Contraception

Is breastfeeding a contraceptive?

I couldn’t help but smile to myself as I wrote that… only today someone was talking about this and said that the chances of sex happening again in the foreseeable future was slim – the process of labour and giving birth was enough to ensure there was little chance of any pregnancy-inducing behaviour happening in their house 🙂

However, the question of the contraceptive effect of breastfeeding does come up quite often so I thought I’d put some information here.  Breastfeeding as a way of avoiding pregnancy is referred to as the Lactational Amenorrhea Method, or LAM.  This method has only a 1% to 2% failure rate providing all 3 of the following are true:

  • the mother’s period have not returned since the birth of her baby (spotting or bleeding during the first 56 days does not count) AND
  • the mother is breastfeeding her baby on demand day and night, with no other regular drink or food substitutes AND
  • the baby is less than six months old

If any one of these is not true then the chance of LAM being effective is reduced, and at the point that any one of the above conditions changes, the couple should use other methods of contraception if they are keen to avoid pregnancy.

Return of Menstruation – during the first 56 days after a woman has given birth, spotting or bleeding does not count as a period.  However, after the first 56 days, spotting or bleeding of 2 days or longer duration should be considered as a period, or any other bleeding that the mothers feels is a return of menstruation.  This would mean that LAM may no longer be effective and other contraception should be used.

Breastfeeding at Night – for the second condition to be considered effective, the mother should be breastfeeding at least once during the night as well as on demand during the day.  Prolactin levels are higher at night thus having a greater impact on fertility.  If the baby goes longer than 4 hours during the day or 6 hours at night without breastfeeding, the effectiveness of LAM may be reduced and other contraception should be considered.

The Baby is less than 6 months old – once a baby reaches 6 months old it is common for other foods to be introduced and for babies to go longer between feeds.  Due to less breastfeeds taking place from 6 months old, LAM may become less effective and other contraception should be used.

Methods of contraception that will not impact breastfeeding are barrier methods such as condoms or diaphragms, spermicides, or non-hormonal IUDs.  Natural family planning methods can be hard to use at this stage due to the impact of breatfeeding on the signs of fertility.

After the first six weeks, progesterone only methods such as the mini-pill, injectable contraceptives, and other IUDs may be suitable.  Progesterone only methods are unlikely to have an impact on breastfeeding, but it is advisable to wait until six weeks or so has passed to allow breastfeeding to become more established.

For more information about LAM and contraception, check out this very useful website:  http://www.waba.org.my/resources/lam/#LAM

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Breastfeeding and contraception

There have been many studies and articles telling us that babies need only breastmilk for around the first 6 months of life, and that this should be continued until at least 2 years of age alongside complementary foods (http://www.who.int/topics/breastfeeding/en/).  This is the best way to support the health, development and growth of the baby.

Before having another baby, it is also recommended that the mother has a chance to regain her normal level of health following the demands of being pregnant, giving birth and feeding her baby.  The healthier the mother is before she has her next baby, the better it will be for the pregnancy, her health and her family.  It is therefore considered that the optimum space between babies is 39 months:  24 months of breastfeeding, a 6 month break to ensure mother’s health is at it’s optimum, plus 9 months of pregnancy; the minim gap considered adequate for maternal recovery is 18 months.  Of course, in developed countries where women are able to have a good diet and a healthy lifestyle, parents may choose to have a shorter gap between their children with no apparent impact to the mother’s health.

Contraception isn’t something automatically at the top of everyone’s list of “things to do” immediately after having their baby… for many couples the idea of sex isn’t even on the horizon, let alone the thought of having another baby 🙂  Usually the mother’s health care provider/midwife will have discussed contraceptive options with the mother before the baby is born, together with the impact of each option on breastfeeding.

Women who breastfeed are less likely to ovulate early after having their baby, whilst women who don’t breastfeed may ovulate as early as 3 weeks after giving birth.  Since data published in early 1970’s suggested that women who breastfeed don’t ovulate early postpartum, studies and meetings between various researchers from several centres have taken place (1998 and 1995), all indicating that breastfeeding women have a time of natural contraception, known as the Lactational Amenorrhea Method (LAM).

This method of contraception is considered to be 98% effective, and therefore may be considered more effective than the progesterone only pill.  In order to use LAM effectively there are three questions that the mother needs to ask herself on an ongoing basis.

  1. Have your periods returned?  For the purposes of LAM, this means any bleed after 56 days postpartum that you believe is a period, or that lasted for 2 consecutive days.
  2. Are there long periods of no breastfeeding during the day or night, or do you regularly supplement your baby?
  3. Is your baby more than 6 months old?

If the answer to any of these questions is yes, or becomes yes over a period of time, then other methods of contraception should be used.  Because of the impact of fully breastfeeding on a women’s fertility, a woman is unlikely to ovulate before her first period.  However, once the first period has taken place, other contraception should be used.  LAM is used in over 30 countries and is widely accepted as a natural family planning method.  LAM is considered to be adequate for 6 months as this is often when complementary foods are added to the baby’s diet, however in some countries it has been shown to work for up to 9 months as the women maintain breastfeeding frequency by breastfeeding before offering other foods.

A study of women who had returned to work the place, showed that LAM was around 95% – 96.5% effective when the mothers expressed milk when they weren’t with their baby – expressing needs to take place at least as often as the mother would have fed her baby had they been together.  This shows a slight increase in risk of pregnancy.

Exclusively breastfeeding mothers often find their periods don’t return for 6 months or more, however some find that even though they breastfeed exclusively and often, their periods return after 2 or 3 months.  In this case, it is not clear whether these menstrual cycles are adequate for ovulation to take place so other methods of contraception should be used if the mother wishes to not get pregnant.

As soon as LAM no longer applies to a mother’s situation, other contraception should be used.  Barrier methods (ie. condom, diaphragm) are considered to be 94% to 97% effective when used perfectly and the next best option to LAM when breastfeeding.  The progesterone only pill may be taken by breastfeeding women from 6 weeks postpartum, however there is much anecdotal evidence to suggest that it may have an impact on milk supply, so it may be prudent to delay using this method until milk supply and breastfeeding is well established.  The combined contraceptive pill is not generally considered a suitable contraceptive while the baby is still breastfeeding.

More information can be found about LAM here:  http://www.kellymom.com/bf/normal/fertility.html

and here:  http://www.waba.org.my/resources/lam/