It is known that a woman remains infertile while she is breastfeeding. This method of natural contraception is called the lactational amenorrhea method (LAM). The duration of this period and infertility depends on the breastfeeding – hence, whether breastfeeding is regular or not, how many times per day breastfeeding happens etc.
The stimulation of the nipple during breastfeeding causes the release of prolactin, which inhibits production of gonadotropin-releasing hormone (GnRH) by the hypothalamus and the luteinizing hormone (LH) by the pituitary gland. Low levels of progesterone in the blood denote the absence of ovulation – the oocyte doesn’t maturate and is not released from the ovary. Respectively, menstruation doesn’t occur. Therefore the condition is called the lactational amenorrhea. “Lactational” refers to the breastfeeding and “amenorrhea” indicates the absence of the periods.
Sometimes the menses return quickly after the delivery, the ovulation doesn’t occur. Still, in some cases even when a woman is breastfeeding intensively ovulation may develop in the early postpartum period. However, the studies suggest that the first menstrual cycle is abnormal and the progesterone concentration is insufficient for the pregnancy to occur. The following cycles should be thought of as fertile.
- Fully breastfeeding – Exclusive breastfeeding means that a baby doesn’t get any other fluids or other food except the mother’s milk. Almost exclusive breastfeeding that a child may get water, juice or other foods occasionally.
- Partial breastfeeding
- High – the intervals between breastfeeding are less than 4-6 hours;
- Medium – breastfeeding comprises about half of the child’s feeding;
- Low – breastfeeding comprises less than 50% of child’s nutrition.
- Token – minimal breastfeeding with long intervals in between and the prevalence of supplemental food;
Despite the spread of this method most women don’t know how to use it correctly and, therefore a large number of unexpected pregnancies occur during the first year after the first child was born. However, when a woman is aware of the characteristics of this method its effectiveness reaches 98-99,5%. When a woman is not breastfeeding fully or nearly fully risk of pregnancy is higher.
Criteria for effective lactational amenorrhea
According to the Bellagio Consensus, LAM may be used effectively only when the following 3 criteria are met:
- Amenorrhea – the periods are still absent;
- The baby was born less than 6 months old;
- The baby is fully or nearly fully breastfed (full and high partial breastfeeding) and the feeding is frequent (the interval between the breastfeeds is not longer than 4 during the day and 6 hours at night);
When to expect ovulation?
You may suspect the ovulation when you detect:
- Increased production of the vaginal mucus;
- Vaginal discharge changes color;
- Basal temperature increases;
- Doesn’t offer protection against sexually transmitted diseases (as well HIV);
- It is not recommended to rely on this birth control method in conditions when pregnancy is contraindicated as it is impossible to predict when the fertility restores;
- For the highest effectiveness of LAM all three criteria should be kept;
- This method of contraception is temporary and may be used only for several months;
- Not always it is possible to continue intensive breastfeeding;
The Seven Standarts of Ecological Breastfeeding
Natural postpartum infertility may be prolonged when the next recommendations are followed:
- Breastfeed exclusively for the first six months of life; don’t use other liquids and solids, not even water.
- Pacify or comfort your baby at your breasts.
- Don’t use bottles and don’t use pacifiers.
- Sleep with your baby for night feedings.
- Sleep with your baby for a daily-nap feeding.
- Nurse frequently day and night, and avoid scheduling.
- Avoid any practice that restricts nursing or separates you from your baby.
When a mother sticks to the Ecological Breastfeeding she will likely start to menstruate 9-20 months after the delivery.