EPISODE 23

Breastfeeding & Birth Control

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Episode Transcript

October 02, 2020

Can I take birth control while breastfeeding?! Are there certain types that I should avoid?!

If the pullout game is weak, they become parents. Right.

This is Maureen Farrell and Heather O’Neal. And this is The Milk Minute. An inclusive, evidence-based podcast, hosted by midwives and lactation professionals. That’s us. Here to talk to you about all things, lactation, and boobs, body positivity, mental health. All the Milky topics. Join us for another episode.

Okay. So welcome to The Milk Minute. Yeah. We’re just reminding you we had a little name change a little while ago. We love it. Hope you do too. Totally love it. And it feels like putting on a pair of jeans that’s new, but used, you know, like it’s already broken in, so it’s the best, but don’t worry. We’re still your breast friends.

You’re still our breast friends. We can still be that to each other if you want. Yeah. Yeah. Just, you know, it won’t be on the merch anymore. So today we’re going to talk about birth control and lactation because we get this question quite a bit. All the time. It’s a big deal.

And then we hear lots of stories about people that, “yeah I started birth control and four hours later, my milk supply dropped.” And it’s like, okay, well. And it’s really important because like, we don’t want you to be in that situation where you come in for your six week checkup and we’re like, “you’re pregnant.” And you about shit a brick. Yeah. It’s pretty important to make sure that everybody’s on the same page with family planning.

Yeah. And because it is important, you will most likely, possibly, get asked at your 28 week prenatal visit what your birth control plans are. Because that’s just gives you time to talk with your provider about, you know, what you’re feeling. Yeah. It’s the new standard of care that midwives, OB’s, everybody, we’re supposed to start asking you prenatally and basically check in at every single postpartum visit.

So I don’t want you to feel like that is a judgment that your provider is putting on you because they think you made irresponsible choices. Like we’re being told as providers that we need to give people more opportunities to talk about it, so we’re trying to do that. And they’re starting to put in IUDs and Nexplanon¬ģ¬† before you even leave the hospital after having your baby.

So it gives the provider some time, not that they really need it. If you decide last minute and you deliver at a hospital. Yeah. The hospital-based practice, they don’t need, you to just tell them. Yeah. Right. But I mean, if you’re delivering with a home birth, CNM that can put in an IUD. I mean, she’s, she or he is definitely going to have to make, do some planning and get that done and order those if they don’t, if you don’t like work with a big facility.

So, right. So let’s talk about birth control and the options if you want to continue breastfeeding. You actually have lots of options and there’s some perks and some, what are the opposite of perks? Cons, no, that perks and cons there’s pros and cons. So pros and cons, I don’t know, but basically if you want to keep lactating and you want your milk supply to be good, you don’t want to harm your baby, you can definitely still use a bunch of different kinds of birth control.

Yep. It’s true. So I kind of broke these down into different groups cause I thought it would be easier mentally for everyone to remember what was going on. Yeah. Do you want to start with the breastfeeding friendly ones?

Oh yeah. Okay. Well, okay. Yeah, let’s do it. Okay. So we’re to go over some breastfeeding friendly options for birth control. First on the list of course is condoms. They work really well when you take them out of the drawer and if you have the right size and if your vagina is appropriately lubricated.

And condoms aren’t the only barrier method. There’s essentially what, okay. So some people call them female condoms. I don’t like that. I think of them as the reverse condom. Yeah. But you know, internal condom. Exactly. So either way, that barrier method where you’re physically putting a barrier between the sperm and the uterus, like an actual barrier.

Right. So that would be condoms, which they work great. People need to stop complaining about them. But I also see when people aren’t like putting their nose in their mask, I’m like, no wonder condoms don’t work very well. So true. That is so true. If you can’t, you just, okay. There’s some fundamental understanding missing there, but anyway, so here we are.

Condoms and other barrier methods work great when you actually use them every time, you use them the way they’re meant to be used. So you get the right size is really important. Not everyone is created equal, but we knew that, right. And so you just get the size that fits you. It’s not a judgment on your sexual prowess or, you know, the size of your reproductive organs, regardless of what they are.

Doesn’t matter. You can still have a great orgasm. You can still have great sex. So just get what fits, get what fits and be proud of it. And then there’s diaphragms. So diaphragms. Yes. You can still get them. Yeah, they work well, if you have a provider that knows how to measure you. Yeah. That’s the big, like you need to ask your provider specifically.

Have they ever done that before? Right. I have actually never done that because not many people request them. And you know, it’s also hard to get them sometimes. So there is, I mean, for a while there, the local hospital was ordering them from Great Britain. It was like the only place you could get them.

Okay. So yeah. So diaphragms work pretty well if you have the right size and you know how to order it and you are leaving it in for the appropriate amount of time. And you have to use spermicide with diaphragms. Yes, you have to use spermicide. So it is a barrier method, but you need that spermicide also.

It doesn’t just work on its own. So I think that turns a lot of people off from it. Yes. I agree. Like spermicide I’m like if it’s going to kill sperm, I don’t know if I want it in my vagina. I don’t want BV. Yeah. I just feel like I’d immediately get BV, but it works really well. I would definitely recommend this method though, for some maybe like, if you’re, it’s not going to be something you use every single day. That would make for like a once a month-er. Right. Some, sometimes we all are guys. Sometimes.

And then there’s cervical caps, which are basically like mini diaphragms. These have a very high failure rate though. I do think that’s because cervixes like move and change. Yes. And I think it’s because people have tilted uteruses. And like, I, you know, okay so I am in this Facebook group for menstrual cup users.

And this is like the number one talked about thing. Like where the fuck is my cervix. And, and like, and seriously, like I get it as somebody who actively searches for other people’s cervixes sometimes I’m like, sometimes I’m like, I just, I don’t, you’re, I maybe, I can’t reach it. Wasn’t that important anyway.

I don’t know. Right. I mean, if you’re okay. Yeah, we’ll just leave it there. I mean, I could talk a lot about that, but I don’t recommend cervical caps. That’s let’s leave it there. Cervical caps are high failure rate, plus you have to stick your fingers all the way up inside you. Plus you don’t know really where your cervix is and there’s a better way to handle it.

I have heard of some people using their menstrual cups with spermicide, but I can’t recommend that. I can’t either. There is no study supporting that that works. And, and people have menstrual discs as well. But the thing is, they just, they’re not typically as tight fitting as a diaphragm. And they’re also not custom fit. Right.

So yeah, you can order a bunch of different sizes for menstrual cups or menstrual discs, but you’re still kind of just ordering like small, medium, large, you know. Of course I’m a large. Right, right. And, and it just like, well, you know, and also people don’t necessarily know what that fit is like.

You know, I thought after having a baby, I had to get a larger menstrual cup. I don’t. I still use a small. I mean, it’s just like, it’s not necessarily about that. So and I, I would not recommend using a menstrual cup as with spermicide, as a diaphragm is not what they’re meant for. They don’t fit the same way.

They’re not as rigid as diaphragms. Yeah. Don’t do it. It’s not gonna, well, probably will not prevent a pregnancy. Yeah. And I can’t imagine that the sex would be very good. Okay. You know what? I have heard though, people. Some people having cup sex or the menstrual discs are really popular to have sex on your period.

If you don’t want to get messy, I don’t know. We just throw a towel down. Yeah. Apparently it feels great for some people. Yeah. I don’t know. Okay. Well, I mean, I mean email us and let us know. If you’re going to try it, just like put a towel down, you know, you never know when the blood volcano might show.

I just imagine you’re just like, I don’t like the idea of menstrual blood back flowing. It doesn’t really do that though. But it, yeah. I don’t know. I just imagined that would be too much stuff in there at once. Yeah. If it’s like suction cupped on there and it’s collecting blood and you have the head of a penis just repeatedly.

Yeah. That’s why, I mean, I, I just think whatever. Just a little extra lubrication, if you want to do that. So anyways, Then we have the lactational amenorrhea method, which is when you are breastfeeding. And yes, breastfeeding is a form of birth control because of the hormone function in your body. We might call this the, the most traditional method.

The most just is essentially how our bodies evolved to protect us from getting pregnant right after having a baby, which can be dangerous. And probably when we were in survival mode more often was not a great idea, right. Not a great idea. And also the thing is there’s stipulations with this one.

Oh, big ones. Yeah. You have to be breastfeeding on demand. Only breast milk. Like no, supplementation. Right? No supplementation. No bottles. You need to be feeding your baby directly from your body, on demand, also all night. So we found that when people stop chest feeding or body feeding at night, then their prolactin levels change.

And when your prolactin level changes, your progesterone level changes sometimes. And then we get this hormone shift. And then an egg pops out. Right, bam. Then you could get pregnant and the real kicker is, as we all should know by now, you will ovulate for the first time before you menstruate for the first time.

Yes. And then this is also really only recommended in the first six months postpartum. So after six months, when your baby starts eating solid food, all bets are off. Eggs can pop out unannounced. And that’s, you know, you, we see a lot of people start to get their periods back seven months, eight months, totally normal.

Right? Yup. And then I always recommend if you’re going to do the lactational amenorrhea method to do the basal body temperature with it. Because that is going to give you some extra assurance because basal body temperature is pretty accurate. So if you don’t know what that is, essentially your basal body temperature, or using that method for birth control is when you’re going to take your internal body temperature, first thing in the morning, before you wake up, same time every morning. Well, you have to be awake. Well, yeah, I’m sorry. I swear to God, if my husband is sticking a thermometer in my vagina before I’m awake, I’m gonna flip out. A lot of people do this vaginally. You can do it orally too.

But it’s, unless you have a really super sensitive thermometer or one that specifically says basal body oral thermometer, you should do it vaginally. And then you track this and you see these really marked temperature dips when you ovulate and then it actually rises after you ovulate. So it’s the rising temperature that you want to watch out for.

Because then it means, Oh, my temperature rose today. So you probably ovulated in the past 24 hours. So it’s, the first time you do it, the first cycle, not accurate. The second, third, it takes about three months, because then what you do is you’re like, Oh wow. You know, if you have a really regular cycle, you’re looking at it and you’re like, day nine, I ovulate. Cool.

Or like day 14 or whatever it is. And then you can, you know, have this kind of safe zone where you can have sex before and you can have sex after, and you have about a week in the middle, but you’re like, we’re not going to do that. And you’re still taking your temperature just in case you have different fluctuations.

Now, when you’re experiencing lactation, amenorrhea, you’re going to kind of have a mostly flat temperature line. But when you start to see those fluctuations, you might be like ooh, condom time. Yeah. That’s a good point. Yeah. That’s a good point because I do get that question a lot. How do I know if I’m ovulating?

Like I haven’t had my period back yet. Cervical mucus, too. I was just going to say, I feel like that is easier, especially if you’re experiencing lactation, amenorrhea, and you want to just check your cervical mucus every day. And you’re like, what you do is you take a little pinch of it and you kind of put it between your fourth finger and your thumb and you separate them and you see how sticky it is, how gooey it is, how slippery it is, the color.

If it’s like slime that is clear and makes a little line when you separate your finger, you ‘re fertile. Yeah. So just watch out there. And then my husband swears he’s like, I can tell when you’re ovulating, because you’re like extra pretty and you smell really good. And he says the same thing too. And he’s like, he’ll like start getting turned on and then he’ll be like, Oh wait, you’re probably ovulating.

Not tonight. Like, hold on. What’s going on with your mucus? I’m like, you’re such a midwife’s husband. That’s okay yeah, totally. You know, and, and you have a couple of different tools at your disposal for this, you know? Yeah. You just have to get to know your body and pay close attention. If you’re a person that’s like, Oh, my body is gross and I don’t like body fluids and I don’t want to touch myself, this probably isn’t going to be the best method for you.

We have other methods. So there’s a new thing that’s not in America yet, but it’s a¬†vaginal progesterone ring. And what? I’ve never heard of that. I am excited. So the Nuva ring is on the no-no list.

We’ll get to that soon. So the estrogen is what we try to stay away from. So this vaginal progesterone ring is a ring that only has progesterone in it, which is the hormone that’s okay for breastfeeding and does not affect supply. And you put it inside of you for up to three months. You don’t even have to change it.

Does it just like sit on your cervix? Yeah. It just, it doesn’t matter where it is as long as it’s up in there and it works the same exact way that a regular birth control ring would work. And it delivers a single dose all the time. That’s like the same dose, the same dose every month, but in your vagina.

Right? So the mini pill, I probably should have done the mini pill first, but I know we’ll get to it. So, basically it’s not in the United States yet. It launched in South America in 2010, and it’s available in seven of those countries and it’s being tested, but not yet approved for women to use in Sub-Saharan Africa who wish to delay ovulation. Because it’s something that they can insert and remove by themselves, which reduces the need of involvement of skilled healthcare providers. Which is great for somewhere where healthcare isn’t super accessible.

Like, I don’t know where we live. Yes. And then also it allows fertility to return shortly after you stop using it. So like you don’t have to wait a long time if you want to have a baby again. And then it’s also so far, the studies are showing it’s 98.5% effective if used correctly. That’s pretty good number as long as you’re breastfeeding four times a day.

Yeah. Let’s take a minute to thank our sponsor¬†Aeroflow. Oh, tell me more about that. You know, do you ever wake up in the morning and you’re like, I would love to call my insurance company today? Literally never once have I thought that. Okay. People at Aeroflow knew this, right. Good. And they decided that it would be in everybody’s best interest if they developed a business where they contacted your insurance company to order your breast pump for you. This sounds good.

So you literally never have to call your insurance company to work out getting a breast pump. Which is fantastic because no one ever wants to do that crap when they’re postpartum. And the other cool part is they will text you and let you know when it’s time for you to replace your pumping parts and when your insurance will pay for new ones.

So maybe, you know, your pump parts are fine for now, but if insurance is going to cover a new set, great. I mean, I don’t know about you, but I’m not really combing through my insurance benefits information postpartum to see when I qualify for replacement parts. No, not at all. Right. So we’re going to go ahead and put a link in the show notes for Aeroflow.

And when you click that link, it’s super easy. You just put in all of your insurance information and then somebody from Aeroflow contacts you directly, and you have like a real person that you talk with and then they do all the dirty work for you. It’s fantastic. I couldn’t recommend it enough.

Please just do yourself a favor and¬†get your pump through Aeroflow. It’s going to save you so much time and trouble. Right. And they have all the top brand name pumps, replacement parts, and accessories. You know, they’ve got cooling gel pads. They’ve got those pumping bras, all the stuff you need. Yeah. Yep. One place.

So I guess the only thing left to say about that is you’re welcome. Yeah. You’re welcome.

Interesting. So the next one, let’s talk about the mini pill. So the mini pill works in the same way as that vaginal progesterone, right. Except the mini pill’s problem is that you literally have to take it at the same exact time, every single day, within the hour.

Yeah, we say, and if it’s off, then you could get pregnant. I mean, it is just that intense of, you know, you have to be really on top of it with the mini pill. Yeah. And, you know, I think the trouble is some people get into with their birth control while they’re breastfeeding, too, is that a lot of people just throw herbal supplements at their body to try to improve milk supply, and a lot of those change the way that your body metabolizes medications.

Yeah. Oh my gosh. That’s funny in a not funny way. Yeah. Anyway, anyway, to throw that out there. Yeah. So, you know, the mini pill needs to be treated with tender loving care, and don’t be taking any weird supplements or other medications that might get in the way of where that’s metabolized in your body.

So then we have the copper IUD, otherwise known as the ParaGard, which is a T-shaped copper wrapped device that’s placed into your uterus. And it’s very small. Let me just remind you. It is very small. And people I think get freaked out because they think it’s really big. Your uterus is also pretty small. So it’s really small.

It’s like what? Like an inch maybe smaller. It’s like probably an inch. Yeah, an inch tall and maybe like three quarters of an inch wide. The copper IUD is one of the bigger IUD’s. And the way it works is it is actually a natural spermicide because of the copper. And so it disrupts the sperm and also it affects the lining of your uterus and it makes it less fertile ground for implantation to happen just in case an egg did get fertile.

Copper’s pretty cool. It actually is pretty cool. Were you the one that told me? Yeah. Yeah. Heather and I were talking about how hospitals now are starting to replace high touch surfaces with copper because it’s antibacterial and antiviral, even it’s really expensive though. But like those metal plates on doors.

Like toilet handles and sink handles. And gosh, now I can’t remember, but there was, I was listening to like a podcast or something, but this one doctor had every single one of those surfaces replaced in a hospital and it just dramatically reduced hospital transmitted infections. And they probably spent like, $2 million.

Sure. But how much are they saving and not paying for the crazy readmission and shit? Anyway, copper. So copper is cool and it, and it kills the sperm when it comes in, but just in case there’s a super sperm that makes it pass the copper IUD and it, and it starts making an embryo, that embryo is not going to go anywhere.

And so this gets a bad rap with a lot of pro-life people, because they say that this is a form of abortion. So, but it’s important for you to know that even in the best case scenario, about 50% of embryos that are created when the sperm and the egg meet never implant, right. They just go right through.

But it can be used as a form of abortion, essentially as like a plan B, you can have an IUD inserted after fertilization. You can. Right. Whether or not, whatever the legalities in your state are, but this is actually an option presented to a lot of plus sized people because that like plan B emergency contraceptive doesn’t work really well if you have a high BMI, just FYI guys.

So getting a copper IUD implanted, gosh, how quickly? Within two weeks. You have a much larger window. I’ll have to look that up again, but that’s another option. So that’s another reason why it gets a really bad rap from people who do not believe that abortion should be accessible healthcare, which if, you know, if that’s you, that’s great.

You can also still use a copper IUD for regular birth control, preventative, right. Preventative birth control. So yeah, the chances that sperm does make it through or actually very slim, but, and then for it to actually meet the egg, but I mean, life, I guess does find a way. Yes. I have had a couple of people contact me with IUD pregnancies. Fun, exciting that those children should start their own religion.

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Right, right. Anyway. But do you want to talk about the biggest complaints about the copper IUD? Yes, yes. Bleeding. So if you are a person who has really heavy menstrual bleeding with every period, don’t get the copper IUD. Yes. The copper IUD is because it does disrupt the lining of your uterus, it can put you at risk to have a much heavier period.

It’s not hormonal. So you’re still going to have your period regularly, just like you did before, except you’ll bleed like a stuck pig if you’re prone to do so. People get that intermittent bleeding too, or more usually at first, but it usually resolves after your body kind of gets used to it. But, but yeah, the bleeding does tend to kind of increase during the period.

Right. No hormones. So if you’re a no hormone person, this is your option. Yeah. Yeah. And you know what, it’s a great option if you’re somebody who you might consider a light bleeder and you don’t really have issues with like dysmenorrhea, extremely painful periods, stuff like that. Like that’s not something you suffer with and definitely consider the copper IUD.

And it’s good for 10 years. Yeah. 10 years. You can get it taken out before then. But if you’re like, I am totally, definitely sure I don’t want to baby and I don’t want to be fucking around with going to the doctor or the pharmacy or whatever, yeah, this is a great choice. But it’s also a great choice for somebody like the Amish population will often use these because as soon as you pull them out, you’re fertile. You know, you don’t have to wait an extended period of time for your fertility to return.

So that’s one of those things like, yeah, it’s good for 10 years, but when you’re ready, yank that back out and you’re good go. You’re not technically supposed to take it out yourself just, but you could. Yeah. We’re not recommending that. Yeah. When I say yank that bad boy out, I’m talking to Maureen yanking, mine out in the alcove. We’ll video tape it for ya. Oh no we will not. Put it on Patreon.

Nope, Nope. Not even for them. So then, next section is the “technically” breastfeeding friendly. So, so all other IUD, the Mirena, the Kyleena, the Skyla, the Liletta, these are also T-shaped and they stay inside your uterus for three to five years and they do have hormones in it, but the hormone is progesterone and it’s a less daily dose than would be.

The pill, because it’s actually right at the source of your reproductive organ. So it doesn’t have to go through your whole, whole gastrointestinal. Doesn’t have to go through your entire GI tract. So the dose is lower, which we like that. We like that. I mean, the less hormone is better, tends to have less side effects.

So if you’re one of those people, who’s like, I didn’t like, you know, whatever pill, because it gave me depression. It made me whatever. These lower dose, progesterone only methods might be better for you. Yep. And then actually with the bleeding, no complaints with bleeding. And in fact, some people don’t have a period at all and that’s great for them, you know, they’re just like, I don’t like having a period.

So even if you’re not interested in having kids, you’re probably not listening to this podcast. But if you are, maybe you tuned in for this episode. Yeah. Maybe. Okay. You know, if you just don’t want to have a period and you don’t want to have kids, this is great. If you’re like lactation amenorrhea rocks.

Let’s keep that going. Yeah. Yeah, seriously. And also the Skyla would be great for those people because the Skyla is little. It’s smaller than the Marina in size. So if you’ve never had a baby before, that’s a great option for you. Because some people are, when their uterus’ have never expanded to have a baby before, they’re extra tight and they’re extra small.

And there’s just less of a chance of the IUD becoming expelled if you use one that’s the right size. So they’ve found, but here’s the but, when you’re lactating, but when you’re lactating. Some people technically are not supposed to have supply issues, but anecdotally I have heard it. Right. So I, I don’t know.

I don’t know. I mean, we, we have looked at the research and the research says that progesterone only options should technically be fine. But you know what, every body’s different. And everybody responds to hormones differently, especially these added hormones that are not something your body created itself.

Right. But you know, like my thing is when somebody is breastfeeding and they get pregnant on purpose, they don’t have to stop breastfeeding. Right. You know, they just keep breastfeeding, but they will often say that they have a temporary dip in their supply as their body is figuring out how to reappropriate those hormones.

So it makes sense to me that if you are taking any progesterone only something, whether it’s an IUD or a pill or whatever, you, you might have a temporary dip in supply as your body just figures out what’s going on. Right. So just keep at it, keep breastfeeding, keep your IUD in or keep whatever pill you’re taking.

Keep taking that because guess what? Getting pregnant, you’re going to have progesterone. Yeah, yeah, yeah, for sure. And I, and I think, you know, some people definitely say like, bam, you know, after a week of using it, they’re out of milk. And that’s one thing, but you know, if you’re like, I started taking this birth control or I got this IUD and all my baby’s doing is cluster feeding for a few days.

That’s okay. We’re going to be like, can you ride that out until the end of the week? We’ll check in. Like your milk supply is really important to us. Also your desire to not get pregnant is really important. And we want to balance that, right? Because you know what affects breastfeeding sometimes? Just the same, pregnancy.

So it’s just kind of that balance, like be in touch with your healthcare provider and, you know, just keep them posted and do a lot of skin to skin and take a bath with your baby and nurse on demand. And hopefully you get through it and get over that hump. Yeah. And then in the same line is the Nexplanon arm implant.

It’s the little tube about the size of a half of a dumdum lollipop stick. And that’s placed under the skin on your inner upper arm. I’ve never heard someone compare it to a lollipop stick. It’s true though. It’s like the same size and it’s white. It’s just. Yeah, never. I’m never going to unthink that. Now, when I see people getting that. I hope our international listeners know what a Dum-Dum is.

It’s like the little candy lollipops that they give out at the bank and they have those like white, like cardboard paper sticks that when you chew on them too long, they just like dissolve in your mouth. Did you never, were you not that kid who had just kept sucking on them? No, my kid does it. I was a biter. Oh, my kid just keeps chewing the stick after he’s done.

And then I am like, what’s in your mouth? And I’m like, Oh God, it’s a wad of something that used to be a stick. You’re gonna make me gag. So this tube that’s in your arm is filled with progesterone as well. And then, but the thing is, it’s not right next to your uterus. So those hormones have to circulate systemically through your whole body to get to your reproductive organs.

So it’s actually a higher dose of hormone than the IUD. But it’s also good for three years and people do like the fact that they can see it. Some people are freaked out by the IUDs because I can’t see it. How do I know it’s okay in there? Right. And I get that and there have been very rare, but definitely real cases where they move in your body and that is terrifying.

You know, or they fall out and you don’t notice. And you know, I, I get it that it’s. The whole point, I’m always so questioning about those though. Like, you know what though, like the whole point of birth control is that you are in control of this choice and whatever gives you, whatever works and gives you that sense of control should be what you go with.

True. Well said. Thank you. Very well said. And the biggest complaint with this Nexplanon is bleeding again, spotting between periods. So it’s not like heavy bleeding, it’s just awkward browning. And that’s what I like to call it. Awkward browning. It just like spotting. The brown blood is always like kind of weird and smelly.

I know, and like I got my period on a second date one time with the Nexplanon. And I, you just never know when it’s coming because your period’s not regular. Like you won’t have a period for months and then all of a sudden out of nowhere, you’ll get a period. And I bled through my dress at the Greene Turtle and we had to leave and he had to cover me up.

I was just so like annoyed. But yeah. You didn’t have your little emergency pack with you? No, because I’m not that prepared. Do you know what I got? The¬†Lily cup¬†makes a collapsible menstrual cup that fits in this little round case, like the size of a half dollar. I know. It’s so great. I got it when my periods were all messed up with breastfeeding.

And it’s like a little bit hard to put in cause it’s collapsible, you know? Oh, but it’s fucking great. It like literally fits in the change purse of my wallet. That’s so cool. Yeah.¬†Link in the show notes. And then there’s the depo shot, which is an, an intramuscular, also known as IM shot that you get in your arm every three months.

This is also all progesterone, but it’s a different kind of progesterone then is found in some of the other products and they, this type of progesterone can cause some weight gain and acne. Big complaint I hear all the time as people get the depo, they gain like 30 pounds and they’re like, I can’t undo this and it sucks.

Yeah. So if you are a person with a high BMI, this one might not be the best choice for you, right. Just health wise, because it increases your appetite like crazy. What about milk production? And same thing with milk production. It should technically be okay. But, but it is kind of a high dose at first.

It is a high dose at first. And so yes. People do tend to say that their milk supply dips with this, for sure. This one, I’ll be honest. The depo shot kind of freaks me out. Cause I’m one of those people, I need all the time to be able to make that choice. Like every day I want to be like, yes, I’m going to use a condom today or yes, I’m going to take this pill today.

Yeah. I can’t deal with that. Like, Oh, I made a choice three months. For the next three months of my future, and now I can’t undo it. Oh, you’re right. Like once you inject it, it’s in there. You can’t un-inject it. So if you don’t like it, you just have to wait it out until it processes in your system and it’s yeah. But you know, at the same time it’s a form of birth control nobody else can mess with.

Like, nobody can sabotage you here if you’re not in a healthy relationship. You know, and, and so that like semi permanency of it is really appealing for some people. Not everybody gains weight on it. Not everybody hates it. You know, a lot of people do actually like this. That’s why it’s on the market.

Yep. Lots of people, lots of I’m shocked actually by how many people and I’m like, you sure you don’t want to Kyleena? I mean, cool, man. They just want an injection every three months. Like that’s really easy. Then you also have to come back every three months. So that’s the other thing. Like if you are a person that is really busy and you do not remember things very well and you won’t remember the last time you got your shot, this one’s probably not for you.

No, you need an IUD. Yeah. Like 10 year IUD. Yeah, because I mean, if you’re off and you don’t go back at that three month mark and get that shot, you’re exposed and it can happen. So that’s what we have to say about that.

So the third category is absolutely not breastfeeding friendly options. So this would be any birth control pill that has progesterone and estrogen in it.

So this is the combo pill. And this is typically what we would put you on to control acne, to control mood imbalance, to, you know, kind of restore some estrogen, if you are deficient in estrogen in some way. So this is what has been scientifically proven to decrease milk supply. Yeah. Right. And you know what?

You get a rise in estrogen when you’re pregnant too. And you know, maybe that’s when people see their dip in milk supply. I don’t know. . Yeah, I don’t know. But the Nuva ring is the same. So the Nuva ring is vaginal ring insert that’s a combo of estrogen and progesterone. There’s a couple of other brands of this ring.

I didn’t write them down though, but you know, they’re out there that if you care to. Considering the progesterone only ring isn’t available here, I don’t think it’ll be a problem if you’re in the United States. If you’re in the United States, don’t use a vaginal ring. Don’t use a vaginal ring. So this one you put in for three weeks and then you pull it out the fourth week to have a withdrawal bleed.

And then the last one is the patch. And this is an arm patch that has estrogen and progesterone in it. And you place this on your skin for three weeks and then remove it for a week to have a withdrawal bleed. And this one actually has a 9% failure rate due to these patches falling off. I always wondered that, like, I just like thinking about how often even like really nice, like band-aids just like peel off and like, whatever.

Like hey! That was a $5 Band-Aid! Like what do they put on that one? What kind of glue is on that patch? Don’t use¬† lotion on your skin. Like, yeah. So, and then, you know, some people don’t like that, you can see it and then some people have skin irritation. Some people like it because you can see it, you can remove it whenever you want. You know, and, and it does, I don’t think this one has a ton of side effects, right?

The patch. Well, it does have to be kind of a high dose because it has to go systemically. So it is a higher dose of hormone, but I haven’t seen, and this is not evidence-based, but I have not seen as many people complain about mood imbalance as they do with certain pills that they’ve been on. Yeah. The pills are really notorious for that.

And this is especially good to remember because postpartum depression is really common and taking the wrong birth control pill can make that a lot worse. But you don’t, but you don’t know which one is not the right one for you unless you’ve taken them before. Yeah. But, you know, it might be a good thing if you’re like, wow, I already have postpartum depression.

Maybe I’m going to choose a different method that’s not a pill. Right. Or more the non-hormonal kind to at least take that out of the equation. Right. And then of course there’s abstinence, but that’s no fun. Yeah. Yeah. And like, if that’s what you choose, honestly, like we talked about this in the¬†sexpisode, you know, a lot of people don’t really want to have sex for a while after having a baby.

Good for you. But when you do, we want to make sure you’re covered. Yeah. Totally covered with all of your options. So I know that was a ton of information, but I wanted it to be available permanently for you guys so you could go back and listen anytime you want. And you know, even if you choose no birth control at all, we support you.

You know what? I had one more thing to say, Oh, I’m sorry. I forgot. It’s okay. So when we mentioned before those natural fertility tracking methods, they’re really a challenge even after your period has returned when you’re lactating, because you have kind of irregular periods. So there are some tools that make that easier.

There are apps that track it all for you and do the math. Yeah. There’s one that comes with the basal body temperature. I have it. Yeah. Yeah. Well let me, let me start from the beginning. So it used to be that everybody would get this book that was taking charge of your fertility, and we’d have these little paper charts and you do your little math and that’s cool.

And it’s like a fun way to learn. And I love doing that with teenagers actually to like, teach about menstruation and cycles. But when you have kids and your milk’s leaking and you’re just like, I don’t have time to chart. You can get apps that do it, or you can get something that there are thermometers that are either Bluetooth linked to your phone.

So the¬†Daysy¬†is one of these, or there are standalone units, like the¬†Lady Comp. Hmm, that it’s just its own little machine and it does it all for you there. How much is that? It’s expensive. Like how much? I don’t know. I know the Daysy is like $200. Yeah. We’ll put a link in the show notes, but I love the Daysy. I used it for a long time, since it came out, really. I think my husband bought it for me for Valentine’s day. Cause he’s cute.

And it’s, it’s a little thermometer. It has a red, yellow and green lights. Yeah. And green is go, you’re not fertile. Yellow is like, Hmm. I’m not sure. You know, take your chances if you want. Red is hard stop. Red is you’re fertile. So make your choice. Oh my gosh. Yeah. And it’s really cute. And you actually, like, don’t even have to sync it every day. Yeah. And basically like, it recommends just as always, like that you use it for a month or two before you rely on it, especially if you have more irregular periods, it recommends you use it for longer before you rely on it.

So that yellow period ends up being longer.¬† But it’s really nice. It takes the thought out of it. Good. So we’ll put those links for you guys in the show notes and you know, if you buy them, if you use them, we want to know about it. Oh, we didn’t talk about pull-out. Let’s keep talking. I honestly like this is a much more popular birth control method then I would like.

I would hope. All of us have used it. Let’s be honest. Yeah, I have. Yeah, everybody, everybody has and will continue to. We call this the pull-out method and this is when the person who has a penis takes their penis out of the vagina before they ejaculate into your belly button. Or wherever.

I don’t like, no, we don’t do that. Yeah me either. What else is it there for? I don’t know. But you know, honestly this is really successful for some people and that’s fine. Things I want to mention. Typically this is more successful the first time you’re having sex that day. Yes. If you have sex multiple times in a row, you’re going to have more sperm waiting in line.

Yeah. And also yeah, if you like that, pre-cum has more sperm if you just keep having sex. Right. So you talk about that a lot, but basically if there’s a chance that any semen or sperm is leftover in the shoot, right, from previous whatever’s, yeah just, you know, definitely try to have them pee in between and I would highly recommend a condom at that point.

Yeah. But you know, a lot of people tell us this works really well for them and that’s fine. But basically when I have clients who say, Oh, no, like, you know, we just pull out and it’s fine. I say, okay, like, honestly, I don’t have a problem with that. As long as you’re okay with a higher chance of accidental pregnancy.

Yeah. Yeah. I mean, there’s a high chance, not because of the pull out method, but because of whiskey. Yeah. Or, or like, you know, like maybe having sex at 2:00 AM and someone’s a little tired, just a little off their game. Yeah, if the pullout game is not strong, the high, what do you call those people? Parents? Yeah. If the pullout game is the weak, they become parents.

Right. That’s what I was trying to say. Anyway, so this is just a birth control method with a high incidence of user error. Yep. Take that into consideration. Sure. Take that into consideration. I actually really like the hybrid method of people pull out and then like when they’re pretty sure they’re going to be ovulating, they use condoms.

And honestly, it’s like four days, you know, when you’re like, I don’t know, kind of think of maybe ovulating. Like that, that’s good. You don’t have to just say all or nothing, you know? Right. Yeah. Pull out just in case. Yeah. Why not? Why not? On that note? We’re pulling out of here. We’re going to pull out at The Milk Minute here.

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