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Birth Control Choices

Find out how to delay expanding your family again.

In the first few months after you have a baby, sex may be the last thing on your mind, so birth control is something you're not even thinking about. But you'll need to consider it soon, because you may be fertile four weeks after giving birth if you're not breastfeeding. Moreover, while breastfeeding may delay the return of your period, it does not prevent ovulation, so it can't be counted on as a reliable form of birth control.
The method of contraception you used before the baby may no longer work with your new lifestyle--and body. Women may need different methods for different phases of their lives, notes Kirtly Parker Jones, MD, associate professor of obstetrics and gynecology at the University of Utah. The most important thing is to choose a contraceptive method that you'll use effectively.

Every option has its pros and cons. The statistics on effectiveness listed here are broken down in two ways: "perfect use" and "actual use." The greater the disparity between the two numbers, the harder time you're apt to have using the method correctly. Here's a rundown of what's available.

Surgical Procedures

Tubal Ligation (for women)

Effectiveness: 99.9%

Cost: $1,000 to $2,500

Benefits: Tubal ligation, in which the fallopian tubes have a portion cut out and are then tied so that the eggs never meet the sperm, is the most popular form of birth control for women in the United States. According to 2001 data provided by the Centers for Disease Control and Prevention, this procedure is used by 18 percent of American women, compared with the 17 percent who rely on the pill. Tubal ligation can be done as early as a day after a woman gives birth. It can also be performed as part of a cesarean delivery.

Drawbacks: Any surgical procedure involves inherent risks. Tubal ligation is meant to be a permanent form of birth control. If there is a chance you may want to have another baby, you should not choose this method.

Vasectomy (for men)

Effectiveness: 99.9%

Cost: $700 to $1,000

Benefits: In a vasectomy, the vas deferens--the tubes that transport sperm from the testicles to the penis--are clipped shut or cut. Vasectomy is a good option for couples who don't want another child and opt for sterilization but are looking for a less invasive surgery than tubal ligation. It requires only local anesthesia, can be done on an outpatient basis, and has fewer risks of complications.

Drawbacks: It's difficult to reverse. Most doctors recommend that couples use backup contraception for six weeks after the procedure.

Hormonal Methods

The Pill

Effectiveness: Perfect use: 99.5%; actual use: 95%

Cost: $25 to $35 a month

Benefits: There's a reason the pill is the most popular reversible contraceptive among U.S. women: It's dependable, it offers relief from menstrual woes such as heavy bleeding and cramping, and studies have shown that it reduces the risk of ovarian cancer.

Drawbacks: The pill offers no protection against STDs and HIV. Women who smoke or who have high blood pressure or a heart condition are advised not to take the pill due to increased risk of blood clots and heart attack. Combination pills that contain estrogen can suppress milk supply during lactation. You must remember to take the pill every day.

What's new: Ortho-Micronor, the first birth control pill for breastfeeding mothers, was recently introduced in the U.S. Unlike other forms of the pill, it's a progestin-only pill, so it won't interfere with lactation. It can be taken as early as six weeks after delivery. It may increase milk supply during lactation.

IUD

Effectiveness: Perfect use: 99%; actual use: 97%

Cost: About $500, including insertion and removal

Benefits: No need to fuss with contraception. An IUD is a small plastic or copper-based device placed in the uterus by a health-care professional. The ParaGard Copper-T IUD is inserted into the uterus, providing convenient, prolonged protection until its removal. The Progesterone-T IUD, which also reduces cramps and lightens menstrual flow, is effective for one year.

Drawbacks: Insertion of an IUD can be slightly uncomfortable. Copper-T IUDs may cause heavy bleeding and cramping in some women. IUDs provide no protection against STDs and they aren't recommended for women who have one or are at risk. This method is not recommended for women who have never had a child.

What's new: Mirena, a new five-year IUD, was introduced and approved by the FDA in early 2001. Mirena releases small amounts of levonorgestrel (a hormone commonly found in the pill) every day to prevent pregnancy. It's made from flexible plastic, making insertion and removal much easier than with the traditional copper-based IUD.

Depo-Provera Injection

Effectiveness: Perfect use: 99.7%; actual use: 98.7%

Cost: $48 to $58 an injection (needed every three months), plus cost of office visit

Benefits: This progesterone-based injection provides long-lasting protection with only four shots a year; one injection of Depo-Provera will last for 12-14 weeks.

Drawbacks: Injections need to be administered by a health-care professional. Return to fertility after ending use of Depo-Provera can take as long as nine months. Recent studies have shown that taking Depo-Provera for a prolonged period may be a serious risk factor for osteoporosis. This injection offers no protection against STDs; some undesirable side effects may include irregular periods, weight gain, dizziness, or headaches.

Nonhormonal Methods
Male Condom

Effectiveness: Perfect use: 97%; actual use: 86%

Cost: 25 to 50 cents each

Benefits: Available over the counter. If you have postpartum endometriosis, an infection of the uterine lining, using condoms can prevent bacteria from being introduced into the vagina.

Drawbacks: Male condoms can tear or slip off. Condoms that contain spermicide may cause vaginal irritation. The male has to be willing to use the condom.

Diaphragm

Effectiveness: Perfect use: 94%; actual use: 80%

Cost: $13 to $25 for the device; less than $10 for spermicide

Benefits: This is an easily reversible method that doesn't require extra hormones.

Drawbacks: Since many women don't use the diaphragm correctly, reported failure rates are high. Prior to use, women must be fitted by their physician to receive a custom-size diaphragm. Since childbirth can affect a woman's diaphragm fit, resizing should be done prior to resuming intercourse after pregnancy. May women find diaphragms inconvenient or difficult to insert. Diaphragms also have been linked to increased rates of bladder infection.

Female Condom

Effectiveness: Perfect use: 95%; actual use: 79%

Cost: $3 each

Benefits: The female condom fits inside the vagina, with its outer edges covering the woman's external genitalia to prevent contact between the penis and the vagina. It is sold without a prescription and can be purchased at most drugstores. Women don't have to rely on a man's willingness to use a condom. It also protects against STDs and HIV.

Drawbacks: The female condom can be tricky to use and may slip during intercourse if not inserted correctly.

Vaginal Spermicide

Effectiveness: Perfect use: 94%; actual use 74%

Cost: Less than $10 a tube

Benefits: Spermicides add lubrication, helpful for new and nursing moms who may be experiencing dryness. They're available without a prescription.

Drawbacks: Some people are allergic to certain types of spermicides. Used alone, they are not as effective as other methods.

What's new: Vaginal contraceptive film has been introduced in recent years as a more convenient form of spermicide. A square of film is pushed high into the vagina. Inside the body, the film dissolves (after a 15-minute waiting period) and is effective for 45 minutes.

Fertility Awareness

Effectiveness: 75% to 99%

Cost: Free, though experts strongly suggest that all couples take a course of instruction. Courses may be offered at local branches of Planned Parenthood. It's important that family-planning classes be taught by certified instructors.

Benefits: By charting changes in body temperature, cervical mucus, and other signs of ovulation, women can plan the size of their family. Women who are familiar with this method can also use it to conceive a baby.

Drawbacks: Requires absolute dedication from both partners, organized record-keeping, and restraint during fertile periods.

Your Newest Options
The Patch (Ortho-Evra)

Effectiveness: Perfect use: 99%; actual use: 99%

Cost: $25 to $35 a month for a package of three (a one-month supply)

Benefits: Ortho-Evra, the first birth control patch, prevents pregnancy by delivering continuous levels of hormones through the skin and into the bloodstream. Each patch is applied by the user and lasts for one week. Women should use one patch each week for three weeks and then go patch-free the fourth week, during their menstrual period. The patch can be worn on any one of four areas, including the upper torso, buttocks, abdomen, or upper arm. It's resilient and remains effective while you're bathing, swimming, or exercising.

Drawbacks: Ortho-Evra can only be obtained with a prescription from your physician. It doesn't protect the user against HIV or other STDs. Women who smoke or have a heart condition are advised not to use the patch due to increased risk of blood clots and heart attack. As with the pill, side effects can include headaches, upper respiratory infections, and abdominal pain.

NuvaRing

Effectiveness: Perfect use: 98%; actual use: 98%

Cost: $35 to $45 a month

Benefits: NuvaRing is a flexible, transparent, 2-inch ring that provides women with monthlong contraceptive protection. A new ring is inserted into the vagina every month for three weeks (then removed for the fourth week) to provide a continuous flow of hormones, preventing pregnancy.

Drawbacks: NuvaRing does not protect against HIV or other STDs. Side effects of the ring may include headaches, weight gain, dizziness, and break-through bleeding in some users. Some women may consider the purchase and insertion of a new ring every month an inconvenience.

Emergency Contraception

Preven

Effectiveness: Perfect use: 100%; actual use: 98%

Cost: $30 to $40

Benefits: Preven, also commonly known as the "morning-after pill," is the first FDA-approved product for emergency contraception. This pill can prevent pregnancy after a known or suspected contraceptive failure, or after sex without birth control. Preven, which contains estrogen, can be taken within 72 hours of unprotected sex, but is most effective within the first 24 hours. Two doses of two pills each are given at 12-hour intervals. It acts as a large dose of birth control pills, which stops or delays ovulation in the aftermath of unprotected sex.

Drawbacks: It's available only by prescription from a doctor or other health-care professional.

On the Horizon
Lea Shield

Awaiting FDA approval later in 2002, the Lea Shield is a cup-shaped bowl that works by completely surrounding the cervix without resting on it. The device acts as a barrier to sperm, with additional spermicide recommended as a supplement. Unlike the diaphragm, the Lea Shield does not require individual fitting--one size fits all. However, similar to the diaphragm, the shield must be left in place for at least eight hours after intercourse.

Electronic Fertility Computers

Small electronic computers, which tell a woman which days she's ovulating, are becoming widely available in Europe and Canada. Clinical trials are being conducted in the U.S. to obtain FDA approval, but such devices are currently not on the market.

Advantage 24 Spermicide

This spermicidal gel provides up to 24-hour protection from pregnancy. The gel bonds to the mucus of the vagina, reducing the messiness of leakage. Advantage 24 is now widely available in Canada and Europe and was recently submitted for FDA approval in the U.S.

Your should know:

The information on this Web site is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.