Let me clear up this breastfeeding as birth control thing
There's a lot of misconceptions about breastfeeding as birth control (aka LAM, or the Lactational Amernorrhea Method).
Yes, it CAN work - as well as any method of birth control (please note, any method you use has a margin of error - how many times have we seen women get pregnant on BCP, even using them correctly?)
For the first six months, if baby is exclusively breastfed with NO supplementation, every 2-3 hours around the clock and no break of more than one 4-5 hour stretch at night, breastfeeding is 98% effective at preventing pregnancy AS LONG AS YOUR PERIOD HASN'T RETURNED. As soon as your period returns, breastfeeding alone is no longer reliable, you must use NFP or FAM principles to avoid pregnancy.
If fertility returns in the first six months while EBF, it is very likely preceded by a "fake" period before actual ovulation returns. Usually there is no ovulation before the first period.
After the first six months, while breastfeeding, ovulation will most likely NOT be preceded by a period. This is why it's important to use NFP or FAM principles after the six months if still avoiding pregnancy.
The most effective method of LAM is to practice the principles of ecological breastfeeding. These are:
Ecological breastfeeding is a stricter form of LAM developed by Sheila Kippley, one of the founders of the Couple to Couple League. Studies have shown it has a 1% failure rate in the first six months postpartum, and a 6% failure rate before the woman’s first postpartum menstruation. The Seven Standards of ecological breastfeeding are slightly different from the LAM criteria:
- Breastfeeding must be the infant’s only source of nutrition – no formula, no pumping, and (if the infant is less than six months old) no solids or water at all.
- The infant must be pacified at the breast, not with pacifiers or bottles or by placing a finger in the mouth.
- The infant must be breastfed frequently. The standards for LAM are a bare minimum; greater frequency is better. Sucking should include non-nutritive sucking when the infant cues the mother, not just breastfeeding as a means of nutrition. Scheduling of feedings is incompatible with LAM.
- Mothers must practice safe co-sleeping as it is the proximity of the child to the mother that increases prolactin.
- Mothers must not be separated from their infants. This includes substitutes for mother such as babysitters and even strollers or anything else that comes between mother and physical contact with her child. Babywearing (using cloth carriers) means tactile stimulation between mother and child and increases access to the breast. Any separation from the mother will decrease the efficacy of ecological breast feeding.
- Mothers must take daily naps with their infants.
- A mother must not have had a period after 56 days post-partum (bleeding prior to 56 days post-partum can be ignored).
The transition to full fertility
Several studies have indicated that fertility and ovarian activity return step by step (Ellison 1996, p. 326-327):
- Follicular activity without
chance of pregnancy.)
1a. Menstruation without ovulation (This does not always occur--see below.)
- Ovulation without luteal competence (After the egg is released, fertilization may take place. During the luteal phase, the uterine lining is prepared for implantation as the egg travels down the fallopian tube and into the uterus. If the uterine lining is not adequately prepared for implantation, the implantation will probably not be successful.)
- Full luteal competence (Full fertility -- at this point breastfeeding no longer has any effect on your chance of pregnancy.)
It is possible to have one or (occasionally) more periods before you start ovulating. In this case, menstruation begins during the first stage of the return to fertility --before ovulation returns. Cycles without ovulation are most common during the first six months postpartum. For other mothers, the first menstruation is preceded by ovulation - a longer period of lactational amenorrhea increases the likelihood that you will ovulate before that first period.
A very small percentage of women will become pregnant during their first postpartum ovulation, without having had a postpartum period. Per fertility researcher Alan S. McNeilly, this "is rare and in our experience is related to a rapid reduction in suckling input."
It is not uncommon for breastfeeding mothers to report cyclical cramping or PMS-type symptoms - symptoms of an oncoming period without the period - for weeks or even months before their period returns. When this happens, the body is probably "gearing up" for the return of menstruation, but breastfeeding is still delaying the return of fertility.
The amount of time that it takes for the transition to full fertility varies from woman to woman. In general, the earlier that your menses return, the more gradual the return to full fertility.
|Reference||Menstruation without ovulation||First ovulation without luteal competence||Time between 1st period and ovulation|
|0-6 mo||after 6 mo||0-6 mo||after 6 mo|
|Eslami 1990||67%||22%||--||8.4 weeks||0.1 week|
|Gray 1990||45.1%||"the rate fell greatly"||41%||--||--|
|Reference||Frequency of ovulation|
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