The average Canadian woman loses her virginity at 16, has 1.6 kids, and hits menopause around 51. Barring problems with fertility, let’s do some quick math (we’ll give her a bit of a postpartum break, and trim that poor sixth of a kid down to a half while we’re at it): We spend about three decades trying to not get pregnant. Now that you’re a mom, there are more than enough obstacles to sex—your birth control method doesn’t need to be another. And as a busy parent, it’s more important than ever to have a reliable, no-fuss way of managing how many more babies you have—and when.
“One thing we ask every patient is, ‘How important is it for you to not be pregnant right now?’” says Nicole Pasquino, a registered nurse certified in reproductive health and a professional practice leader at Options for Sexual Health in Vancouver. Then it’s a question of what you’ve tried—both successfully and unsuccessfully—in the past, and what your thoughts are about the different options: Maybe condoms are too much of a hassle, or you felt depressed on the pill, or the idea of an IUD completely freaks you out. You also need to consider the future: How many more kids do you want to have? Is this a temporary situation, or are you looking for a more permanent solution?
“There really is a contraception method for everyone,” Pasquino says. (Or two—you can always double up!). Here are five moms who have found their fit.
Past methods: NuvaRing, the pill, condoms Current status: Too sleep-deprived to remember to take the pill.
What is it? The intrauterine device’s huge resurgence in Canada is showing no signs of slowing down, says Pasquino. So why is it so popular? It’s a set-it-and-forget-it form of contraception that doesn’t impact your fertility afterwards—a way of easily hitting pause on the baby making or stopping it altogether. Quarter-sized and T-shaped, the IUD is inserted into your uterus by your health-care practitioner (it may pinch or be uncomfortable for a minute or two). They come in two basic types: copper ones, which can stay inside for up to 10 years, and inter-uterine systems (IUS) such as Mirena and Jaydess, which contain levonorgestrel, a synthetic form of progestin, and can stay in for five years. Both types are 99 percent effective and work by changing the chemistry of your uterus, making it inhospitable to sperm.
Why she loves it: “I chose an IUD because my research told me it was more effective than other methods, and I went copper over hormonal because both of my attempts to take the pill left me feeling depressed. (I don’t know for sure that it wasn’t just coincidental, but I figured since there was a non-hormonal option, why not go for it?) I had a copper IUD before having my son and got my second put in about a year after he was born. I’m really happy with it. I had heavier periods and some cramping for about a year with the first one, but after that it was totally normal. With this one, my periods seemed normal right off the bat. And it’s so great not to have to remember to take a pill. I don’t think I could be counted on to do that these days!”
Is it right for you? It is if you want a simple way to not make babies. “IUDs are worry-free, very safe, long-lasting, effective and discreet,” says Pasquino. Copper IUDs are also effective as emergency contraception—unlike Plan B, which needs to be taken within five days (and becomes less effective the longer you wait), an IUD can be inserted up to seven days after unprotected sex. And while some experts advise waiting six weeks postpartum to allow your uterus to return to its normal size before having one inserted, IUDs can be put in immediately after giving birth. Pilot programs are currently underway to develop practice recommendations for this, Pasquino says.
Is it wrong for you? It is if the idea of hosting a foreign object in your uterus freaks you out. “If you’re uncomfortable with the idea of having something in there, you’ll want it out within six months,” says Erika Feuerstein, staff clinician at the Bay Centre for Birth Control at Women’s College Hospital in Toronto. “Every twinge or cramp will make you think something’s wrong.”
Past method: Condoms Current status: Really can’t get pregnant right now.
What is it? The pill is still, hands-down, the most popular form of birth control in North America, and it’s 99 percent effective when used perfectly. (Typical use, though, brings that number down to 85 percent.) There are many types available, with varying levels of different synthetic hormones, but all prevent pregnancy in much the same way: by stopping ovulation.
Why she loves it: “I went on the pill for the first time at 26, after having my first child. I knew I didn’t want to use condoms anymore, but thinking about inserting contraptions into my vagina made me feel weak. I was happy with the pill right away. I went off the pill when I moved away from that doctor, and before I managed to get a new prescription—surprise!—I got pregnant. After my second child was born, I went back on it. It’s easy and non-invasive. I’ve never noticed any emotional or physical side effects—and I love not getting pregnant!”
Is it right for you? The pill is ideal if you’re looking for a hormonal method of contraception and can remember to take it every day. If you want a bit more freedom but like the efficacy of the hormone combo, look into the NuvaRing, which you insert into your vagina and keep there for three weeks a month, or the Evra transdermal patch, which you change every week. And while breastfeeding moms were once told they had to settle for the progestin-only mini pill to keep it from interfering with their milk supply, that’s not true anymore: “By six weeks postpartum, once breastfeeding has been well established, women can go on the pill,” says Pasquino. If you want to conceive again, it might take a full cycle for menstrual bleeding to return.
Is it wrong for you? If you’ve already tried three or four different brands and you still have side effects, such as spotting, nausea, weight gain, and moodiness, then it’s not the method for you,” says Feuerstein. It’s also a no-go for women over 35 who smoke or who have migraines, because of an increased risk of blood clots. Otherwise, she says, you can safely stay on the pill until menopause.
Past methods: Plan B, condoms Current status: In tune with her body.
What is it? Also known as the rhythm method, the fertility awareness method (FAM) involves keeping very careful track of your cycle by closely monitoring your temperature and cervical mucus, and using a calendar to avoid sex on your most fertile days. If done perfectly, it’s 95 to 98 percent effective, but it’s 75 to 88 percent effective with typical use—so double up with condoms if you really don’t want to get pregnant.
Why she loves it: “I’ve been using a period tracker app for about five years now (I used to just use a calendar, as we didn’t have apps then!). I also monitor discharge, bloating, breast tenderness and cramps. We use condoms and withdrawal when I’m ovulating.”
Is it right for you? It’s a good fit if you’re looking for an all-natural form of birth control, and if it’s not the end of the world if you get pregnant. In fact, you probably are already practising it in some way, points out Pasquino. “Many women are pretty used to tracking their periods.” If you want it to be more effective, use a backup method.
Is it wrong for you? Skip it if your cycle—or brain—is all over the place. Effective FAM requires a regular period and strict attention to detail: Your temperature taking, for example, must happen before you even get up to pee in the morning. And remember, so many things—including stress—can throw your cycle off, says Feuerstein.
Past method: The pill Current status: Two kids and done.
What is it? A permanent form of birth control in which your Fallopian tubes are cut, cauterized or blocked.
Why she loves it: “When our second baby was two, we knew it was time to close shop. I chose to have my tubes clipped. My husband was willing to have a vasectomy, and everyone said he should be the one to do it, since I’d had two C-sections plus a D&C after a miscarriage. But I wanted to be in control of my body’s ability (or inability) to get pregnant. I’m a Type 1 insulin-dependent diabetic on a pump, and because of my diabetes, everything in my life has had to be so strategic. The tubal was a way of me being in control of this body that tries to control me. It was very easy—they went in laparoscopically through my C-section scar and my belly button—and the pain was minimal. I was just weak and tired for about a week.”
Is it right for you? It is if you’re done—really done—and your partner is resistant to having a vasectomy. Fewer women are opting for tubals, though, in favour of less-invasive and less-permanent IUDs: “Often women come in to consult about having a tubal ligation and leave with more information and an appointment to have a Mirena put in,” says Feuerstein.
Is it wrong for you? If you have even the slightest remaining desire to have another baby, this irreversible surgery is not for you.
Past methods: Condoms, the pill Current status: Her partner was ready to step up.
What is it? A simple 20-minute procedure, using local anesthetic, in which the vas deferens (the tubes that sperm use as a way out of the scrotum) are snipped. This keeps sperm out of the seminal fluid, leaving them to be absorbed by the body. The “no-scalpel” procedure, said to result in less pain and complications, uses one single puncture to the scrotum and doesn’t require stitches. Recovery time varies, but most men are back to their normal activity level in a few days. The procedure does not affect a man’s hormones or sex drive. Vasectomy is nearly 100 percent effective, though not immediately—a semen analysis is done about three months later to confirm success.
Why she loves it: “We agreed he’d get a vasectomy after our son was born, even though I was the tiniest bit weepy about closing the door. He never, ever admitted to being scared before or during the operation. There was a twinge of fear on my part that his bits might be too sore to play sports or ride his mountain bike, but no: After a few hours of sitting with a bag of frozen peas in his lap, he was ready to roll. But the first time we had sex after the procedure was a whole other matter. He was tense. He’d convinced himself that the experience would be different somehow or that he wouldn’t be able to do it at all. But it was fine. Everything worked perfectly.”
Is it right for you? It is if you feel like it’s his turn to be in control of contraception—and he’s willing, of course.
Is it wrong for you? If there’s even the slimmest chance you may want another baby, look at other options. Reversal is possible in some cases, but it’s expensive (around $5,000) and is not guaranteed to restore his fertility.
The lactational amenorrhea method is an effective (98 percent) form of birth control for the first six months postpartum, but it comes with strict guidelines: “You need to be exclusively breastfeeding—not pumping, as it releases different hormones—every four hours during the day and every six hours at night,” says registered nurse Nicole Pasquino. After six months, even if you’re exclusively breastfeeding, your fertility may return
A version of the article appeared in our July/August 2015 issue with the headline, "In control," p. 35-8.
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