After giving birth, women require contraception after day 21.

Progestogen-only pill (POP)

• the FSRH advise 'postpartum women (breastfeeding and non-breastfeeding) can start the POP at any time postpartum.'
• after day 21 additional contraception should be used for the first 2 days
• a small amount of progestogen enters breast milk but this is not harmful to the infant

Combined oral contraceptive pill (COCP)

• absolutely contraindicated - UKMEC 4 - if breastfeeding < 6 weeks post-partum
• UKMEC 2 - if breastfeeding 6 weeks - 6 months postpartum*
• the COCP may reduce breast milk production in lactating mothers
• should not be used in the first 21 days due to the increased venous thromboembolism risk post-partum
• after day 21 additional contraception should be used for the first 7 days

The intrauterine device or intrauterine system can be inserted within 48 hours of childbirth or after 4 weeks.

Lactational amenorrhoea method (LAM)

• is 98% effective providing the woman is fully breast-feeding (no supplementary feeds), amenorrhoeic and < 6 months post-partum

An inter-pregnancy interval of less than 12 months between childbirth and conceiving again is associated with an increased risk of preterm birth, low birth weight and small for gestational age babies.

• this changed from UKMEC 3 in 2016