DEAR DOCTOR,

I just had my fourth child and my husband and I have agreed that we are done having kids. What birth control method would you recommend? Possibly something with minimal effects.  THERESA

DEAR THERESA, 

Accept my heartiest congratulations on the new addition in your family. As such, till four to six weeks after child birth, the hormonal balance remains such that conception is not possible. Levels of prolactin, the hormone that stimulates milk production from the breasts, remain high after delivery and this also prevents conception till one is breastfeeding and is nature’s device for family planning. Hence, a new mother is advised to breast feed the baby as much as possible.

Use of condom by the male partner remains the best choice for prevention of another pregnancy after child birth. It is cheap, mostly effective and free from side effects. However, one has to be prudent while using the condom. It should be of good quality, preferably made of latex and put on before beginning intercourse. Any time if it bursts accidentally, the male partner should withdraw immediately. After use, it should be disposed of and never reused.

Intrauterine device (IUD) is a safe and effective option for the female partner to prevent another pregnancy after child birth. It can be inserted within 24 to 48 hours and even 4 to 6 weeks after delivery. It may be hormone coated or without hormone coating.  The only risk with an IUD is of infection, if it is inserted without following hygienic precautions.  Hormone coated IUD may cause breast tenderness, leg cramps, swelling over feet, i.e. side effects of progesterone.

"Withdrawal method” is followed by some couples to prevent pregnancy. Here, the male partner withdraws before ejaculation. However, this involves self-discipline and accuracy of timing. Because, if even few drops of semen are deposited in the vagina, it can result in fertilisation and conception.

As you both do not want any more children, consider sterilisation as well as a permanent measure to limit family size.  It is a minor procedure, safe and almost 100% effective in preventing pregnancy.  If your child is still very young, you can wait for her to become 4 or 5 years, i.e. becoming strong and growing well, then go for sterilisation. Till then a temporary measure like condom or I.U.D, can be used. Sterilisation can be done for the man (vasectomy) or the woman (tubectomy). Here, the tubes carrying sperms (in man) or eggs (in woman) are cut and ligated. This prevents transportation of semen or eggs, thus preventing fertilisation.  However, male sterilisation is easier, less cumbersome and if needed, can be reversed easily in future.

Hormonal contraceptives have risk of causing side effects like hypertension, heart diseases, high lipid levels, clotting, hence, best avoided for long term use.

Dr. Rachna Pande is a specialist in internal medicine

rachna212002@yahoo.co.uk