BIRTH CON­TROL AF­TER PREG­NANCY

You’ve just given birth to your bun­dle of joy. And while sex is pos­si­bly the last thing on your mind, there will come a time that you crave that in­ti­macy. We give you a low down on ev­ery­thing you need to know to make your decision and hope­fully life a lit

Mother & Baby - - CONTENTS - BY STEPHLINA DCUNHA

Ev­ery­thing you need to know about con­tra­cep­tion post de­liv­ery

SURE you are ex­hausted! Your body is slowly com­ing to terms with the trauma it has been through, your breasts are leaky, you are hardly get­ting any sleep and post­par­tum blues may be mak­ing you feel de­jected and de­tached from your baby, not to men­tion a lit­tle cranky as well. In short, you are a mess! And, in such cir­cum­stances, the thought of get­ting in­ti­mate with your part­ner might make you break into a cold sweat or even an­noyed. How­ever, this won’t be the case for­ever and you would want to get phys­i­cal with your part­ner soon. Make note, there is ab­so­lutely noth­ing wrong with that. In fact, ex­perts sug­gest that cou­ples should start hav­ing sex as early as four weeks af­ter child­birth. This is be­lieved to help the part­ners con­nect not only on an emo­tional level, but also, on a men­tal level and help un­der­stand each other’s re­spon­si­bil­i­ties as par­ents.

Be­sides, with all the happy hor­mones that float around in your body post the act, sex has been rightly touted as a stress buster. Be­lieve us, you need it! How­ever, you don’t want to get preg­nant again this quickly, which is ex­actly why you need to think about birth con­trol op­tions. Post preg­nancy con­tra­cep­tion is a decision which needs to be thought long be­fore even your baby is born, sug­gest ex­perts.

WHEN THE GO­ING GETS TOUGH

When you’re try­ing your best to fill in the shoes of par­ent­hood and ful­fill your moth­erly chores, get­ting preg­nant again is prob­a­bly the last thing on your mind right now. The ear­li­est days of par­ent­hood may not make you feel the sex­i­est, since your body is re­cov­er­ing from child­birth. How­ever, you and your part­ner might just want to get reac­quainted af­ter about six weeks. In this case, birth con­trol may seem like a non-ne­go­tiable op­tion. There are sev­eral mis­con­cep­tions which often mis­guide women on when they can start get­ting preg­nant again af­ter hav­ing a baby. “As a gen­eral rule, most women don’t start ovu­lat­ing im­me­di­ately af­ter hav­ing a baby. The re­turn of men­strual cy­cle and fer­til­ity, af­ter you have given birth to your first child, may vary from per­son to per­son,” says Dr Shilpa Ghosh, se­nior con­sul­tant and head of birthing, ob­stet­rics and gy­ne­col­ogy, Venkatesh­war Hospi­tal, Dwarka. Af­ter giv­ing birth, your uterus re­turns to its nor­mal cy­cle, mean­ing that you can get preg­nant again within a month. Most women think that they can­not get preg­nant again un­til af­ter they’ve had their first post-preg­nancy pe­riod. But, that’s not true. You can get preg­nant be­fore hav­ing your first pe­riod af­ter child birth. “Women often start ovu­lat­ing in less than 25 days af­ter hav­ing a baby, which im­plies that there is a solid chance of them con­ceiv­ing again within a month af­ter child­birth. It is often com­mon for women to miss the symp­toms of ovu­la­tion, es­pe­cially if you are not ex­pect­ing them. So, it is ad­vised to stay ex­tra cau­tious dur­ing this par­tic­u­lar time,” ex­plains Dr Ghosh. And since your abil­ity to bear an­other child can re­turn as quickly as a month, it is ad­vis­able to think about post­par­tum birth con­trol in the weeks be­fore de­liv­ery. When con­sid­er­ing birth con­trol op­tions, many women also re­alise that their ear­lier choice may not be the most suit­able one for their new life­style. In such an in­stance, be­ing in­formed of all the avail­able op­tions is a good idea. Your newly-ac­quired rou­tine may not be the most suited for your pre­vi­ous mode of con­tra­cep­tion; for ex­am­ple, tak­ing your daily pill might eas­ily slip your mind when you haven’t had a good night’s sleep in weeks. Sim­i­larly, a con­tra­cep­tive pill might not be the best op­tion in case you are breast­feed­ing your baby or con­doms which used to feel fine be­fore might now be un­com­fort­able. “There are sev­eral meth­ods of con­tra­cep­tion avail­able. How­ever, choos­ing the one that works best for you de­pends on the mother’s health and largely on cir­cum­stances.” con­firms Dr Ghosh.

MAK­ING THE RIGHT CHOICE

First things first, it does make sense to have a fair idea of how quickly you want your fam­ily to grow af­ter hav­ing your first baby. While there doesn’t need to be a solid plan with cer­tain terms, it would make your life much sim­pler if you and your part­ner are on the same page about how and when you’d like to ex­pand your fam­ily. Once you’ve got that fig­ured out, choos­ing a birth con­trol method can be­come a lot eas­ier and less messy. Dr Ghosh sheds some light on the var­i­ous op­tions avail­able. She ex­plains that con­tra­cep­tion meth­ods can be broadly cat­e­gorised into two classes: Bar­rier meth­ods: This method pre­vents the sperm from reach­ing the egg and often do not in­ter­fere with your hor­mones, af­fect your lac­ta­tion or have any sig­nif­i­cant side ef­fects. The most com­monly used bar­rier meth­ods are: 1. Con­doms 2. Cer­vi­cal cap 3. Di­aphragm Hor­monal meth­ods: These birth con­trol mea­sures use syn­thetic hor­mones to sup­press ovu­la­tion, in­crease the vis­cos­ity of cer­vi­cal fluid to pre­vent the sperm from reach­ing the egg and ob­struct the im­plan­ta­tion of the egg in the uterus. While these meth­ods are highly ef­fec­tive and are avail­able only on pre­scrip­tions, they do not pro­vide any pro­tec­tion from STDs. These in­clude: 1. Com­bined pill or the con­tra­cep­tive

patch 2. Con­tra­cep­tive vagi­nal ring 3. Con­tra­cep­tive im­plant 4. The birth con­trol shot ev­ery three

months Apart from these op­tions, in­trauter­ine de­vices (IUDs) are also con­sid­ered to be an ef­fec­tive method for long term pro­tec­tion. IUDs can be in­serted im­me­di­ately af­ter vagi­nal or cae­sarean birth in about four to six weeks. Cou­ples who have com­pleted their fam­ily may de­cide for one of the part­ner to be ster­ilised. Tubal lig­a­tion (to cut and tie the fal­lop­ian tubes) is the most com­mon method of ster­il­i­sa­tion amongst women. Men can opt for a va­sec­tomy, which in­volved cut­ting the tubes that carry the sperm from the testes, is cheaper, eas­ier and safer than fe­male ster­il­i­sa­tion. “While there is prob­a­bly not one sin­gle gold stan­dard when it comes to birth con­trol af­ter hav­ing your first baby and find­ing a re­li­able method is not al­ways easy, us­ing a long-term rev­ersible con­tra­cep­tion method such as in­trauter­ine de­vice or pro­ges­tero­neonly pill are nowa­days sug­gested by many doc­tors. Hav­ing pro­tected sex us­ing con­doms is also some­thing that most doc­tors would recommend. Also, oral con­tra­cep­tives are most com­monly used by young women in our coun­try, whereas patches and im­plants are the meth­ods that are not usu­ally used in In­dia,” adds Dr Ghosh.

BREAST­FEED­ING: A NAT­U­RAL CON­TRA­CEP­TIVE IN IT­SELF?

While many moth­ers de­cide to nurse their child, oth­ers opt out. Breast­feed­ing is be­lieved to of­fer some pro­tec­tion and is known to sup­press fer­til­ity, and is often an ap­peal­ing method of con­tra­cep­tion in the first few months af­ter de­liv­ery. They have a name for it as well; lac­ta­tional amen­or­rhoea (LAM). “Breast­feed­ing can help to de­lay the fer­til­ity cy­cle when you start ovu­lat­ing or hav­ing pe­ri­ods af­ter the birth of your first child. How­ever, if you want to follow the LAM method, you must be ready to breast­feed ex­clu­sively and reg­u­larly. LAM can be up to 98 per cent ef­fec­tive in pre­vent­ing preg­nancy, and the ef­fec­tive­ness lasts up to six months af­ter the birth,” ad­vises Dr Ghosh. Nev­er­the­less, be mindful of the fact that breast­feed­ing is but only a short-term op­tion and be­comes less re­li­able once your baby starts on solid foods. There’s an­other gl­itch as well—you’re not pro­tected af­ter you get your first post­preg­nancy pe­riod. How­ever, since you wouldn’t know that you have ovu­lated un­til your pe­riod, there’s a huge pos­si­bil­ity of you get­ting preg­nant if you’re not us­ing any other means of con­tra­cep­tion. An­other

Women often start ovu­lat­ing in less than 25 days af­ter hav­ing a baby, which im­plies that there is a solid chance of them con­ceiv­ing again within a month af­ter child­birth

as­pect to con­sider is the choice of con­tra­cep­tives if you are breast­feed­ing your baby. Dr Ghosh ex­plains that it is ad­vis­able for nurs­ing moth­ers to re­frain from hor­monal meth­ods such as com­bined pill, patch or the shot, since these routes in­volve the use of es­tro­gen which can en­ter the milk as also de­crease the pro­duc­tion of breast milk.

WHEN IT COMES TO DE­CI­SIONS

While the avail­abil­ity of choices might seem over­whelm­ing, ask­ing your­self a few ques­tions can sim­plify things. Often the sim­plest things make the most no­table dif­fer­ence in de­cid­ing. Fi­nances count: It’s inar­guable that money mat­ters and for most cou­ples, cost has been a de­cid­ing fac­tor since many forms of con­tra­cep­tion may be out of bud­get. While most re­sort to con­doms or pills be­cause they are com­par­a­tively cheaper than IUDs or im­plants, they might even­tu­ally cost you more in long term. IUDs or im­plants do cost higher than con­doms or pills, but the pro­tec­tion does last longer. Make sure you dis­cuss all your op­tions and doubts with your doc­tor be­fore you de­cide. Feed­ing your baby: It’s best to stay away from es­tro­gen-based meth­ods if you are plan­ning to nurse your baby. Cer­tain types of oral con­tra­cep­tion, such as the mini pill, as well as im­plants and IUDs are safe for breast­feed­ing, but com­bi­na­tion pills are out. Fam­ily Plan­ning: If you want to ex­pand your fam­ily then you need to speak to your part­ner about it. In this case, if you are on bar­rier method, you’d need to make the nec­es­sary ar­range­ments to be able to con­ceive again. Con­sider how long a method re­mains ef­fec­tive be­fore you buy it— you wouldn’t want to pay for a pricey three-year method only to re­move it a few months later. Fi­nally, don’t shy away from speak­ing to your doc­tor about the var­i­ous op­tions that you could con­sider af­ter hav­ing the baby. Also, a lit­tle home­work on your part will go a long way. Re­mem­ber, it’s your decision and your choice.

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