A woman has many birth control options that allow her to plan whether or not she has children, when she has children, and the age difference between her children. This guide is designed as an overview of available options to help you plan an in-depth discussion with your health care professional about choosing a birth control method that matches your physical, emotional, and lifestyle needs.

At different stages of life, a woman may find that one method of birth control suits her needs better than others. Periodic review of available birth control options will help ensure you choose a method to best meet your current lifestyle. Some factors to consider include, method effectiveness, permanency, convenience, and protection again sexually transmitted infections (STIs).

The American College of Nurse-Midwives expects your health care professional to take time to answer your questions and counsel you about making good decisions about your health. The philosophy of midwifery care is to help you make personalized, informed decisions about what is right for you.

We encourage you to discuss the benefits and risks of each birth control method and to ask questions about them as well as any reproductive issues that are important to you. This will ensure you are well informed as you make decisions about birth control.

HORMONAL CONTRACEPTIVES
Hormonal contraceptives are safe and effective birth control methods when used consistently and correctly.

Pills. Birth control pills typically come in packs to help you to remember what to take and when. Most are designed to create a monthly period (bleeding), but they can also be taken so that a woman has fewer periods (for example, four times a year instead of monthly). Some monthly packs have 21 pills with hormones and seven without. Other monthly packs have 21 pills then no pills are taken for seven days. Pills are typically a combination of estrogen and progestin. Some pills only contain progestin and are used by women who cannot take estrogen.

Patch. The contraceptive patch delivers a combination of estrogen and progestin through your skin. You apply one a week for three weeks then don't wear a patch for one week, during which you get your period. The patch can be worn on the upper arm, upper back, torso, or buttocks, and it can be hidden by clothing.

Vaginal ring. This is a small, flexible ring that you insert in your vagina and leave for 21 days, take a seven day break, and insert a new one. It contains a combination of estrogen and progestin.

Injection. The contraceptive injection contains progestin and is given every three months.

IUD (see the IUD section below)

Most hormonal contraceptives have these characteristics:

• Contains either or both of the hormones progestin and estrogen to inhibit ovulation
  
• Reversible
• Can be used long-term
• May decrease cramping and bleeding during periods
• Protects against cancer of the ovaries and the endometrium
• May cause nausea, spotting and headaches
• Women who are 35 years old or older and smoke or those who have certain health conditions are not good candidates for hormonal methods
  

BARRIER METHODS
Barrier methods work by keeping the man's sperm from reaching the woman's egg. Barrier methods are less effective than other birth control methods and require attention and planning each time you have intercourse. Barrier methods are non-hormonal and reduce the risks for some sexually transmitted infections (STIs).

Diaphragms and cervical caps. A diaphragm is soft, rubber dome inserted into the vagina prior to intercourse to prevent sperm from reaching the cervix. A cervical cap is a latex or silicone dome that fits over the cervix.

• Requires a prescription
• Typically is reusable
• Must be used with a spermicide

Condom. A shield made of latex, polyurethane, or natural membrane that blocks male sperm from reaching a woman's egg. You must plan for and use a condom each time you have sexual intercourse. The male version fits over the penis and the female version fits inside the vagina.

• Does not require a prescription
• Synthetic condoms are the only birth control method that protects you against the human immunodeficiency virus (HIV) infection, as well as most STIs
• Not reusable

Vaginal sponge. A disposable polyurethane foam, pre-filled with spermicide. It works by acting as a barrier, absorbing semen, and via spermicidal action.

• Available without a prescription
• Prefilled with spermicide

Spermicide. Spermicide is inserted into the vagina and may be foams, creams, jellies, films, or suppositories. They prevent pregnancy by forming a chemical barrier that either kills the sperm or makes them inactive.

• Does not require a prescription
• Most effective when combined with another barrier method
  

IUD
IUDs (intrauterine devices) are reversible at any time and are easily inserted and removed by a trained health care professional. The hormonal IUD contains progestin. The copper IUD does not have hormones - if you are looking for a non-hormonal contraceptive.

• Can be used continuously for up to 10 years (non-hormonal ) and 5 years (hormonal)
• May increase cramping or bleeding during periods (non-hormonal) or decrease bleeding (hormonal)

STERILIZATION
If you are absolutely certain that you do not want children in the future, sterilization offers a safe and effective method of birth control. There are two version of female sterilization - cutting or burning the tubes leading from the ovaries to the uterus, or placing micro-inserts into the tubes to cause scar tissue to grow and block the tubes. For men, sterilization (vasectomy) involves cutting the tubes that allow sperm to mix with semen.

• Has no effect on the production of sex hormones in men or women. Men will continue to produce sperm-free seminal fluid during intercourse and women will continue to menstruate.
• The procedure takes about 20 minutes for men and one hour or less for women.
• Depending upon the procedure, a general or local anesthetic is used
• Considered permanent. Surgery to reverse the procedure is available, but is costly, is considered major and results are not guaranteed.

NATURAL FAMILY PLANNING
This method relies on the woman to carefully monitor her body to determine the days where she is least fertile to reduce the likelihood of getting pregnant. During the time when the woman is fertile, she either abstains from intercourse or uses a barrier method. It is non-hormonal and non-invasive, but requires commitment on the part of a woman and her partner to planning optimal times for sex to plan for conceiving or not conceiving a pregnancy.

Sample questions for your health care professional

• How is the method used?
• How safe and effective is the method?
• What are the side effects of the method?
• How quickly can I become pregnant after I stop using this method?
• Are there methods that are or are not recommended due to my medical history?
• What birth control method would you recommend for me at this stage of my life?

Consider Your Options
If you recently had sexual intercourse and didn't use contraception, ask your health care professional immediately about emergency contraception options.

Safer sex practices are encouraged for all sexually active women and men, including use of a condom, as most birth control methods do not protect you from sexually transmitted infections. Please discuss this information, along with the benefits and risks of each method, with your health care professional.

This was prepared for you by members of the American College of Nurse-Midwives (ACNM). ACNM represents certified nurse-midwives (CNMs) and certified midwives (CMs) who provide comprehensive health care to women of all ages throughout the U.S. These women may be pregnant, need an annual check-up, have common health problems, be transitioning into menopause, or need more information in order to stay healthy. Women, families and doctors who value safe, personalized and respectful treatment give high praise to CNMs and CMs.