Many women who relied on oral contraceptives before starting a family feel at a loss when it comes time to think about birth control again. We believe that oral and injectable hormonal contraceptives should absolutely not be used by nursing mothers. The estrogens contained in oral contraceptives can dramatically diminish the quality and quantity of a mother's milk. We recommend against other hormonal forms of contraception as well. While low-estrogen hormonal contraceptives (such as progestin-only pills, implants such as Norplant, and injectable contraceptives such as Depo-Provera) do not have the same effect on milk supply as those containing estrogen, they can have adverse effects on your mood, and we do not know enough about what the progestins may do to the baby. We generally advise against the use of hormonal contraceptives in any case. They block your body's natural production of progesterone and can increase your lifetime risk of developing breast cancer.
What forms of contraception can work in harmony with nursing? In the first six months, mothers who breastfeed exclusively and on demand no nipple substitutes, no bottles are highly unlikely to become fertile again. However, if you are absolutely against becoming pregnant again so soon, use a barrier method of contraception such as a condom, diaphram, or cervical cap whenever you have intercourse, just to be safe. Of course, if you are not exclusively demand-feeding your baby, you could become fertile much sooner. Choose a nonhormonal method such as the intrauterine device (IUD), condoms, diaphragm, spermicide, or cervical cap.
Once your menstrual cycle returns and becomes regular, you can begin to track your fertile periods. The rhythm method does work very effectively if you carefully track your monthly ovulation, using body temperature and vaginal mucus to identify the time of ovulation, and use contraception or abstain during the fertile period that follows. This is the most natural way to avoid pregnancy and puts you in greater touch with your fertility. Dr. John Lee recommends the use of a small, lipstick-sized microscope called an Ovu-Tech that allows you to view your saliva. Specific changes in the saliva help you to know when you are fertile.
Maybe you are feeling, "I'd rather abstain, thank you very much." Many women complain of lack of sex drive postpartum. Very low progesterone and estrogen levels during the breastfeeding period can cause vaginal dryness that makes intercourse painful. After long days of baby care, some women feel "touched out" and do not want more physical closeness, even with their spouses. This can cause a partner to feel hurt and rejected, and resulting disagreements over sex can create unpleasant rifts at a time when you genuinely need each other's support. The most important thing to do is keep the lines of communication open. Talk to one another about your feelings and wishes. Keep in mind that if your libido is low, your body is telling you it's not the right time for intercourse. You and your mate might try to find some other way to express your love for each other.
Many women feel stressed out by their partners' pressure on them to have intercourse when it is literally the last thing on their own priority list at least a few notches below ten more minutes of sleep. Do not be afraid to stand up for yourself on this one. It is easy to underestimate the added burden that this kind of spousal pressure creates on an already harried nursing mother. If this is a constant source of conflict, consider seeing a counselor together so that you can reach an agreement that works for both of you. For most women, libido returns naturally within a year after giving birth, and usually to some extent within about six months. Having your hormone levels checked, and using supplemental progesterone if necessary, may bring back your libido sooner.
Although there are many pharmaceutical drugs that should not be used while breastfeeding, there are some natural remedies, including herbs, that can be effective and safe for both you and your baby.