Barrier methods of birth control such as diaphragms, cervical caps, or condoms, appeal to women who don't want extra hormones in their
systems. None of these impact breastfeeding or future fertility. The diaphragm is a latex cup which is filled with spermicide and inserted into the vagina prior to sexual
intercourse. The cervical cap is similar, but smaller. The cervical cap has a high failure rate among women who have had children, so it's not recommended for new
mothers. The diaphragm is 94% effective when used correctly. A newly fitted diaphragm may be inserted six weeks after birth. Condoms are highly effective,
(especially when their partners use a spermicide) and are the only non-permanent birth control option for men. Condoms help protect against venereal diseases and
HIV, but other barrier methods do not.
In recent years, a new form of intrauterine contraception (IUC) has been
developed. It is a reversible method that is easy to use, provides long-term protection from pregnancy, and does not require monthly trips to the pharmacy. Ninety-six
percent of women currently using IUC are satisfied.
Another IUC option, Mirena (R), lasts for five years and is more than 99% effective. Mirena delivers a low
dose of the hormone levonorgestrel, which usually results in shorter, lighter periods. Since this hormone is a type of progesterone, there may be negative mood
changes in those women vulnerable to depression.
Intrauterine contraception is recommended for women in mutually monogamous relationships who have
had at least one child. Women with a history of pelvic inflammatory disease or ectopic pregnancy should not use Mirena. IUCs do not protect against HIV or other
The Pill, The Shot, and The Implant
New mothers can use Depo-Provera, Norplant, and progestin-only mini-pill six weeks
after birth, even if nursing. Depo-Provera is a hormone shot given every 12 weeks. Depo-Provera may delay pregnancy for a year after being discontinued.
Norplant, a capsule inserted under the skin, contains hormones which prevent pregnancy for five years. Upon removal, pregnancy can take place immediately. The
pills, which are taken daily, contain estrogen and progestin and can be used by new moms six weeks after birth. Progestin-only pills contain no estrogen and are
compatible with breastfeeding. Depo-Provera, Norplant, and the pills are all nearly 100% effective. Birth control pills, shots, and implants do not protect against HIV
or venereal diseases.
Note: For women who are susceptible to depression, I don't recommend these methods, especially the first two (Depo-Provera and
Norplant), since the hormones delivered may cause depression. Once the shot is given, the woman needs to wait three months before she'll feel normal again, which
is miserable for her. Norplant would need to be removed if the woman experiences mood problems, and that isn't always simple. Birth control pills can also cause
negative mood changes, but can be stopped if this occurs.
Natural Family Planning
Natural Family Planning, or NFP, requires charting your
basal body temperature and monitoring cervical fluid to determine when you ovulate. For most women, there are only a couple of days each month when you can
get pregnant. Ovulation occurs once a month and the egg lives two days, during which time pregnancy is possible. During ovulation and around that time for a few
days, the couple abstains from sexual activity or they use a barrier method.
This method takes time to learn - it takes patience and discipline to chart every
day. However, when accurately used, research has shown that NFP has a high degree (95-99%) of effectiveness. NFP does not prevent HIV or other venereal
Permanent Birth Control Options
If your family is complete, consider sterilization. Tubal sterilization for women and vasectomy for
men permanently prevent pregnancy. A woman's fallopian tubes are cut during tubal sterilization, usually immediately after giving birth. This procedure does not affect
breastfeeding, but it can cause mood changes. Vasectomy, the blockage of sperm-carrying tubes, can be performed in a doctor's office under local anesthetic and
is a very simple procedure. These methods are considered to be 100% effective, but they don't prevent venereal diseases.
Bennett, Ph.D. is the author of "Postpartum Depression For Dummies" and co-author of "Beyond the Blues": Understanding and Treating Prenatal and Postpartum
Depression. She's also created guided imagery audios that are specifically focused on helping moms take care of themselves. ABC's "20/20" featured Dr. Shoshana
as the postpartum expert and news stations including CNN consult her. Several publications including the San Francisco Chronicle and the San Jose Mercury News
have written articles on Dr. Shoshana's work. She's interviewed regularly on radio and television and has been quoted in dozens of newspapers and magazines
such as the Boston Globe, Glamour, Psychology Today, New York Post, Self, Cosmopolitan, USA Weekend and the Chicago Tribune. Dr. Shoshana is a survivor of
two life-threatening, undiagnosed postpartum depressions. She founded Postpartum Assistance for Mothers in 1987, and is the Past President of Postpartum Support