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The Best Birth Control After the Baby

Norplant Implant and Depo-Provera Injections

Pluses: If you're not nursing, before you leave the hospital you can arrange to have Norplant, a time-released progestin device that works for up to five years, surgically implanted in your arm. Or you can get an initial Depo-Provera injection, a progestin contraceptive that's administered four times a year by your doctor, in your arm or buttocks.

Effectiveness: Norplant, 99.95%; Depo-Provera, 99.7%

What You Should Know: As with the Pill, you may want to wait to use these two methods until after your first postpartum menstrual period, to be sure your cycle has returned to normal before you alter it. Nursing mothers may want to wait at least six weeks after delivery, for extra peace of mind.

The most common side effects associated with Norplant are irregular bleeding, headaches, and nausea. You should also make sure that the doctor inserting the device is experienced or it could be difficult to remove.

One potential side effect of Depo-Provera is that fertility may not return for up to a year after the injections are stopped. Some women also experience increased weight gain with each year of use (about 5 pounds the first year, and 3 to 5 pounds each year after). Although the injection shouldn't prevent loss of the pounds gained during pregnancy, women who have had weight problems in the past should discuss this with their clinician.

The Intrauterine Device (IUD)

Pluses: Today's IUDs are considered safe and effective by health experts and can be used by most women, although manufacturers, looking to prevent legal problems (memories of multimillion-dollar claims against the Dalkon Shield are still with them, years after it was taken off the market), recommend using their products only after having had a child.

Effectiveness: Progestasert, 98%; ParaGard, 99.2%

What You Should Know: Health experts recommend that any woman choosing an IUD be in a mutually monogamous relationship, where the risk of sexually transmitted infections is low. The device is linked to a slight increase in pelvic infections in women who have multiple partners. Most doctors prefer to insert the device at the four- to six-week postpartum checkup, when the uterus has returned to its normal size. Depending on the advice of her doctor, a woman who has had repeat cesarean sections can have an IUD safely inserted.

There are two IUDs available today. The first is ParaGard, a T-shaped device that is made of plastic wrapped with copper wire. ParaGard can be kept in place for up to ten years. It works by killing the sperm before they come in contact with an egg; the copper does not affect the quantity or quality of breast milk in nursing mothers.

The other type of IUD is Progestasert, also a T-shaped device, which releases the hormone progestin. Progestasert works by thickening the cervical mucus, so a fertilized egg can't implant itself in the uterus. It needs to be changed annually.

Side effects of IUDs include uterine cramping and increased menstrual bleeding, the main reasons some women have had them removed.

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