After you've had your new bundle of joy for a few weeks (or more precisely 6) you will have your "postpartum checkup". If all is well, your OB will clear you for exercise and sex. Two things that probably couldn't be further down on your list of priorities. But that won't be the case for forever. When intimacy starts to look appealing again, it's important to know your options for birth control if avoiding another pregnancy is important to you and your partner.
We've all heard conflicting pieces of advice about breastfeeding and return of periods after birth. It can all be boiled down to one sentence:
Breastfeeding is designed to suppress ovulation,
What factors? Well there are many. Some we can control, like rooming in with your baby and pacifier use - some we can not, like your unique threshold of Prolactin (the nursing hormone) to Follicle Stimulating Hormone and Estrogen (the menstruating hormones). While on average we see 6 months of ovulation suppression with exclusive breastfeeding, that first ovulation (and therefore menstruation) can come any point from 4 weeks to 2 years after birth while breastfeeding. That's a pretty big window! While OB's are happy to write a script for the mini pill (progestin only birth control pills, the only "approved" hormonal contraception for breastfeeding), many moms want to steer clear of hormones while nursing. And clinically speaking, as a lactation counselor, I've seen even the mini pill affect milk supply. So what's a mom to do?
The good news is that ovulation and that first menses after birth don't have to be surprise visitors. From 4 weeks to 2 years, you can track your fertility to know when your hormones start to rev up again. If you aren't already familiar with Fertility Awareness Based Methods, I would recommend working with a certified FAM Practitioner. If you have absolutely no idea what I'm talking about, you can learn more here. Even if you are using barrier methods in the meantime, or any method that doesn't actively interfere with ovulation, it's nice to have a window into knowing what the heck is going on.*
Technology in this field has advanced so rapidly in the last 15 years, there are so many options to make Fertility Awareness Charting easier and more seamless. There are a few obvious ways to know your hormones are kicking in gear.
That's right - just the moment you start to think sex sounds appealing, it's likely that is coming from Estrogen, one of the main drivers of female sex drive. Estrogen is second in line of the hormones that kickoff ovulation. Meaning when estrogen gets to a certain threshold, it pings to the brain to make Luteinizing Hormone, which officially kicks off ovulation. I joke with my clients that if you feel interested in sex, it's probably related to potential fertility. I haven't figured out the punch line to this joke yet.
I usually give my spiel here about how Cervical Fluid is literally the substance of life, if men had it they would be bragging about it in bars, etc etc. Cervical Fluid, other than being the substance of life, gives us a direct line to our ovaries. It tells us everything we need to know about estrogen and progesterone production. What does this mean? It means when you are producing estrogen, and probably feeling a little hot and bothered to boot, you will see an increase in cervical fluid production. Yea, that stuff on your underpants. Cervical fluid production changes vastly in the postpartum period, and you can go months producing it without it leading to ovulation. FAM Practitioners are able to help you learn the language of your own cervical fluid to figure out what's happening. Sometimes learning that language is tricky, especially for those who didn't chart before baby. So that's when we lean on technology to help us...
There are gadgets and gizmos these days to just test your hormones with at home urine tests. I know it doesn't sound sexy, but it gets the job done. Hormonal Monitors tell you when that Estrogen production is actually going somewhere. It also tells you when there are days that are completely infertile. (Good evenings to get the kids to bed early.) I'm still waiting for the toothbrush that just reads your hormones and gives you a full report directly to your cell phone. While we wait for that, Elon Musk, we'll use these primitive urine tests in the meantime.
Birth control is an extremely personal issue. But if you want to avoid hormones while nursing, and even if you are using non hormonal forms like barrier methods, you can track your hormones so that first period after birth does not have to be a surprise. (Doesn't parenthood have enough surprises??) If you want to use Fertility Awareness Based Method for family planning intentions, I would recommend working with a FAM Practitioner. Be in the know and understand that wild hormonal postpartum ride just a little bit more!
*If you are on any form of hormonal contraception, including the hormonal IUD, shot, or implant, you can not use a Fertility Awareness Based Method as they work primarily by suppressing the hormones that kick start the ovulation/menstrual cycle.