Breastfeeding As Birth Control – LAM

One of the many benefits of breastfeeding is its contraceptive effect. Women using the lactational amenorrhea method (LAM) have less than a 2% chance of becoming pregnant in the first 6 months after birth.

What is LAM?

Lactational amenorrhea refers to the cessation of ovulation and menstruation that naturally occurs while breastfeeding due to the hormone prolactin, which makes breast milk. LAM is the only completely natural form of birth control that does not require any abstinence. It costs nothing and requires very little thought or planning (if any)

How LAM Works

Since the effectiveness of LAM is directly related to your prolactin level, the more you breastfeed, the more effective it is.  LAM is over 98% effective if the following criteria are met.

1. Baby is under 6 months old.

2. Your period has not returned since 56 days post-partum. (bleeding before 56 days is not indicative of fertility)

3. Your baby is exclusively breastfed or at most receives very little nutrition besides your milk.

4. Your baby nurses at least every 4 hours during the day and doesn’t go more than 6 hours without breastfeeding at night.

5. You express your milk at least as often as your baby would be nursing and never less than every 4 hours, if you must be separate from your baby.  (studies have shown expression to be slightly less effective than breastfeeding.)

Making LAM More Effective

Women who offer their baby unrestricted access to the breast and offer no other source of sucking or nutrition for 6 months often find that LAM works for them even after their babies begin solids. Here are some ways to make LAM work longer for you;

1. Breastfeed the baby whenever she wants day and night.

2. Avoid using pacifiers – let baby use the breast for food as well as comfort.

3. If you start solids before 9 months, offer the breast first and then solids.

4. Practice attachment parenting, i.e. sleeping with or napping with baby and wearing baby in a carrier.

Knowing When To Consider Yourself Fertile

A woman breastfeeding in Western society should consider herself fertile if she can answer “yes” to any of the following questions.

1. Have your menses returned?

2. Are you supplementing regularly or going long periods without breastfeeding; more than 4 hours during the day or more than 6 hours at night?

3. Is your baby more than 6 months old?

However, as stated above, women who breastfeed unrestrictedly often stay infertile longer. It is trickier then to know when your fertility has returned. Any woman who begins menstruating should consider herself fertile even though her first periods may be anovulatory. On the other hand, once a year has passed since the birth and you still haven’t had a period, you are likely to ovulate before menstruating. In that case, you will have no warning signs and will very likely go from one birth to the next without ever having a period.  There are also women who need to cease breastfeeding completely in order to get pregnant again just as there are women who will get pregnant very early on despite exclusive breastfeeding.  Your first experience with LAM will tell you how your body responds.

Your decision as to when to begin using another form of birth control while still breastfeeding should probably be based on whether your intention is to prevent pregnancy or to just delay it.

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