If you do a Google search for “Essure birth control,” the first hit is the Essure official site and the second joins you to be a part of the law suit against it. Probably not the best sign. In theory, the Essure device sounds pretty good – a permanent birth control for people with internal female anatomy that doesn’t rely on hormones, nor requires surgery to implant the device. How it works: the tiny device in inserted into the fallopian tubes where it stays and the body creates scar tissue around it, blocking the path the ovum (egg) would take from the ovaries through the fallopian tube to the uterus. If the path is blocked, the egg can’t be fertilized, no more babies. The problem is that the side effects have been numerous and severe, such as heavy bleeding, abdominal and back pain, allergies to the device (it is nickel), hysterectomies to remove the device, and pregnancy. I’m a little confused because when I first heard of this device my first thought was, scar tissue is bad – how is creating scar tissue going to be a good thing? The FDA has reviewed the client testimonies plus other feedback and concluded that the device “should be cataloged as a surgical procedure on its product labeling. Also, the device should come with better instructions and guidelines for its proper use.” And maybe that people should be advised to look into a different form of birth control?

There are many types of birth control out there, some more available than others, some more expensive than others. I’m not going to jump into the debate going on about Planned Parenthood right now (#istandwithpp) because I want to stay focused on these birth control options instead. Specifically, the options for people who have had a baby and may be breastfeeding, because this group is sadly limited.

These sites have a great list of the options, how they do their job, how they are used, and how effective they are at preventing pregnancy. The basic breakdown is this:

• Barrier methods: condoms, diaphragm, cervical cap (must be re-fitted if you had one prior to getting pregnant), sponge – these are pretty good but you gotta remember to use them!
• IUDs: a device that is inserted into the uterus for long term pregnancy prevention – there is a hormonal (progesterone only), and non-hormonal option
• Natural family planning and pulling out: these can work but keep this in mind, after you give birth you don’t know when your menstruation will return and we ovulate before we menstruate. This means you may be fertile and can get pregnant again before you get the signal from your body in the form of your period that your cycles have returned. Plus, while breastfeeding, your cycles may not be regular for many months.
• Exclusively breastfeeding: while it’s true that for some people exclusively breastfeeding can prevent ovulation and regular menstruation from occurring, it is not true for everyone. Like I said above, you ovulate before you menstruate so you don’t know when you will be fertile. The exclusive breastfeeding form of birth control can be good for the first 6 months after birth, you need to continue to breastfeed around the clock, and you cannot have already started menstruating.

Above is a handy chart of the menstrual cycle, which begins with the first day of your menstruation (bleeding). It is the follicular phase, from Day 1 to ovulation, that is usually the most variable, especially after the birth when your cycles have not returned to normal. So you could have your first period after the birth and expect to ovulate a couple weeks later but either you haven’t begun ovulating yet, or you will ovulate later. You just don’t know. This is how “Irish Twins” happen – babies that are less than a year apart in age, possibly from unintentional pregnancy with the second. You may get signals that you are ovulating, like increased sexual desire, increased fertile mucous, or a softer feeling cervix, or you may not.

Can I use hormonal birth control while breastfeeding? Yes you can but many hormonal options contain estrogen, which can interfere with your milk supply. The mini pill is a progesterone-only pill and may be an option for the breastfeeding person, but for it to be the most effective you cannot skip any days and you must take it at the same time each day. I don’t know about you but I would not be able to do that, between the milk brain and the fog of sleep deprivation. Some people report a drop in milk supply even with progesterone-only options, like the mini pill or the Merena IUD.

But I want another baby, why not have another right away? It is a really, really good idea to replenish your body and bring yourself up to full health and healing between pregnancies, meaning waiting at least a year between pregnancies, if not longer. Some wise people believe it is better to wait for a full year after weaning from breastfeeding so you are not actively making a baby or milk for that year, just restoring your body. Plus pregnancy while breastfeeding has the potential to decrease the milk supply or change the flavor of the milk enough that the baby may reject nursing. Timing is tricky, of course, and there are many different factors to consider, but I recommend that your health should be one of them.