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Mamas and Papas Magazine

These questions were from Mamas and Papas and appeared in this issue.


What are the contraceptive choices after giving birth?

Dr Mokaya:
Family planning is a personal choice. It should be initiated after the various options available have been discussed by the couple and agreed upon. These can vary from male/female condoms, pills, injections, intrauterine devices and implants, or permanent contraception such as vasectomy and tubal ligation (typing up the tubes). This is particularly important if the couple is not planning on trying for a baby in the immediate term.


The best way to prevent an unplanned pregnancy soon after giving birth is by using an effective method of contraception. Before a woman decides on which contraceptive method she is going to use, it is important to understand the following:

  • How the method works
  • How reliable the method is
  • How reliable the method is
  • When it will start to work


How soon after giving birth should women use contraceptives?


Dr Mokaya:
A woman can start using contraceptives immediately after giving birth, especially if she doesn’t intent to breastfeed. If she isn’t breastfeeding, a wider variety of contraception options are available to her. The options for breastfeeding moms are limited to those contaiing progestorone, or non-hormonal barrier contraceptives such as condoms, diaphragms and cervical caps.


Will breastfeeding act as a contraceptive?


Dr Mokaya:
Breastfeeding, when used as a contraceptive method, is known as lactactional amenorrhoea. It can be up to 98% effective in preventing pregnancy if all of the following conditions apply:


  • The mother breastfeeds exclusivelyy, meaning she isnt giving her baby any other liquid or solid food
  • The mother breastfeeds almost exclusively, meaning she is mainly breastfeeding her baby and infrequently giving her baby other liquids
  • The baby is younger than six months
  • The mother has no periods

The risk of pregnancy increases if:

  • The mother starts brestfeeding less often
  • There are long interval between feeds, both during the day and night
  • The mother stops night feeds and uses supplemental feeding instead

Once the baby is older than six months, the mother’s risk of getting pregnant increases. Even if the mother doesn’t have periods and is fully or nearly brestfeeding, she should use another cotraceptive method.


Will using hormonal contraceptives affect milk supply? Will they affect the baby?


Dr Mokaya:
Hormonal contraceptives containing oestrogen can adversely affect your milk supply and therefore shouldn’t be used during breastfeeding. Progestorone-only pillls are less likely to decrease milk supply, It is recommended to start with a lower-dosge form such as the progestorone pills, rather than higher-dose progestorone injectables. These injectables last two to three months and cannot be reversed once given. If there are no problems with your milk supply after using progestorone-only pils, you can have the injection if desired. Hormonal contraceptives will not affect the baby.



What are the benefits of using contraceptives after birth? What are the risks?


Dr Mokaya:
In addition to preventing pregnancy, the general benefits of using contraceptives may also apply after birth, though to a lesser degree. Some include:


  • Regular or lighter monthly periods
  • Improved acne or facial hair growth
  • Easing of menstrual migraines
  • Reduced risk of ovarian cancer (potentially) if used for more than five years

Apart from limiting milk production, the risks may include reduction in libido, a risk of developing blood clots, breakthrough bleeding (irregular periods) and mood changes.


Can using contraception cause weight gain?


Dr Mokaya:
Weight gain is commonly cited as a side effect of hormonal contraception. There is general agreement that the use of combined (oestrogen and progestorone) contraceptives doesn’t lead to weight gain, and that progestorone-only methods (like Depo-Provera) seem to be the cause of some weight gain. This is especially so in younger adolescents compared to older women.


How long does it take for birth control pills to get into the system?


Dr Mokaya:
Most contraceptive methods have their onset of action almost immediately after initiation. If monthly periods have alread begun and the cotraceptive pill is being used the following guideline aplies: if the pill is started on day one of bleeding then it is effective immediately. If started on day five, then it wil be effective in 14 days’ time – any other starting point is not safe until the start of the second packet of the pill.

This question was from Dischem Expert Input.


What is infant reflux?


Dr Mokaya:
Reflux is a condition in which the muscle between the oesophagus and the stomach relaxes to let stomach acid back up into the oesophagus. This results in a type of vomiting or spitting called ‘posseting’. While reflux is normal, and often just the result of a baby's underdeveloped oesophagus (food canal), it can be very frustrating for parents. Most babies will outgrow reflux, with symptoms stopping when the baby reaches 12 to 14 months of age. This is around the same time that the ring of muscle at the bottom of their oesophagus fully develops and closes off, preventing stomach contents from leaking out. It's unusual for reflux to continue after 18 months.


There are a few ways of easing reflux and these include:

  • Burping your baby regularly throughout feeding
  • Avoiding overfeeding and rather feeding little and often
  • Checking that the hole in your baby's teat is not too big
  • Holding your baby upright for a period of time after feeding and raising the head end of your child's cot or crib for sleep time.


If these methods don't work, it's best to see a paediatrician who will be able to be able to determine the best treatment.


Not every baby who vomits has reflux. Sometimes vomiting can be caused by another medical problem ranging from a bacterial or viral infection, to a cow's milk allergy, an intestinal blockage, or a head injury. Repeated projectile vomiting that begins around three to five weeks may be due to a thickening of the muscle where the stomach empties into the small intestine. This condition – known as pyloric stenosis – requires immediate medical attention and minor surgery. Vomiting may also be a result of gastro-oesophageal reflux disease (GORD), a more serious long-term form of reflux. It is estimated that 65 to 85% of premature babies suffer from GORD. The symptoms include pain and discomfort in the chest or upper abdomen, which might make your baby cranky. Your baby might cry a lot or arch his back. If your baby has GORD, her sleep might be disrupted sometimes, or she might show poor weight gain. You should also look out for a chronic cough and wheeze. GORD can be treated with medication.

Arrange an AppointmentGynaecological Services


Doctor Tom Mokaya is a specialist Obstetrician and Gynaecologist practising in Johannesburg. He did his specialist Obstetrics and Gynaecological training with the University of Witwatersrand becoming a Fellow of the College of Obstetricians and Gynaecologists of South Africa (FCOG (SA)) in 2003. Read more


Sunninghill Tel: 011 257 2155 / 011 257 2156
Sandton Tel : 011 706 9620 / 011 709 2015
Email:  tmokaya@mokaya.co.za