only pill, implant, hormonal IUD) pass into breast milk in very small quantities and have no proven effect on the baby. Some women report a slight decrease in milk production during the first 6 weeks, which can be compensated for by increasing the frequency of feedings for a few days. After 6 weeks, breastfeeding is well established and this risk disappears.
How to Choose the Method That Suits You
There is no single "best" universal contraceptive method. It all depends on your personal situation, your medical history, your preferences, and your postpartum lifestyle.
Questions to ask yourself
Do you want a long-term or temporary method?
If you don't want any more children for several years → IUD or implant. If you want to space them out by a year or two → pill, condoms.
Are you able to take a pill every day?
With a newborn, the days are chaotic. If you often forget, opt for long-acting methods (IUD, implant) that don't depend on you.
Do you want to avoid hormones?
Copper IUDs, condoms, or the LAM method (if conditions are met) are your options.
Do you have any medical contraindications?
History of thrombosis, migraine with aura, hypertension, smoking: discuss these with your doctor to rule out certain methods.
General medical recommendation
Healthcare professionals favor LARC (Long-Acting Reversible Contraception) postpartum, i.e. IUDs and implants.
- Maximum efficiency : 99%, comparable to sterilization but reversible
- No possibility of forgetting Once installed, you are automatically protected.
- Long duration : 3 to 10 years depending on the model, you won't think about it anymore
- Optimized pregnancy spacing An American study showed that women using an IUD or implant have a 6% chance of closely spaced pregnancies (less than 27 months between births), compared to 21% for those using the pill, patch, or ring.
Protection & Comfort For Your First Weeks
After childbirth, lochia (postpartum bleeding) lasts 4 to 6 weeks. Our period panties offer comfortable and breathable protection during this delicate time.
Frequently Asked Questions About Postpartum Contraception
Resuming Contraception: Anticipating Rather Than Reacting
Ovulation resumes as early as 21 days after childbirth, even without a return of menstruation. Without contraception, nearly one in four women becomes pregnant within 18 months of giving birth. Exclusive breastfeeding can protect against pregnancy, but only if you strictly adhere to all the conditions of the Lactational Amenorrhea Method (LAM) (98% effective).
IUDs and implants are the most effective (99%) and best-suited methods for the chaotic postpartum period, as they are not dependent on you. If you are breastfeeding, avoid estrogen-containing contraceptives for 6 months. Progestin-only pills, implants, and IUDs are compatible as early as 3-4 weeks postpartum.
Choosing contraception after childbirth is never mandatory, but being informed about the timeframes, options, and risks allows you to make an informed decision. Discuss it with your midwife or doctor as soon as you leave the maternity ward to have a solution in place before resuming sexual activity.
Sources & Scientific References
This article is based on official recommendations and validated scientific studies on postpartum contraception.
Official recommendations
- High Authority of Health (HAS). (2019). Contraception in postpartum women. Fact sheet. Saint-Denis La Plaine.
- World Health Organization. (2015). Medical eligibility criteria for contraceptive use. Fifth edition. Geneva: WHO.
- ACOG Committee Opinion No. 736. (2018). Optimizing Postpartum Care. Obstetrics & Gynecology. DOI: 10.1097/AOG.0000000000002849
Effectiveness of the MAMA method
- Kennedy KI, Visness CM. (1992). Contraceptive efficacy of lactational amenorrhoea. The Lancet. DOI: 10.1016/0140-6736(92)90018-X
- Van der Wijden C, Manion C. (2015). Lactational amenorrhoea method for family planning. Cochrane Database of Systematic Reviews. DOI: 10.1002/14651858.CD001329.pub2
Comparative effectiveness of postpartum methods
- Brunson MR, Klein DA, Olsen CH, et al. (2017). Postpartum contraception: initiation and effectiveness in a large universal healthcare system. American Journal of Obstetrics and Gynecology. DOI: 10.1016/j.ajog.2017.02.036
- Lopez LM, Gray TW, Hiller JE, Chen M. (2015). Education for contraceptive use by women after childbirth. Cochrane Database of Systematic Reviews. DOI: 10.1002/14651858.CD001863.pub4
Hormonal contraception and breastfeeding
- Stanton TA, Blumenthal PD. (2019). Postpartum hormonal contraception in breastfeeding women. Current Opinion in Obstetrics and Gynecology. DOI: 10.1097/GCO.0000000000000571
- Phillips SJ, Tepper NK, Kapp N, et al. (2016). Progestogen-only contraceptive use among breastfeeding women: a systematic review. Contraception. DOI: 10.1016/j.contraception.2016.04.006
Spacing of pregnancies and maternal health
- Grisaru-Granovsky S, Gordon ES, Haklai Z, et al. (2009). Effect of interpregnancy interval on adverse perinatal outcomes—a national study. Contraception. DOI: 10.1016/j.contraception.2009.06.006
Note: The DOI links provide direct access to the original scientific publications. This article will be updated regularly to reflect changes in medical recommendations.
Medical Warning: This article is for informational purposes only and is not a substitute for professional medical advice. For help choosing the right contraception for your situation, consult your midwife, gynecologist, or general practitioner.
