Introduction After birth, when will my fertility return? Why is it important to understand your fertility? How can fertility be managed? Establish your fertility goal: For how long do you want to avoid childbearing? How important is it for you to not get pregnant right now? What would you do if you experienced an unintended pregnancy? Determine what your breastfeeding goal and actual patterns are: How old is your baby? Are you exclusively or partially breastfeeding right now? For how long do you want to breastfeed? How important is it to you that the contraceptive method you use is compatible with breastfeeding? Consider what fits your personal circumstances and daily routines: How does your relationship status affect your contraceptive choices? How important is ease of use? Do you need a method which is long-acting? Discreet? If you have used certain methods in the past, what did you like and dislike about them? Respect your own conscientious convictions: What methods are compatible with your personal values and religious beliefs? Prioritize: Of all these considerations, which ones are more important to you and your family right now? Consult your health-care provider and/or partner before starting or stopping a contraceptive method. There may be health considerations--such as your age, any illnesses, or smoking--which affect what contraceptive methods you can safely use. Your health-care provider will help you determine your clinical eligibility and identify whether there are methods you should avoid. Your health insurance may restrict what methods are covered under your plan. Talk to your provider about all of your options. Below are some useful questions that you can ask. If you have chosen a method, your provider should also explain or demonstrate how to use it correctly. Questions to ask your health-care provider:
Contraception Lactational Amenorrhea Method (LAM):
For LAM to effectively reduce the risk of pregnancy, you need to meet three conditions:
The last condition means that your baby does not get supplements of foods or liquids, does not use a pacifier frequently, and does not go longer than approximately four hours during the day and six hours during the night without breastfeeding. With perfect use, the failure rate of LAM is 0.45% for six months after birth. With typical use, it is 2%.2, 8 LAM may not be as effective for mothers who are separated from their babies and rely heavily on expressing milk, including mothers who are employed outside the home or are full-time students.9 LAM requires that you evaluate and re-evaluate your situation on an ongoing basis to make sure that the three conditions are still met. Whenever one of the conditions is no longer met, the failure rate may be increased, and an alternative contraceptive method would be recommended.5 Other natural methods:
Abstinence means refraining from shared sexual activity that can result in pregnancy and sexually transmitted infections. To be effective abstinence needs to be practiced constantly. If you decide to have sex, another method is necessary to prevent pregnancy. There are different fertility awareness-based methods that can help you identify when you are fertile. The symptothermal method requires you to 1) check your cervical mucus daily; 2) take your temperature each morning at the same time and before voiding, and; 3) chart your ovulation symptoms. 10 It can be used once your menstrual cycle has started and become regular again.11 During days when you are at risk for pregnancy, you can practice periodic abstinence, withdrawal, or use a barrier method (discussed below). Withdrawal (or the ‘pull out’ method) requires your partner to completely remove the penis from the vagina before ejaculation to prevent sperm from entering the vagina. If a man ejaculates on the vulva or near the vaginal opening, sperm can still enter the vagina. After an ejaculation, small amounts of sperm may be left in the man's urethra. There is inconclusive evidence whether the amount of sperm in pre-ejaculatory fluid (precum) can cause pregnancy, and research shows that this is likely to vary greatly between individual men. While withdrawal is more effective in preventing pregnancy than unprotected sex, it is not recommended if avoiding pregnancy is critical for you. With perfect use, natural methods have very low failure rates (constant abstinence: 0%; symptothermal method: 0.4%; withdrawal: 4%).6 These methods are accessible to all women at no or low cost. Their main disadvantage, however, is that they are often used incorrectly and inconsistently. They require user knowledge, significant self-control, and good communication between partners. Failure rates increase exponentially with typical use: (no method: 85%; fertility awareness-based methods: 24%; withdrawal: 22%).6 Barrier methods:
The most common barrier method is the condom. There are female and male condoms. They are relatively inexpensive and usually easy to acquire. With perfect use, the failure rate for male condoms is 2%, and for female condoms it is 5%.6 Many people use condoms incorrectly and inconsistently. With typical use, the failure rate for male condoms is 18%, and for female condoms it is 21%.6 Condoms also reduce the risk of sexually transmitted infections. They can be used simultaneously with other contraceptive methods, thus offering ‘dual protection.’ Other barrier methods, such as the cervical cap, diaphragms, and the sponge, are less effective than condoms, especially for women who have given birth. Diaphragms need to be refitted after childbirth or with large weight swings. Diaphragms and cervical caps are more effective when used in conjunction with spermicides. Hormonal methods:
Note: Since this article was published the Academy of Breastfeeding Medicine has changed its recommendations regarding hormonal contraceptive use for lactating women.
site> Hormonal methods can be divided into different sub-categories, including short-acting and long-acting, and combined hormonal and progestin-only contraceptives. Combined hormonal methods, such as the ‘pill,’ the patch, and the vaginal ring, contain both estrogen and progestin. Estrogen may decrease milk production and negatively affect breastfeeding duration.2, 16 The World Health Organization recommends that breastfeeding mothers avoid combined hormonal contraceptives in the first six months after birth unless other methods are not available or acceptable.18 The Academy of Breastfeeding Medicine recommends alternative methods until after the baby has weaned.2 If you are breastfeeding, progestin-only methods are preferred over combined hormonal ones.2, 19 Progestin-only contraceptives include the ‘mini pill,’ the implant, injectables, and the intrauterine system (IUS). The earliest recommended use of progestin-only methods by breastfeeding women, who are clinically eligible to use them, is usually six weeks after birth, if milk production is well-established.2, 16, 19 There are anecdotal clinical reports that progestin-only contraceptives can decrease milk production, too.2, 16 The possible negative effects on milk production can sometimes be difficult or impossible to fully reverse with either combined hormonal or progestin-only methods, especially with methods that cannot be stopped quickly. A nursing mother needs to carefully consider whether to use any of the hormone-based contraceptives while the baby is dependent on breastmilk for the majority of his nutrition. The importance of pregnancy prevention versus maintaining optimal milk supply is something that only the mother can assess. The following information is based on evidence current as of the date of publication and is not meant as an endorsement of any particular method or as being compatible with breastfeeding. Select progestin-only contraceptives2, 6, 11, 12, 13, 14, 19 Progestin-only pill (also called the ‘mini pill’)
Implant
Injection
Intra-uterine system
If I choose a hormonal method, will hormones in my breastmilk affect my baby? Copper-bearing intrauterine device (IUD):
The copper-bearing IUD is available for breastfeeding mothers who want long-acting, reversible contraception without hormones. After the IUD is placed by a trained provider, there is no daily routine, and it can be used for at least 10 years. In the first year, the typical failure rate is 0.8%.6 Over the course of 10 years, the typical failure rate is 2%.11 The copper-bearing IUD can also be used as emergency contraception for up to five days after unprotected sex.21 When placed after unprotected sex, the copper-bearing IUD prevents fertilization and may also prevent implantation.22 Permanent methods:
If you are positively certain that you have completed childbearing, permanent contraceptive methods may be for you (or your partner). With tubal ligation, the fallopian tubes are surgically cut or blocked. If you want to have the procedure done immediately after childbirth, you have the right to give informed consent before giving birth.11, 23 In the first year after the procedure, the typical failure rate is 0.5%.6 Over the course of 10 years, the typical failure rate is 2%, and a small risk of pregnancy remains until you reach menopause.11 Vasectomy is also a surgical procedure. The vas deferens that carry sperm to the penis are blocked. It takes up to three months after the procedure until it is effective in preventing pregnancy. After three months, the man can have his semen analyzed to see whether it contains sperm.11 In the first year, the typical failure rate is 0.15%.6 If the semen is not analyzed, the failure rate in the first year may be as high as 3%.11 Vasectomy is simpler, safer, and less expensive than tubal ligation.2, 11 Emergency contraception: Unintended pregnancy Continuing the pregnancy: Abortion: Three in 10 American women will have an induced abortion in their lifetime. 29 The majority (61%) already have children29 and may still be breastfeeding. In the first trimester, abortion can be done using vacuum aspiration or medicines. If you have decided to terminate a pregnancy and are considering an aspiration abortion, you can discuss pain management options with your health-care provider. Together you can agree on a pain management plan that has no or low adverse effects on breastfeeding. Medical abortion can be done with a combined regimen of mifepristone and misoprostol.30 Mifepristone passes into breastmilk, and there are no known adverse effects on the breastfed infant.30, 31 One small study found that levels of mifepristone in milk samples taken 6-12 hours after maternal intake ranged from undetectable to low, depending on the dose. The study concluded that with the low dose of mifepristone, “breastfeeding can be safely continued in an uninterrupted manner during medical abortion.”32 Alternatively, you can opt to express and discard milk for two days after taking mifepristone.31 Misoprostol is used for a range of reproductive health indications, including management of postpartum bleeding.33 It passes into breastmilk, and drug levels rise and fall quickly. Misoprostol may temporarily cause infant diarrhea.20, 31 Within five hours, there are no detectable traces left in breastmilk.34 About one in five confirmed pregnancies end in spontaneous abortion (miscarriage). If you experience an incomplete miscarriage (when some pregnancy tissue remains in the uterus) or a missed miscarriage (when fetal death has occurred but the body does not expel the pregnancy), vacuum aspiration or a misoprostol-only regimen may be used as part of your treatment. Conclusion Online resources Information about contraception and breastfeeding: Citations Photo Credit: USBC Can precum cause pregnancy after giving birth?Pre-cum doesn't usually have any sperm in it. But some people may have a small amount of sperm in their pre-cum. If there is sperm in someone's pre-cum, and that pre-cum gets into your vagina, it could possibly fertilize an egg and lead to pregnancy.
How much of a chance is it to get pregnant off precum?"It's estimated that about 20% of people can get pregnant from withdrawal method during sex, so it's possible those people got pregnant from pre-ejaculate," says Dr. Hsieh. According to the World Health Organization (WHO), the chance of conceiving from pre-cum is about 20% if you're using the withdrawal method.
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