Breastfeeding as Birth Control? September 1, 2014 14:21
Written By Michelle Roth, BA, LCCE, IBCLC
In teaching breastfeeding workshops, women (and men!) were always dubious when I taught that breastfeeding could be used as birth control. “Well, my friend’s sister’s roommate has babies 9 months apart, so breastfeeding must not be effective,” I heard. Of course, there are criteria to meet for it to be effective; but, in the early months after birth, the Lactational Amenorrhea Method (LAM) can be an effective means of preventing pregnancy.
LAM has a 99% effectiveness rate when used correctly and consistently. As it’s commonly used, LAM is 98% effective at preventing pregnancy. These rates are comparable to ‘the Pill’ and better than condoms! Check out this chart from the World Health Organization (WHO) to compare LAM to a variety of contraceptive methods.
For women who do not breastfeed, periods typically return six to eight weeks after birth. Women who do breastfeed, however, tend
to go much longer without regular periods. Some women’s menses don’t return until after baby is weaned – even if baby nurses a year or more! Research shows that the sooner after birth a baby breastfeeds, the longer the delay in the return of a woman’s periods. And it’s not just active feeding at the breast that counts – non-nutritive suckling also serves to prolong the time without menstrual cycles.
Lactational amenorrhea is a normal phase in a woman’s reproductive cycle. Levels of luteinizing hormone and estrogen, both necessary for ovulation, are low in breastfeeding moms, and researchers theorize that high prolactin levels are also at play. While these are the basic underlying hormonal mechanisms thought to control return of menses after birth, the research about lactational amenorrhea is ongoing.
So, how can you tell if this is the right method of postpartum contraceptive for you? If you can say ‘yes’ to all three of these criteria, then LAM is a good option:
- Your baby is younger than six months old.
- You have not started having menstrual periods again.
- Your baby is breastfeeding often (day and night) and gets no other food or drink.
In a review of data for 45 countries, however, Fabic and Choi found “nearly 75 percent of women who characterize themselves as current LAM users do not practice LAM correctly.” So it’s important to keep in mind that when you can answer ‘no’ to any one of the above, it’s time for a different method of birth control if you don’t want to get pregnant.
Another benefit of LAM is that it doesn’t have side-effects. If you are breastfeeding, be cautious with hormonal methods of birth control, especially those containing estrogen. One concern has to do with the transfer of these hormones to baby through breastmilk. But, these contraceptives have the potential to impact your milk supply as well. While not every woman will have decreased supply after starting hormonal birth control, some do. So proceed with caution if you choose this method rather than LAM, and know how to boost your supply if it starts to falter.
Research about LAM is compelling, but lack of clear definitions can make it difficult to compare studies and the rates of pregnancy they report. According to a Cochrane Collaboration review, it was difficult to ascertain if LAM was more effective than just the natural period of infertility after birth. What made their review most difficult was lack of consistent definitions of amenorrhea as well as selection bias, lack of control groups, and inconsistent control for confounding variables.
On the other hand, some argue that LAM should be promoted more often than it is – regardless of these study inconsistencies. It is a no-cost, easy-to-explain method that any postpartum mom can use on her own without medical intervention. Panzetta and Shawe suggest that perhaps healthcare providers need to learn more – they are simply misinformed about LAM and its effectiveness. In their survey of women’s health practitioners in the UK, these authors found that attitudes about LAM ranged from “it’s too difficult to teach” to “women just want pills” to “we should be promoting the strongest, most reliable contraception available.” These beliefs show that persistent myths about LAM are limiting its use.
Labbok believes LAM promotion takes a ‘transdisciplinary approach’ – with governments, public health officials, healthcare providers, breastfeeding counselors, and more working together to promote innovative ideas that better women’s health (such as LAM).
LAM is free. You don’t need to remember to take it or worry about it ripping. It comes in convenient packaging. Trust your body, follow the guidelines, and consider breastfeeding as a valid birth control option.
Fabic MS, Choi Y. (2013). Assessing the Quality of Data Regarding Use of the Lactational Amenorrhea Method. Studies in Family Planning, 44(2), 205-221.
Labbok, MH. (2008). Transdisciplinary breastfeeding support: Creating program and policy synergy across the reproductive continuum. International breastfeeding journal, 3(1), 16.
Panzetta S, Shawe J. (2013). Lactational amenorrhoea method: the evidence is there, why aren't we using it?. Journal of Family Planning and Reproductive Health Care, 39(2), 136-138.
Riordan J, Wambach K. (Eds.). (2010). Breastfeeding and human lactation. Jones & Bartlett.
Van derWijden C, Brown J, Kleijnen J. (2003). Lactational amenorrhea for family planning. Cochrane Database of Systematic Reviews, Issue 4.