How To Prevent Pregnancy While Breastfeeding

Being an experienced mom is one thing, but for new moms, this issue can pull them into uncharted waters. Your doctor might suggest going back on birth control following your baby’s birth, and sure, this seems to be the easiest solution. Or you might be planning to have your kids close together and not use contraception at all. Every woman is different, and her family planning choices will definitely look different from another’s. 

Her fertility and the return of her first postpartum period will also look different from someone else’s. A mom who chooses to formula-feed her baby might get her period back more quickly than a mom who breastfeeds for six months or longer. Breastfeeding is used by many as a form of pregnancy prevention because the production of prolactin while breastfeeding essentially stalls the return of menstruation. But does it really work as a form of contraception?

Is the Lactational Amenorrhea Method Effective?

Breastfeeding as contraception, like breastfeeding itself, is an ancient practice, but it’s only within the last few decades we’ve examined it from a deeper, more scientific perspective. Using breastfeeding as contraception, a natural form of pregnancy prevention, is known as the lactational amenorrhea method.

Lactational refers to the production of breastmilk in the mother, while amenorrhea refers to the complete absence of a period in a woman of childbearing age. Before we get into LAM, though, it should be noted that LAM is a short-term method of contraception for several reasons. While it may be effective for the first few months of your child’s life, it becomes less effective and your chances of getting pregnant may increase if you’re not using other means of protection or prevention. With perfect use, though, it’s 99% effective.

According to the extensive research we now have on LAM, three criteria must be met by the mother for it to be effective as a form of contraception. First, her baby must be less than six months old. As babies begin to nurse less and eat more solids, the chance that a woman’s period will return becomes higher. Secondly, her baby must be completely (known as “exclusively”) breastfed on demand, day and night. The more a woman breastfeeds, the better the chance that menstruation won’t return. As babies nurse less or sleep longer throughout the night, the less effective LAM becomes, as the mother is not producing as much prolactin as she was in the beginning of the postpartum period. Finally, a woman’s period cannot have returned for her to be using LAM as an effective contraceptive method. LAM’s success hinges on the delay of ovulation and a period, and once a period has returned, it can no longer be effective. 

As babies nurse less or sleep longer throughout the night, the less effective LAM becomes.

LAM is ideal for new moms who are breastfeeding because it doesn’t require any means of hormonal birth control to prevent pregnancy to be effective. It can begin immediately when a mom resumes sexual activity following childbirth (usually, the recommended time is 6 weeks postpartum, depending on the mom, but every couple is different) and is free and requires no other commitment from her besides exclusively breastfeeding, which provides a myriad of benefits to the baby as well as mom. A comprehensive study examined the use of LAM in 12 countries and found that it is 98% effective for the first six months of breastfeeding, provided that the mom meets all three of the criteria. This study, led by experts in Italy in the mid ‘90’s, helped widely establish LAM as a natural means of contraception.

Know Your Options

A postpartum body will begin to experience hormonal shifts once mom lessens the frequency of nursing sessions and/or once a baby begins to receive solids or other supplemental nutrition in addition to breastmilk. It’s for this reason that LAM is most effective within the first six months of mom’s postpartum period. To give you an idea, a study of 50 breastfeeding moms who used natural family planning methods as contraception concluded that for 25 of the women, their period fully returned by 10 months postpartum, though one documented participant did ovulate before the return of menstruation.

Because LAM is a short-term contraceptive method, eventually, mom will have to decide which other pregnancy prevention measures she wants to begin. Relying solely on LAM even if your period hasn’t returned but your baby has decreased their nursing time isn’t recommended because ovulation may (or may not) have occurred and without the return of a period, it’s difficult to tell.

Many moms might choose to begin hormonal birth control during this time, especially if they’re done having kids or planning to wait a few years to have another. This includes options like the pill, an intrauterine device (IUD), or hormonal patch. All of these release artificial hormones into the body, and when a period returns, it won’t be an actual period but a withdrawal bleed. It doesn’t regulate or encourage your period at all, but it might bring a whole host of unexpected side effects you’ve never experienced before.

Moms who don’t want to use hormonal birth control following LAM may feel stuck in a rut. You might want to try natural family planning, but without a period or knowing when you’ve ovulated, you’re not exactly playing it safe, even if you use condoms or withdrawal. Once your period has returned, it’ll be easier to practice a method like fertility awareness, but if you’re experiencing irregularities in menstruation, things become more complicated. 

Contrary to popular belief, you can try natural family planning methods even if you have irregular periods or irregular ovulation. Some sites even have quizzes to help you determine which method of NFP may be ideal for your individual situation. If you’re seeking to prevent pregnancy while using NFP, look into talking with a certified instructor.

Above All, Be Safe 

Consent to unprotected sex, as extreme or harsh as it may sound, is consent to the possibility of pregnancy every time. Whatever method you choose and whatever direction your family planning journey is headed for, be safe.

Be an advocate for your postpartum body.

Most of all, be an advocate for your postpartum body. It has just accomplished the most extreme evolution a female body can undergo, and if things aren’t shipshape six months after your baby’s birth, give yourself grace. Your body is still figuring out how to right itself, and if you were experiencing regular menstruation before, don’t be discouraged or dismayed at the potential of being late or irregular following pregnancy. Take these new developments and indicators of your fertility returning as an opportunity to learn about your body and what it’s trying to tell you.

If you’re committed to practicing LAM within the first six months of your breastfeeding experience, be committed all the way: make sure your period hasn’t returned, notice signs of a potential return of ovulation like cervical mucus production or an elevated basal body temperature (all of which you can learn about through the fertility awareness method, or FAM) and make sure you’re exclusively breastfeeding your baby on-demand. That means no introduction of solids or other supplements like formula, and nursing consistently, which for the average mom is about 8 times within a 24-hour period.

Have backup methods of contraception on hand should you need them, specifically what feels most comfortable to you and your way of life, and most importantly, get educated on the contraceptive methods your doctor or girlfriends may be pushing on you. Remember, what’s ideal for someone else may not be ideal for you. Be safe when it comes to this transition, but be realistic as well.

Closing Thoughts

When you stop and think about it, the female body is consistently working for us, day in and day out. After delivering a baby, it gives us the means of preventing pregnancy, even as we nourish another human being for their growth and development. Lactational amenorrhea is incredible by design, and we may not even know fully how it can benefit us. Breastfeeding truly benefits both baby and mother, and reaping all of the rewards it offers can help us wholeheartedly embrace the postpartum experience.

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