After nine months or more of thinking of little but pregnancy, your new baby is born. You may be surprised to find that pregnancy is suddenly the furthest thing from your mind. But even while you honeymoon as a newly expanded family, you need to make some important decisions about when you might get pregnant again, if ever.
Betsy Bailey

Knowing what's available
While there are many contraceptives available -- with yet more in development, such as the male birth control pill -- most of the current ones are not 100 percent effective, and all of them have both advantages and drawbacks. In the accompanying table, we've offered a comparison of the most popular methods to assist you in your research and decision-making.

Deciding which contraceptive is often difficult; and even after that decision has been made, many couples are not completely satisfied with their choice. Lana* of Pennsylvania, who gave birth to her second child earlier this year, is not thrilled with her birth control options. "To tell you the truth," she says, "I didn't even want to think about birth control after our first child was born. He was conceived after six years of infertility. Obviously, we hadn't spent much time trying to prevent a pregnancy! Now we have two wonderful kids and we're done having children. The options seem so invasive -- surgery, hormones, IUDs, implants. For now, we're using condoms and sometimes just withdrawal." She laughs, "Actually, now that we have an infant, we are not having much sex these days. Abstinence is probably our number one method right now."

Sharon in Texas is also unhappy with the invasiveness of the more effective contraceptives. She considered an IUD several years ago, but decided against it for two reasons. She explains: "For one thing, the placement procedure seems really invasive. Secondly, I just couldn't forget the Dalkon Shield problems a few decades ago. We ended up using the pill until we were ready to start our family." Now pregnant with her fourth child, she is not sure what they will do for birth control after this baby is born. "I'm pregnant!" she says with a smile, "I don't even want to think about it right now."

Not all methods of birth control are invasive or risky, however. In recent years, the rhythm and fertility awareness methods (FAM) have gained some popularity. Women who are willing to stay in tune with their cycles and record them faithfully may find great satisfaction with these methods. Jenny in Arizona has used the rhythm method successfully for more than six years to not only prevent pregnancy, but also to plan it. She says, "After I had my son (who was conceived the first month we tried). . .the doctor gave me a prescription for Micronor because I was nursing. I never used it. I get cramps when I ovulate, so I always know my fertile days. I am also very regular and keep track of my cycles on a calendar."



According to the U.S. Food and Drug Administration, combined oral contraceptives -- commonly called "the pill" -- are the most popular form of reversible birth control in the United States. Kris of Maryland chose to go on the mini-pill after the birth of her daughter last year. "I tend to have a bad reaction to condoms and the inconvenience of having to take a pill at the same time every day is minor. At my annual checkup next month, I hope to be transferring back to the regular pill, since we aren't quite ready to add to the family."

Making a decision
While some women know exactly what contraceptive they want; others are less certain. "On the whole, the contraceptive choices that Americans have are very safe and effective," says Dennis Barbour, former president of the Association of Reproductive Health Professionals, "but a method that is very good for one woman may be lousy for another."

Start below to inform yourself about the pros and cons of various contraceptives, then make the best decision for your personal circumstances. If you fail to decide on some method of birth control, the choice to become pregnant might be made for you!

Birth control methods
Surgical Sterilization -- female or male (tubal ligation/vasectomy)
- Estimated effectiveness: Over 99 percent
- Some risks (c): Pain, bleeding, infection, other minor postsurgical complications
- Protection from sexually transmitted diseases (STDs): None
- Convenience: One-time surgical procedure
- Availability: Surgery

Injection (Depo-Provera)
- Estimated effectiveness: Over 99 percent
- Some risks (c): Irregular bleeding, weight gain, breast tenderness, headaches
- Protection from sexually transmitted diseases (STDs): None
- Convenience: One injection every three months
- Availability: Prescription

Implant (Norplant)
- Estimated effectiveness: Over 99 percent
- Some risks (c): Irregular bleeding, weight gain, breast tenderness, headaches, difficulty in removal
- Protection from sexually transmitted diseases (STDs): None
- Convenience: Implanted by health-care provider -- minor outpatient surgical procedure; effective for up to five years.
- Availability: Prescription

IUD (Intrauterine Device)
- Estimated effectiveness: 98 to 99 percent
- Some risks (c): Cramps, bleeding, pelvic inflammatory disease, infertility, perforation of uterus
- Protection from sexually transmitted diseases (STDs): None
- Convenience: After insertion by physician, can remain in place for up to one or 10 years, depending on type.
- Availability: Prescription

Oral Contraceptives -- combined pill
- Estimated effectiveness: Over 95 percent
- Some risks (c): Dizziness; nausea; changes in menstruation, mood and weight; rare side effects: cardiovascular disease, including high blood pressure, blood clots, heart attack and strokes
- Protection from sexually transmitted diseases (STDs): None, except some protection against pelvic inflammatory disease.
- Convenience: Must be taken on daily schedule, regardless of frequency of intercourse.
- Availability: Prescription

Oral Contraceptives -- progestin-only "mini pill"
- Estimated effectiveness: 95 percent
- Some risks (c): Irregular bleeding, weight gain, breast tenderness, slightly increased chance of ectopic pregnancy ?
- Protection from sexually transmitted diseases (STDs): None, except some protection against pelvic inflammatory disease.
- Convenience: Must be taken on daily schedule, regardless of frequency of intercourse.
- Availability: Prescription

Male Latex Condom
- Estimated effectiveness: 86 percent (a)
- Some Risks (c): Irritation and allergic reactions (less likely with polyurethane)
- Protection from sexually transmitted diseases (STDs): Except for abstinence, latex condoms are the best protection against STDs, including herpes and AIDS.
- Convenience: Applied immediately before intercourse; used only once and discarded.
- Availability: Nonprescription

Diaphragm with Spermicide
- Estimated effectiveness: 80 percent
- Some Risks (c): Irritation and allergic reactions, urinary tract infection
- Protection from sexually transmitted diseases (STDs): Protects against cervical infection; spermicide may give some protection against chlamydia and gonorrhea; otherwise unknown.
- Convenience: Inserted before intercourse and left in place at least six hours after; can be left in place for 24 hours, with additional spermicide for repeated intercourse.
- Availability: Prescription

Female Condom
- Estimated effectiveness: 79 percent
- Some risks (c): Irritation and allergic reactions
- Protection from sexually transmitted diseases (STDs): May give some STD protection.
- Convenience: Applied immediately before intercourse; used only once and discarded.
- Availability: Nonprescription

Spermicides Alone
- Estimated effectiveness: 74 percent
- Some risks (c): Irritation and allergic reactions
- Protection from sexually transmitted diseases (STDs): May give some protection against chlamydia and gonorrhea; otherwise unknown.
- Convenience: Instructions vary; usually applied no more than one hour before intercourse and left in place at least six to eight hours after.
- Availability: Nonprescription

Periodic Abstinence
- Estimated effectiveness: About 75 percent (varies, based on method)
- Some risks (c): None
- Protection from sexually transmitted diseases (STDs): None
- Convenience: Requires frequent monitoring of body functions (for example, body temperature for one method).
- Availability: Instructions from health-care provider

Cervical Cap with Spermicide
- Estimated effectiveness: 60 to 80 percent (b)
- Some risks (c): Irritation and allergic reactions, abnormal Pap test
- Protection from sexually transmitted diseases (STDs): Spermicide may give some protection against chlamydia and gonorrhea; otherwise unknown.
- Convenience: May be difficult to insert; can remain in place for 48 hours without reapplying spermicide for repeated intercourse.
- Availability: Prescription

Sponge with Spermicide
- Estimated effectiveness: 60 to 80 percent (b)
- Some risks (d): Irritation and allergic reactions, difficulty in removal
- Protection from sexually transmitted diseases (STDs): Spermicide may give some protection against chlamydia and gonorrhea; otherwise unknown.
- Convenience: Inserted before intercourse and protects for 24 hours without additional spermicide; must be left in place for at least six hours after intercourse; must be removed within 30 hours of insertion; used only once and discarded.
- Availability: Nonprescription

Notes:
(a) Effectiveness rate for polyurethane condoms has not been established.
(b) Less effective for women who have had a baby because the birth process stretches the vagina and cervix, making it more difficult to achieve a proper fit.
(c) Serious medical risks from contraceptives are rare.

* Some names and personal details have been changed to protect privacy.PregnancyAndBaby.com

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