Janice had it all planned: Three children, each two years apart, and each gap facilitated by the birth-control pill. But after her first child, a beautiful boy delivered with no complications, her viewpoint changed - like so many women in the immediate aftermath of childbirth.

"I still want three children," she explained, as she sat in my office several weeks later, but I don't want to take the pill again - which I liked using - until I stop breastfeeding. Actually, my husband and I were talking about trying natural family planning or the diaphragm."

Having a baby changes us. Our relationships change, our bodies change, and our day-to-day lives change. All of these changes affect our plans for birth control. During the postpartum period, women now have the ability to meet their contraceptive needs with a wide variety of birthcontrol options that fit their changing lifestyles.

You may want to reevaluate your own family planning goals during your pregnancy and early postpartum. Have they now changed? Are you feeling confident about the previous methods you have used? Your goals will determine your choice of a contraceptive method. For example, if you are concerned about the spacing of future pregnancies, you might choose a method that is safe during breastfeeding, even though it may not be as reliable as other methods. If you want to delay a future pregnancy with a long-term method that is highly reliable and affords privacy, you may consider one of the available implants or injectables. To temporarily suspend childbearing, you might look into getting an IUD. For a more permanent option, consider sterilization.

Here are some important questions you should review with your health care provider:

Do you smoke? Smoking can cause complications when using the birth-control pill, especially if you are over 35. For your general health and the health of your children, it would be wise to stop smoking immediately.

Do you have medical conditions? Some conditions might prevent you from using certain methods. Be sure your provider knows your (and your family's) medical history. Also inform your provider of any medical complications during a pregnancy.

What is your family history? Genetic disorders might affect your decision to have children. What should you do? Some common genetic diseases that pass through families are sickle cell anemia and Tay Sachs Disease. Please give your health care provider a complete history of family medical conditions. You may want to undergo genetic testing before becoming pregnant again.

Do I take any medications? Because medications can alter the effectiveness of some methods of contraception, inform your health care provider of any medications you take frequently or on a routine basis. This includes prescription, over-the-counter and herbal remedies.

Do you want another baby? A nonhormonal IUD could provide an effective, nonpermanent solution. To permanently terminate childbearing, look into sterilization. Once you've reviewed the above items with your health care provider, there are other factors to consider:
Is the method safe to use during breastfeeding?
When can the method be started after delivery?
What is the method's average rate of success?
How long can the method protect me against unplanned pregnancies?
How long will I have to wait to have another baby after I stop the method?
How private is the method? Does my partner need to be involved?
How much will it cost to use the method?
Will it protect me against sexually transmitted diseases?
Finally, now that I have a (or another) baby to take care of, how easy is it to use the method?

Just as you depend on your birth-control method, your birth-control method depends on you. An important factor to consider is whether or not you are breastfeeding.

Breastfeeding, which often delays the resumption of your period, should not be considered a contraceptive method. All breastfeeding women should use another form of contraception because ovulation can occur before menstruation begins.

For example, the Lactation Amenorrhea Method (LAM) is an effective form of birth control (1 percent to 2 percent chance of pregnancy until your baby is 6 months old) if: You have not menstruated since delivery
You are not offering formula supplements or allowing long periods (five or more hours) between breastfeeding sessions
Your baby doesn't frequently suck on any artificial device such as a pacifier
Your baby is less than 6 months old.

Another important factor to consider is how practical your method is in your daily life. After we have babies, we are all faced with more work to do. As one new mother claimed, "With a baby to take care of, I don't want anything else to worry about!"

On the other hand, some women reevaluate family planning in terms of awareness of their menstrual cycles. Some even come to see birth control as a collaborative effort between themselves and their husbands.

Although it is vital that you learn all of your method's side effects and that you continually monitor yourself for their occurrence, how much attention do you really want to give to the actual use of your method? How often do you want to think about the method you choose: at each act of intercourse? Daily? Monthly? Yearly?

Methods such as natural family planning require continual attention and cooperation between partners. The birth-control pill requires that you remember to take a pill daily. Using IUDs, injectables, a hormonal patch or implants allows for freedom from daily attention but requires vigilance at certain intervals.

Even though there is a wide variety of birth-control methods available to us now, we must keep an eye on the future for new options that become available.

Those new options being developed are safe and effective, safe for breastfeeding, allow us to continue with our busy lives as mothers, and may protect us from sexually transmitted diseases.

Those that will be available soon include implants that last fewer than five years, hormonal vaginal rings that may be left in place for extended periods of time, IUDs that have lower expulsion rates and less discomfort, birth-control hormone patches, and new kinds of female condoms.

The vaginal sponge, a spermicidal sponge inserted before intercourse, is being reintroduced to the American marketplace. Also, male contraceptives that prevent the development of sperm contain "anti-sperm" compounds and that have temporary sterilization effects are now under development.

To make informed choices about birth control:

• Know your own family-planning goals
• Know the options available with regard to general health and any medical conditions you may have
• Know your method and how it fits in your life
• Know how your method works, the side effects and what health risks are associated with its use
• Know if your method fits with your sex practices.