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.
The ‘Hormone Cocktail’ of Birth and Breastfeeding July 19, 2014 19:16
Written By Michelle Roth, BA, LCCE, IBCLC
Mother Nature has endowed women with a system to handle growing, birthing and feeding a baby – a complex array of hormones that direct pregnancy, childbirth and breastfeeding. In fact, these hormones can make birth easier, safer, and maybe even ecstatic or orgasmic. And the release of hormones in breastfeeding not only aids milk production, but enhances relaxation. Pregnancy, birth, breastfeeding – all a part of the same continuum of sexuality and reproduction and all under the control of your hormones.
The hormonal roller coaster starts with pregnancy. A steady increase in hCG from the first week or so after conception until around weeks 8-10 of pregnancy signals that your body should produce more progesterone and estrogens. These hormones help the endometrium and embryo grow. Around week 10, the placenta takes over. Estrogen, progesterone, relaxin, prostaglandin, and more are produced to support the pregnancy. Progesterone relaxes the uterus and prepares the breasts for feeding. Estrogen increases blood flow to the pelvis. Relaxin loosens the ligaments for the expanding abdomen and impending birth. All of these hormones decline dramatically when the baby and placenta are delivered.
Researchers believe that the ‘nesting’ behaviors shortly before labor can be attributed a shift in hormones that means labor is imminent, though it’s not clear what the actual mechanism is that starts labor. The main ingredients of the ‘hormone cocktail’ during labor and birth include
Sometimes called the ‘hormone of love’, oxytocin is released during sexual activity, orgasm, birth, and breastfeeding – it stimulates feelings of love and altruism. It is also at the root of uterine contractions during labor, and it mediates ejection reflexes (such as the sperm ejection reflex during intercourse, and the fetus ejection reflex during birth). This hormone increases throughout labor and is highest at the time of birth. It makes a woman feel euphoria and opens her to interaction with her newborn baby. Baby’s body is also producing oxytocin, creating a hormonally driven reciprocity with mom after birth. Oxytocin is also needed after the birth to aid in the release of the placenta, and to decrease postpartum bleeding. Pitocin and syntocinon are synthetic forms of oxytocin used for labor induction and augmentation, and sometimes after the birth. Be cautious, as these do not seem to act the same way (in mom or baby) as naturally occurring oxytocin does.
These are ‘nature’s narcotics’ – opiate-like hormones that act as pain killers. Beta endorphins also cause feelings of pleasure, euphoria, and dependency – which can be great for bonding with a newborn baby. But these traits also mean a mom needs to turn off her thinking brain, and depend on those around her for support and advocacy. Extreme levels of endorphins can slow contractions – nature’s way of helping a mom adapt to her labor over time. These hormones facilitate prolactin release, another essential birth hormone.
Prolactin is a necessary component for breastfeeding – it is the hormone that signals to the body to make more milk. But it’s also known as a hormone of submissiveness, anxiety and vigilance, thus giving it the name ‘the mothering hormone’. Thanks to prolactin, new mothers exhibit protective behaviors to keep their babies safe, especially when combined with oxytocin.
The release of adrenalin and noradrenaline in labor seems counterintuitive – why would a woman release hormones associated with either fighting or fleeing? If a mother feels especially fearful of birth, these hormones may even cause labor to stop or slow down, and can lead to interventions such as augmentation and cesarean birth. But these hormones are necessary for the actual birth of the baby. A release of these hormones close to the time of birth give mom a burst of energy to push her baby out once the cervix is fully dilated. Levels of these hormones drop sharply after birth, but still help a mother learn to care for and protect her newborn baby.
According to experts, such as Sarah Buckley and Michel Odent, any disruption of this ‘hormone cocktail’ can have profound effects – maybe some we don’t even know about yet. Odent suggests that the hormones of labor and birth prepare a baby for extra-uterine life, and disruption of this process can wreak havoc with baby’s adaptation.
In order to make the most of this hormone cocktail, women need to feel safe, and to labor undisturbed. This doesn’t mean to labor alone, but to minimize any interruptions that take her focus away from labor. She needs an environment of privacy where she won’t need to worry about intrusions. Dim lights and warmth help, too. Help her turn off her thinking, rational brain, and let her older, more primitive brain take over.
Once the baby is born, another hormonal shift takes place. The sharp dive in the pregnancy supporting hormones gives way to an increase in lactation supportive ones. Prolactin and oxytocin are the main players in this game. Oxytocin is the milk-ejection hormone – when the nerves in the areola are stimulated, the brain sends a signal to the milk making cells to contract and send milk to the baby. Prolactin is the milk-making hormone. But oxytocin is also the ‘hormone of love’ – released to enhance bonding. Prolactin receptors are increased in the early weeks of feeding – the more baby nurses, the more prolactin receptors there will be, and ultimately the more milk mom will make. Prolactin also makes a mom feel relaxed while the baby is nursing.
Another important hormone-like substance is the ‘feedback inhibitor of lactation’ (FIL). This is released when the breasts are too full to signal to the body to make less milk. This helps to even out your milk supply to meet baby’s needs, but can also lead to low milk supply if your baby isn’t nursing often enough or isn’t transferring milk well.
You can maximize these breastfeeding hormones by nursing early and nursing often. Put your baby to the breast within the first hour after birth, and expect your newborn to nurse eight to twelve times every 24 hours. Don’t schedule feedings or restrict how long your baby nurses. Know the signs of good milk transfer, and get help if you need it.
Want to learn more? Read anything by Sarah Buckley and Michel Odent, among others. Type Ecstatic Birth or Orgasmic Birth into your web browser’s search engine, and read more about maximizing your birth hormones. Read about how breastfeeding works before birth so you are better prepared when baby arrives. And trust that you were made to grow and nourish a baby – your body knows what to do as long as culture doesn’t get in the way of your enjoying this hormone cocktail.
Buckley, SJ. (2010). Ecstatic Birth: Nature’s hormonal blueprint for labor. E-book. Available at www.sarahbuckley.com.
Nichols, F. H., & Zwelling, E. (1997). Maternal-newborn nursing: Theory and practice. WB Saunders.
Odent, M. (2007). Birth and breastfeeding. Clairview Books.
Odent, M. (1999). The scientification of love. Free Assn Books.
Riordan, J., & Wambach, K. (Eds.). (2010). Breastfeeding and human lactation. Jones & Bartlett Learning.