Can I Get Pregnant While Breastfeeding?

Getting pregnant again may be the last thing you want to do after having a baby and caring for a demanding newborn. But once sexual activity has resumed, we at Westchester Health advise couples that they should think about their birth control options if they want to prevent another pregnancy from occurring right away.

Yes, you can get pregnant even when you’re breastfeeding

Dennis McGroary, MD, FACOG

Since many couples don’t wait 6 weeks to start having sex again, it’s important to understand that women are still able to become pregnant even when breastfeeding. And, contrary to popular belief, it is perfectly safe to take birth control pills while breastfeeding.

Why people think breastfeeding prevents pregnancy

During pregnancy, a woman’s menstrual period stops. For many women, it also stops while they are breastfeeding. This has led people to believe that you can’t get pregnant while breastfeeding because you’re not having a period. However, this is not universally true for all women and should not be relied upon as a reliable method of contraception.

When breastfeeding can act as birth control: the LAM method

One form of natural contraception brought about by breastfeeding is the lactational amenorrhea method, or LAM. (Amenorrhea refers to the absence of menstruation.) This method is grounded in the scientific belief that exclusive breastfeeding suppresses a woman’s fertility, thereby preventing pregnancy.

LAM can be a very effective family planning method as long as certain conditions are met:

  • the woman’s period has not returned since she gave birth
  • the baby is exclusively breastfeeding on demand and is not eating any other foods or liquids
  • the baby is less than 6 months old

If the mother and baby meet all of these conditions, the chance of pregnancy is very low (less than 2%, according to World Alliance for Breastfeeding).

However, once you stop exclusively breastfeeding and your baby starts taking supplemental foods, such as formula or baby cereal, your body will begin preparing for another pregnancy and ovulation will begin.

Two types of birth control: hormonal and non-hormonal

Regardless of what method of contraception you choose, it’s important for you to discuss your options with your doctor and your partner, if appropriate.

Non-hormonal birth control

If you don’t want to get pregnant right away after having a baby but do not want to take hormones for birth control, here are several options to consider. These range from readily available and relatively inexpensive choices, such as condoms, to devices requiring a prescription or even surgery. Some of these options include:

  1. Barrier contraception. Physical barriers to conception, such as condoms, diaphragms or the cervical cap, are effective methods of contraception. They do not contain any hormones so they do not affect a woman’s milk supply, her ability to breastfeed or her own health.
  2. Copper intrauterine device (IUD). There are two different types of IUDs: copper and hormonal. Copper IUDs are a highly effective form of birth control that do not have any effect on the milk supply. The IUD is a small coil that, in this case, is wrapped in a small amount of copper and prevents implantation, sperm movement and fertilization. A doctor needs to insert an IUD, which is effective in preventing pregnancy for up to 10 years. If a woman decides that she wants to get pregnant again, the IUD can be easily removed.
  3. Sterilization (getting your tubes tied). This method is a permanent form of birth control and involves cutting the fallopian tubes, which connect the ovaries to the uterus. Tying up or blocking the tubes then completely prevents sperm cells from meeting with an egg. Many women choose to have this procedure done during a planned cesarean delivery, and it will not have any effect on a woman’s milk supply.

Hormonal birth control

According to the InfantRisk Center, most forms of hormonal contraceptives are safe and will not affect a nursing infant. However, the bigger concern is the effect that these forms of contraception will have on a woman’s milk supply.

Hormonal birth control usually contains forms of the hormones estrogen and progesterone. While some women may tolerate hormonal contraceptives without an issue, sometimes the estrogen in these products can cause a woman’s milk supply to dry up completely. This is a bigger risk in women who are nursing an older baby, or those who are already dealing with low milk supply issues.

As a result, most doctors will recommend using a progesterone-only option:

  1. Progestin-only pills (POPs). POPs are similar to the traditional birth control pill but they only contain progesterone. Unlike the standard “pill,” these types of pills do not contain any sugar or placebo pills, so each one is active. This option is less likely to adversely affect a woman’s milk supply.
  2. Depo-Provera. Depo-Provera is a progesterone-only injection that will prevent pregnancy for up to 3 months. Some women can be sensitive to progesterone, however, and there is no way to reverse the medication once injected. As a result, a woman’s doctor may suggest that she take POPs for a month or two to see how the progesterone affects her and her milk supply before committing to a longer-acting dose.
  3. IUDs. In addition to the copper IUD, some IUDs are coated in progesterone. This type of IUD works in the same way as POPs and the Depo-Provera injection. In some women, however, the hormonal IUD has been found to decrease the milk supply. Hormonal IUDs are effective for 3-5 years depending on the brand, and can be easily removed if a woman changes her mind about pregnancy.

Birth control and STDs

At Westchester Health, we stress to all of our female patients of childbearing age that hormonal forms of birth control do not protect against the transmission of sexually transmitted diseases (STDs). If you do not know the sexual health status of your sexual partner, or if you have multiple sexual partners, you should always use a condom during intercourse to protect yourself against STD transmission.

Want to know more about birth control methods? Come see us.

If you’d like more information about your options when it comes to birth control methods, whether or not you’ve just had a baby, please make an appointment with Westchester Health to see one of our OB/GYNs. He/she will answer all of your questions, give you plenty of practical information, and advise you on the pros and cons of each contraception option so you can make an informed decision about your reproductive health. Whenever, wherever you need us, we’re here for you.

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By Dennis McGroary, MD, FACOG, Department of OB/GYN, Westchester Health, member of Northwell Health Physician Partners

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