A Midwife’s Approach to Women’s Health and Contraception

As a midwife, our work is not only about pregnancy and birth. It’s about caring for women as a whole before conception, between pregnancies, and throughout every stage of life.

One of the most important conversations I have with women is about contraception, because the choices we make here can have a profound impact on our hormones, our cycles, and our long-term health. Contraception should never be a one-size-fits-all decision. And before you tell me your 50-year-old male doctor had a 3-minute conversation with you within 24 hours after birth – I know! It’s the hospital’s top priority to make sure you know about contraception. But for us, we talk about it when the time feels good and as things settle down after the baby is born, at least 2 weeks. But we don’t talk about it to ensure you don’t call us back in a year! We talk about it because we care about your health, wellbeing, and future fertility and plans.

Okay, let’s start. I'm going to talk you through some routinely offered medication-based options, and also holistic methods. The more alternative options focus on understanding the body's natural processes, while other or modern methods often involve devices or hormones to prevent pregnancy.

Let’s start with the oral contraceptive pill.

The pill is often prescribed quickly and routinely. While it can be effective at preventing pregnancy, it works by switching off ovulation and overriding your natural hormone cycle. The bleed you get on the pill isn’t a real period; it's a withdrawal bleed from the synthetic hormones.

Over the years, I’ve supported many women who weren’t warned about possible side effects, including:

Mood changes, anxiety, or low mood
Headaches or migraines
Reduced libido
Nutrient depletion
Ongoing hormonal imbalance once they stop the pill

The pill can mask underlying issues rather than fix them. When women come off it, they’re often left wondering why their cycle is irregular or why symptoms suddenly appear. These are conversations we should be having before a script is written.

I have some concerns about the oral contraceptive pill, but as always, everything is your choice. Gather as much information as you can and explore if this choice is right for you.

Hormonal options such as the arm implant (Rod) and the Mirena IUD are often marketed as low-effort solutions. While they may suit some women, they still work by altering natural hormonal processes.

The contraceptive implant (Rod) is placed under the skin of the upper arm and releases a synthetic version of progesterone (progestogen) into the bloodstream. This hormone works by preventing ovulation (so the ovary does not release an egg), thickening cervical mucus to block sperm, and thinning the lining of the uterus. Because it suppresses or alters ovulation, it changes the body’s normal monthly hormonal rhythm. Women often report side effects such as mood swings, irregular and unpredictable bleeding, and more.

The Mirena IUD is placed inside the uterus and releases a small, steady amount of progestogen locally. It thickens cervical mucus and thins the uterine lining, and in some women it also suppresses ovulation. Although the hormone level in the bloodstream is lower than with the implant, it can still affect the body’s natural cycle and bleeding patterns. The benefit here is it can be removed easily compared with the Implanon. Some women love this option; some experience constant pregnancy-like symptoms and would never get it again.

Some women experience lighter periods or no bleeding at all, while others notice irregular bleeding, mood changes, headaches, breast tenderness, or changes in libido. For some, these effects settle over time; for others, they don’t feel quite like themselves.

About DEPO Injection

One option that deserves careful discussion is the DEPO injection.

DEPO is a hormonal contraceptive given every three months. It works by suppressing ovulation and altering the body’s natural hormone signalling. Once administered, it cannot be reversed and remains active in the body for months afterwards.

A Little Background…

DEPO took more than 20 years to receive FDA approval for contraceptive use. This lengthy process raised important safety questions and is part of why many health professionals believe it deserves careful discussion before being prescribed. In general, it’s quite uncommon that it’s recommended as an option. Even the mainstream medical system doesn't rate it. So although only 2% of the world prescribes it, considering its risk profile, I feel it important to mention it here!

Known Risks and Side Effects

DEPO acts not only as a progesterone-like hormone but also behaves similarly to a steroid in the body. This helps explain some of its recognised side effects, which may include:

Loss of bone density (now a formal safety warning)
Mood changes and low mood
Weight gain
Delayed return to fertility (often 12 months or longer)
Poor immune system

Because the injection cannot be stopped once given, women may experience these effects for some time.

Some women choose DEPO for its convenience or because it may stop periods. From a midwife’s perspective, it’s important to understand that a regular menstrual cycle is a sign of hormonal health. Suppressing it can sometimes hide underlying imbalances.

We believe every woman deserves the time and space to understand how a contraceptive works and how it may affect her body now and in the future.

Natural Fertility and Natural Family Planning

I hear you, you have probably heard of someone getting pregnant while using natural fertility. But did you know, when used appropriately, it can be up to 99% effective! One of the most empowering tools I share with women is fertility awareness and cycle tracking. These methods are often misunderstood, but when taught correctly, they can be highly accurate.

Cycle tracking involves understanding your ovulation, cervical fluid, and natural hormonal patterns. It allows you to work with your body, not against it. Beyond contraception, it helps women:

Understand their fertility
Identify hormonal imbalances early
Feel more connected to their bodies

As explored in the book The Fifth Vital Sign, your menstrual cycle is a key indicator of overall health. When we suppress it, we lose valuable insight into how our body is functioning.

Why Our Cycle Matters

A regular menstrual cycle tells us so much about a woman’s health. It shows us that ovulation is occurring, hormones are communicating effectively, and the body is functioning well. When hormonal contraceptives interrupt this cycle, they can affect many interconnected systems, from emotional wellbeing to energy levels and digestion. As a midwife, I see time and time again how important it is to honour the body’s natural rhythms, and it doesn't stop at having a baby!

Long-Term Contraceptives

For couples who feel their family is complete, there are long-term contraceptive options to consider:

Male Sterilisation (Vasectomy, also known as “The Snip”)

A vasectomy is a minor surgical procedure that blocks the tubes (vas deferens) that carry sperm. It prevents sperm from mixing with semen during ejaculation.

Benefits:
Highly effective (over 99%)
Quick procedure (often 15–30 minutes)
Usually done under local anaesthetic
Lower complication rates compared to female sterilisation
No impact on testosterone, erections, libido, or orgasm

Risks & Considerations:
Small risk of infection or chronic pain
Not immediately effective (backup contraception is needed for several weeks)
Reversal is possible but not guaranteed

Female Sterilisation (“Tubes Tied” / Tubal Ligation)

Tubal ligation involves surgically blocking, clipping, or sealing the fallopian tubes to prevent the egg and sperm from meeting.

Benefits:
Highly effective (over 99%)
Permanent contraception without ongoing maintenance

Con’s:
Requires abdominal surgery (usually under general anaesthetic)
Higher complication risk than vasectomy
Reversal surgery is complex and not always successful

These options are best chosen when you feel confident that you’ve finished having children, as they are intended to be permanent.

As always, informed choice matters here. Overall, I tell clients that a vasectomy appears to have the lowest-risk option overall. But I have heard concerns around the male’s long-term health being mildly affected. It appears there is no one-size-fits-all amazing option!

My role is not to tell women what to choose. It is to ensure they feel safe, heard, and fully informed. We talk about all options, hormonal, non-hormonal, and natural, and we consider each woman’s health history, lifestyle, and future plans. Contraception should support a woman’s wellbeing, not compromise it. And choices around planning conception and short- and long-term options are paramount for women to consider, as well as physical and mental wellbeing through the childbearing years.

Every woman deserves clear information and the confidence to make choices that feel right for her body.

Chat soon,
Hannah x