Contraception after birth and while breastfeeding: when fertility returns and which method to choose

Sooner than many people expect. The NHS, the UK's public health service, says you can get pregnant as early as 3 weeks after the birth, even if you are breastfeeding and your periods have not come back. Ovulation, the release of an egg, comes before a period, so your first fertile ovulation can happen before you see any bleeding. The World Health Organization (WHO), in its medical eligibility criteria for contraceptive use (MEC), notes that ovulation before the first period after birth is common.

According to the WHO, the risk of pregnancy in the first 21 days after birth is very low, but it rises after that in women who are not breastfeeding. That is why the UK FSRH guidelines (Faculty of Sexual and Reproductive Healthcare) advise contraception from day 21 after the birth for anyone who wants to avoid pregnancy, unless they meet all the criteria of the lactational amenorrhoea method (LAM). The WHO family planning handbook gives a different frame: a woman who is not fully or nearly fully breastfeeding can become pregnant as soon as 4-6 weeks after the birth. The most cautious approach is to take the earlier of these limits, 3 weeks.

When your periods return depends mainly on how you feed your baby. We cover this in our article on how long the postpartum period lasts. The WHO handbook advises not waiting for bleeding to return before starting contraception, but starting as soon as the guidance for a given method allows. It is easiest to talk about it with a doctor or midwife while you are still pregnant or in the first weeks after the birth.

Frequent breastfeeding temporarily suppresses the hormones that trigger ovulation. The lactational amenorrhoea method (LAM, in Polish metoda laktacyjnej niepłodności) means using this effect deliberately. The WHO stresses that it only works when all three conditions are met at the same time:

• Your periods have not returned. The NHS points out that any bleeding counts, even spotting.
• You are fully or nearly fully breastfeeding. According to the WHO handbook, “nearly fully” means that more than three quarters of the baby's feeds are breast milk.
• Your baby is under 6 months old.

The WHO handbook recommends feeding on demand, with gaps of no more than 4 hours during the day and no more than 6 hours at night. When the conditions are met, about 2 in 100 women become pregnant in the first 6 months after birth with typical use, and fewer than 1 in 100 with fully correct use. The only study of LAM among women working away from home estimated about 5 pregnancies per 100 women over 6 months.

The NHS advises switching to another method when your baby turns 6 months, has anything other than breast milk, your periods return, you stop night feeds or the gaps between feeds get longer. According to the NHS, expressing milk may make LAM less effective, although it is not known by how much. The NHS Lanarkshire guideline, based on the FSRH recommendations, also lists dummies as something that can weaken the method.

Sources differ on the details. Prof. Violetta Skrzypulec-Plinta, writing for Medycyna Praktyczna (a Polish medical publisher), describes the conditions more loosely (up to two drinks of water or juice and one formula feed a day), counts bleeding as a period only after day 56 after the birth, and says protection is usually assumed for the first 12 weeks, or up to 14 weeks according to some authors. The WHO and the NHS speak of 6 months. The WHO adds that if pregnancy would be a serious health risk for you, LAM may not be suitable, because its failure rate with typical use is relatively high. LAM does not protect against sexually transmitted infections.

The WHO rates each method in four categories: 1 means no restriction, 2 means the advantages generally outweigh the risks, 3 means the risks usually outweigh the advantages, and 4 means an unacceptable health risk. According to the FSRH, progestogen-only methods have no adverse effects on lactation or on the baby's growth and development. In its 2025 edition the WHO reviewed 61 studies and found no consistent negative effect of these methods on the start of lactation, milk supply, breastfeeding duration or the baby's growth.

Category 2 is not the same as 1. The WHO notes that the evidence on premature and low birth weight babies is limited, and the studies did not include women at risk of breastfeeding difficulties. If you have problems with milk supply or your baby was born early, mention it when choosing a method. You make the final decision together with a doctor or midwife, taking into account your health, how the birth went and how long you want to delay another pregnancy.

A copper or hormonal coil is fitted in one of two windows. The first is the 48 hours after the birth, ideally straight after the placenta is delivered. According to the NHS Lanarkshire guideline based on the FSRH recommendations, this applies both to a vaginal birth and to an uncomplicated caesarean. The second window opens 4 weeks after the birth. Between 48 hours and 4 weeks the WHO generally advises against fitting a coil (category 3), and with a postpartum infection of the uterus it should not be fitted at all (category 4).

• According to the WHO, the risk of the coil coming out (expulsion) is lower when it is fitted immediately after the placenta than when it is fitted some days later, and a coil fitted during a caesarean comes out less often than one fitted straight after a vaginal birth.
• According to the WHO, the risk of perforating the uterus and of infection does not increase whenever in the postpartum period the coil is fitted.
• Breastfeeding increases the relative risk of perforation during fitting, but the absolute risk stays low. The FSRH reports that in breastfeeding women up to 36 weeks after the birth it was about 6 per 1,000 fittings in a large European study.

Having a coil fitted straight after the birth requires discussion and consent beforehand, so if you are considering it, ask the hospital where you plan to give birth while you are still pregnant. If you had a caesarean, we write about wound healing in our article on recovery after a caesarean, and after a vaginal birth in our article on perineal healing. In Poland a coil is fitted by a gynaecologist.

Combined pills, patches and vaginal rings contain oestrogen. After birth they are postponed for two reasons. The first is blood clots. The WHO explains that the risk of venous thromboembolism is raised in pregnancy and after birth, highest in the first 3 weeks and back to near normal levels by day 42. Oestrogen adds to that risk. The second reason is breastfeeding: according to the WHO, studies of combined methods and breastfeeding give conflicting results, no consistent effect on the baby's growth has been found, but the studies were not designed to rule out long-term effects.

Recommendations differ by source:

• If you breastfeed, according to the NHS and guidance based on the FSRH: usually wait at least 6 weeks after the birth and discuss the choice with a doctor.
• If you breastfeed, according to the WHO: combined methods are contraindicated before week 6 (category 4), generally not recommended from week 6 to month 6 if the baby is mainly breastfed (category 3), and acceptable from month 6 (category 2).
• If you do not breastfeed: the NHS allows combined methods from 3 weeks after the birth if a healthcare professional confirms you have no risk factors for blood clots. With such risk factors the NHS Lanarkshire guideline based on the FSRH advises waiting 6 weeks, and the WHO rates them category 3 or 4 until day 42.

The WHO lists these risk factors for blood clots after birth: immobility, blood transfusion at delivery, BMI over 30, postpartum haemorrhage, the period straight after a caesarean, pre-eclampsia and smoking. If any of them applies to you, your doctor may suggest a method without oestrogen. If you notice your milk supply dropping after starting any hormonal method, contact a midwife or lactation consultant. We describe how lactation settles in the first weeks in our article on milk coming in.

According to the FSRH, emergency contraception is not needed in the first 21 days after the birth, and for women who meet all the LAM criteria it is not needed for 6 months after the birth. After that, or earlier if any LAM criterion stops applying, it is used as usual.

• Levonorgestrel: the WHO places no restriction on it while breastfeeding (category 1), and the FSRH says limited evidence shows no adverse effects on breastfeeding or the baby, so you can carry on breastfeeding.
• Ulipristal acetate: here sources differ. The 2025 WHO edition advises not breastfeeding for a week after taking it, expressing and discarding milk during that time (category 2). The FSRH, in its guideline updated in 2026, considers that no break is needed after a single dose, because in the only study the amount in breast milk was negligible. Agree what to do in your situation with a doctor, midwife or pharmacist.
• Copper coil as emergency contraception: according to the NHS Lanarkshire guideline based on the FSRH, it can be used from day 28 after the birth.

In Poland emergency contraception is available only on prescription. It is prescribed by a doctor, and since 15 June 2024 the pill with ulipristal acetate can also be prescribed by a midwife who holds independent prescribing rights. In pharmacies taking part in a Ministry of Health pilot programme, a pharmacist can issue this prescription after a consultation with a patient aged 15 or over, no more than once every 30 days. According to the Ministry of Health the pilot has been extended to 30 June 2028; the list of pharmacies is kept by NFZ (the National Health Fund) and can be checked on pacjent.gov.pl. Say that you are breastfeeding at the appointment.

Fertility awareness methods, based on observing signs of fertility, are harder after birth. The WHO says they may be less effective while breastfeeding. In women who are exclusively breastfeeding and have no periods, signs of fertility usually do not appear in the first 6 weeks after the birth, but the chance of fertility returning grows with time and as other foods are introduced.

• According to the WHO, the first cycles after birth in breastfeeding women vary a lot in length, and it takes several cycles for them to become regular.
• According to the WHO, a symptoms-based method (for example observing cervical mucus) can be used once you notice signs of fertility.
• The WHO allows the calendar method only after at least three periods since the birth and once your cycles are regular again.
• Until then the WHO advises using a barrier method, such as condoms.

Prof. Violetta Skrzypulec-Plinta, writing for Medycyna Praktyczna, points out that the first period may be preceded by ovulation, so she advises watching for changes in mucus, cervical position and temperature. The NHS Lanarkshire guideline based on the FSRH notes that these methods are difficult to use accurately after birth and while breastfeeding. If you want to use them, it is worth learning them with someone who knows how cycles behave after birth.

The WHO recommends waiting at least 24 months after a live birth before trying for another pregnancy, to reduce the risk of adverse outcomes for the mother, the pregnancy and the baby. The NHS gives a gentler limit: waiting at least 12 months is usually recommended, because an earlier pregnancy may increase risks such as low birth weight.

These are general recommendations, not a ban. If you plan your next pregnancy sooner, for example because of your age, or you have had a caesarean or complications, talk about the gap between pregnancies with your doctor. It is worth matching your contraception to how long you want to delay pregnancy.

You usually choose a method with a gynaecologist. You do not need a referral to see a gynaecologist and obstetrician on NFZ, which follows from the Polish act on publicly funded healthcare. The perinatal care standard provides that the POZ midwife (the primary care midwife funded by NFZ) tells you about the need to see an obstetrician after the postpartum period ends, that is 6 weeks after the birth. This check-up is usually booked around 6-8 weeks after the birth and is a good moment to talk about contraception, but if you need a method earlier, for example from day 21, book sooner or ask while still in hospital.

A midwife has a defined scope in contraception:

• Education. Under the perinatal care standard, the POZ midwife provides education during home visits on topics including the return of fertility after birth and family planning methods. The Polish act on the nursing and midwifery professions lists education on family planning methods among a midwife's tasks.
• Emergency contraception. A midwife with a master's degree in midwifery or a specialist title who has completed a prescribing course, or gained this knowledge during her training, can independently prescribe medicines from the Minister of Health's list (art. 15a(1) of the act on the nursing and midwifery professions). Since 15 June 2024 the list for midwives includes ulipristal acetate, the morning-after pill. No other contraceptives are on this list.
• Continuing treatment. A midwife with at least a bachelor's degree and a prescribing course can issue a prescription for a medicine needed to continue treatment previously ordered by a doctor (art. 15a(2)), excluding medicines containing very potent substances, narcotics and psychotropic substances. Whether this applies to your product, the midwife will assess based on your medical records.
• Coil and implant. The regulations listing what a midwife may do independently without a doctor's order do not include fitting a coil or an implant. In Poland this is done by a doctor.

Not every midwife can prescribe, because the right depends on her education and completed course. If you want a prescription from a midwife, ask about it when booking.

The list of reimbursed medicines changes several times a year, so check the current price of a specific product at the pharmacy. If after the birth you want to talk about returning fertility and choosing a method at home or online, on MyMidwife you will find midwives who offer postpartum visits. A midwife can help you prepare questions for your gynaecologist and check whether the chosen method fits with breastfeeding.