Sex after pregnancy — we don't talk about it much, do we?
The stuff you do hear, timelines, what it's going to feel like, and whether you can get pregnant right away, is often tied up in so many myths it's hard to keep track of the truth.
Most of us have been in a place where we've needed emergency contraception; whether the condom broke, we forgot a pill, lost track of our cycle, or something went wrong with an IUD.
What happens if a situation like this pops up after you've had a baby? In this article, we'll explore your options for contraception after having a baby — whether you need them in a hurry, or are looking at longer-term solutions.
What is the morning after pill?
The morning after pill is an emergency contraceptive taken to prevent pregnancy. In Australia, we generally have two types of pills available:
- a progestogen called levonorgestrel (LNG)
- ulipristal acetate (UPA)
Both are taken orally and you can usually get them over the counter from a chemist without a prescription.
The morning after pill isn't supposed to be used for ongoing contraception — but as a backup option when your other contraceptives might not have worked properly.
Because even the best laid (excuse the pun) plans can go awry!
Other pill options may sometimes be offered to you if the morning after pill isn't available or recommended.
But because levonorgestrel and ulipristal acetate are the main emergency contraception pills used in Australia, they're the ones we're going to check out.
Let's take a look at how they work:
How does emergency contraception work?
Most emergency contraceptive pills work by delaying or preventing ovulation, making it harder to fall pregnant after unprotected sex.
Depending on the pill type, there's different timelines for when they're at their most effective.
For example, LNG pills should be taken as soon as possible — within 72 hours of unprotected sex.
UPA pills can be effective for a bit longer (up to 120 hours or five days after unprotected sex), but it's still best to take them as soon as you can.
It's important to know that morning after pills don't work if ovulation has already occurred, or if you're already pregnant (2).
They also don't protect you from sexually transmitted infections/STIs.
If you might be pregnant, or aren't sure where you're at with your menstrual cycle, it's best to get some professional medical advice about which emergency contraception options are available to you.
Now, the big question: how well do they actually work?
How effective is the morning after pill?
Studies suggest that you've got the highest chance of becoming pregnant when you've had unprotected sex during the six days leading up to ovulation (1).
You're absolutely not alone if this is tricky to keep track of after having a baby!
Different types of emergency contraception all have different levels of effectiveness.
Most researchers agree that emergency contraceptive pills (both LNG and UPA) will prevent around two thirds of pregnancies, if they're used within 24 hours of having unprotected sex (1).
There are some factors that might affect how effective emergency contraceptive pills are, such as:
- The timing of when you take it
- Any existing medical conditions you have
- Other medications you might be taking
- If you've recently vomited or had diarrhoea
- If you've already ovulated or are pregnant (1)
Are there other options for emergency contraception?
There's one option we haven't talked about yet — the copper IUD.
The IUD is a small, T-shaped, copper intrauterine device; this means it's placed inside your uterus.
After it's been inserted, it releases copper to stop eggs implanting or being fertilised (4).
In terms of preventing pregnancy, doctors and researchers suggest that the copper IUD is the most effective type of emergency contraception.
This is because it has a toxic effect on sperm, and can be inserted up to five days after unprotected sex.
According to peer reviewed studies, less than one per cent of women who have a copper IUD inserted become pregnant.
The other benefit of the IUD is that it can be left in for longer term contraception (if you and your doctor decide on this).
We talked about myths earlier, so let's bust the main one you've definitely heard before: can breastfeeding prevent pregnancy?
Does breastfeeding work as contraception?
The answer is...sometimes. There's a fancy term that gets thrown around: lactational amenorrhoea.
This refers to when your period stops while you're breastfeeding.
If you're only breastfeeding your baby (e.g. not supplementing with formula or introducing solid foods), this can cause you to stop ovulating.
If you're not ovulating, you won't get pregnant or have a period.
If you're planning on using the lactational amenorrhoea method (LAM) to avoid pregnancy, there are a few things to know:
- It's only effective in the first six months after having your baby
- You have to be exclusively breastfeeding for it to work (e.g. not feeding baby anything else, breastfeeding every four to six hours)
- It's not effective if you're using breast pumps (6)
If you follow the LAM method to the letter, it can be really effective at preventing pregnancy— almost as effective as hormonal contraceptives.
But if your breastfeeding is slowing down, your period comes back, or your baby starts trying foods or formula — LAM isn't going to be a reliable method of contraception (6).
To get the most out of your breastfeeding journey, check out our Breastfeeding Essentials kit. It comes with everything you need to overcome the really common breastfeeding problems all women experience— it'll keep you breastfeeding for longer.
Do emergency contraceptive pills cause side effects?
There haven't been any long-term negative side effects reported for the emergency contraceptive pills we've mentioned, but you might experience some short-time side effects after taking them.
Things like headaches, nausea, stomach cramps, and changes to your period are all common after taking an emergency contraception pill.
If you throw up within two hours after taking the pill, make sure you get some medical advice; you might need to take another dose to make sure it works properly.
If you notice any symptoms that aren't going away after a few days, if your next period is noticeably different (late or much lighter), or if you get sudden pains in your lower abdomen— you should see your GP or other healthcare professional immediately (4).
Who can take the morning after pill?
There aren't many restrictions on who can use the morning after pill. Most women can safely take emergency contraception, even if they can't take other types of birth control pills (4).
There might be a few cases in which it isn't safe to take an emergency contraceptive pill, such as:
- If you're allergic to any of the ingredients
- If you have severe asthma
- If you're taking medications that might interact with the pill (including but not limited to St John's Wort, some epilepsy medicines, reflux/stomach acid medicines, some antibiotics) (4)
It's always a good idea to let the pharmacist or GP know of any medications you're taking, so they can let you know which option is the safest for you.
But what about if you're already breastfeeding?
Who can use the copper IUD?
Like with emergency contraception pills, it's safe for most women to use the copper IUD. There might be a few reasons why it isn't a suitable choice for you, though.
If you're experiencing an untreated sexually transmitted infection, pelvic infection, pain or discomfort in your uterus, or unexplained bleeding, the IUD might not be right for you.
If this is the case, chat to your GP about what birth control method they recommend.
The IUD has some side effects listed, which are rare, but important to know.
This might include pain, infection, the IUD coming out or heavier/more painful periods.
If you decide to keep your IUD in and experience any of these symptoms, you should seek immediate medical attention.
You also shouldn't have an IUD inserted if you think you might already be pregnant.
Is it safe to take the morning after pill while breastfeeding?
There's been a lot of research done on methods of contraception women use while breastfeeding, but most studies focus on the levonorgestrel emergency contraceptive pill (LNG).
Studies show that LNG is safe to take while you're breastfeeding, and won't have any negative effects on your baby or milk supply.
That means you shouldn't have to interrupt your feeds too much if you've taken it (1).
There isn't enough research to be able to tell whether UPA pills are safe to use while breastfeeding, so they're not currently recommended (unless there's no other option available) (4).
How long should you wait to breastfeed after taking the morning after pill?
The jury's still out on how you should time taking your emergency contraception pill if you're currently breastfeeding.
Some sources say you can keep feeding as normal (1), while others say you should pause breastfeeding for up to eight hours after you've taken levonorgestrel (7).
The one thing all the experts seem to agree on, though, is that if you've had to use a UPA pill — you should express and discard your breast milk for up to a week after the dose is taken (1).
How soon after having a baby can you get pregnant again?
We've talked about all the options for an emergency, but how soon should you actually be worrying about contraception?
Apparently it's possible to become pregnant within 21 days of delivering your baby! (1) It's possible to ovulate within three to four weeks postpartum (5), and pregnancy can happen earlier in women who aren't breastfeeding.
Studies also show that around half of people resume sexual activity within six weeks of giving birth (5).
It's important you don't feel pressured to have sex before you're ready, but if you are sexually active (and especially if you're not breastfeeding), it's a good idea to chat to your GP about longer term contraception.
What are the risks associated with pregnancies that are close together?
Just because you can get pregnant fairly early after having a baby, it doesn't mean you necessarily should.
The evidence suggests that shorter breaks between pregnancies can lead to negative outcomes for the baby— such as premature birth, slowed foetal growth, and low birth weight.
Most experts recommend waiting one to two years between pregnancies to give your body a break, and reduce the risks to the baby.
Because of this, it might be worth discussing family planning as soon as you feel up to it.
When should you start using contraception after having a baby?
Choosing the right contraception when you're postpartum can feel overwhelming, but it shouldn't be.
If you don't want more children right away, you should start exploring contraceptive options as soon as you can.
There will be some timings and recommendations to consider.
Fertility awareness methods (i.e. planning around your cycle) won't work until your period has come back.
Barrier methods can be prone to failing, and female condoms and/or diaphragms shouldn't be used before six weeks postpartum (8).
It's also not recommended to use the combined contraceptive pill (with both estrogen and progestogen) until after six weeks postpartum, because of the risk of a condition called venous thromboembolism— where blood clots can appear in your veins (8).
Again, it's really important to talk to your doctor or maternal health nurse about which medication or option is going to be best.
How to take the stress out of getting back on the pill
If you've explored your options and confirmed it's safe to go back on the contraceptive pill — let us do the rest of the work for you.
You've been out of the game for a while, so it's normal to feel worried about forgetting to take your pill or getting a new script. We're here to help.
Our Contraceptive Pill Subscription service is the easiest way to get the pill in Australia.
All you have to do is fill out a survey online, have a quick online consult with one of our practitioners, and we'll deliver your pill straight to your door. It even comes in a gorgeous sleeve — too pretty to forget!
Wherever you're at with your family planning journey, there's choices for you to explore. And if you need a little extra advice, our GPs are only a message away.
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