A common myth is that you can’t get pregnant while breastfeeding, but what is the connection between breastfeeding and fertility? Lactational Amenorrhea is when a newly postpartum woman’s cycles have not restarted due to breastfeeding. This method of NFP is also called LAM, Ecological Breastfeeding, Natural Child Spacing and Breastfeeding-induced Infertility.
But what are the rules? Who qualifies? And why do so many women seem to get pregnant while breastfeeding?
I’m glad you asked 🙂
Let me preface this by saying I am not a medical professional, an NFP instructor, lactation consultant or anything of the sort. I am just a mom who has reaped the benefits (and sometimes burden) of being able to use LAM not just for 6 months but for closer to 18 months! Even at 23 months, my cycles have not returned, though signs of fertility have begun to show up in a way that if we were trying to not conceive we would be reintroducing another method of NFP.
NFP and More has a great at-a-glance on using breastfeeding to delay return of fertility.
So first, why would you want to use breastfeeding to delay a return to fertility? Why not just get on the pill or an IUD?
First, as a practicing Catholic, I don’t believe using contraception is healthy for a woman, a marriage, a family or society. So I would be against it from a moral perspective. From a health perspective, contraceptive methods using hormones to suppress fertility are extremely unhealthy for a woman. Your hormones are extremely out of whack and it can wreak havoc on your gut. Plus only progesterone-only birth control pills are safe while breastfeeding, or the copper IUD which has some pretty serious potential side effects, like perforating your uterus. So simply breastfeeding to your baby’s demands to suppress fertility seems like a no-brainer.
What are the principles for “perfect use” of using breastfeeding for NFP?
Per Sheila Kippley, a La Leche Leader who has written several books on breastfeeding and natural child spacing*, there are seven standards in Phase 1 (birth-6mos) listed below with my personal explanation of each.
- Breastfeed exclusively for the first six months – This means introducing no formula, expressed milk, water, etc.
- Pacify and comfort your baby at your breasts – Even when your baby is nursing for comfort, that sucking can help release the hormones that suppress your return of fertility.
- Don’t use bottles or pacifiers – Related to #2, there is an amazing biological connection between mother and baby and when an outside object interferes and begins taking some of that sucking away, a mother’s hormones may react and her cycles may begin.
- Sleep with your baby for night-feedings – One thing I find so interesting is that the optimal time your body produces prolactin (the hormone that produces milk AND suppresses return of fertility) is at night so making sure your baby is nursing at night is imperative to suppressing your return of fertility.
- Sleep with your baby for a daily nap feeding – Again, this is related to supply/demand. You don’t want to go too long without nursing during those first six months so it seems natural to just catch some extra sleep during at least one of your baby’s naps.
- Nurse frequently day and night, and avoid schedules – Nursing on your baby’s schedule instead of trying to push your baby onto your schedule ensures you are hitting your personal “magic number” of milk withdrawals for optimum milk production and hormone suppression.
- Avoid any practice that restricts nursing or separates you from your baby – This means not going back to work unless you can take your baby with you, not sending baby to grandmas for more than an hour or two, etc. A good guideline would be not to separate for longer than 1hr during the first three months (especially the first 6wks) and then no longer than a normal nap length during months 3-6.
If you follow all 7 standards perfectly, you are almost guaranteed 6-8 months of infertility. La Leche League has a more in-depth look at these standards or you can purchase Kippley’s book (which I personally own and learned a ton from).
Phase 2 of ecological breastfeeding has six standards because many parents begin introducing solids to their babies between 6 and 8 months. You would follow standards 2-7 of Phase 1 and focus not reducing the frequency of which your baby nurses. By following your baby’s pace to weaning you can suppress your fertility even longer. This means not denying your baby your breast at any time (or at least almost never). The average return of fertility when following these principles is between 14 and 18 months (depending on which source you are asking).
- If a woman experiences no bleeding after the 56th day PP, the chances of becoming pregnant is essentially none.
- Months 3-6, if a woman still experiences no bleeding, there is a 1% chance of her becoming pregnant.
- After 6 months, there is a 6% chance a woman will become pregnant prior to a return of her periods. A family needing to avoid conception can reduce this down to closer to 1% by also using another NFP method, observing signs of fertility and abstaining as needed.
KellyMom cites typical use of LAM to be 4x more effective at preventing pregnancy than the pill, almost 9x more effective than condoms, only being beaten in efficacy by the Mirena® IUD
Now I have certainly heard stories of women who were following these standards and still had their periods return or conceived babies really close together. Often, it’s those night feedings that are overlooked, especially during peak-prolactin production time, or the nap a day. Some women are more sensitive to needing to follow these perfectly while some women can go a few hours here without nursing or allow their child to use a pacifier and still reap the fertility-suppressing benefits. This can also vary based on the child. One child may be an avid constant-nurser while you may have to rouse another in order to not go too long without nursing. Some women are naturally less fertile and can be a little more lackadaisical about the standards, but some women may need to begin tracking signs of fertility earlier.
A bit of background on why I got so interested in LAM. I went back to work when V was 10 weeks old. I was pumping 3-4x each day and nursing her in the morning, as soon as I returned from work, and all through the night. I had heard so much about how once you go XX hours without physically nursing your babe, your cycles will kick back in. So I waited. V turned 3 months, then 6 months, then 9. Surely Aunt Flo will come for a visit by the time she’s 1? At 11.5 months, V started refusing expressed breastmilk regardless of the delivery system. Not in a bottle, not in a cup, not a sippy cup, not a spoon or bowl, nothing. She was still a nursing fiend but would not drink expressed milk. So I kept pumping until her 1st birthday just in case it was a phase and then I stopped. And threw a party, because pumping is the pits. So I was now going from 8ish until 4:30 five times per week without nursing OR pumping. Surely they’ll start now? Nope. As I’m writing this I am at 23 months PP and still no periods. Pretty awesome huh?
So why do I think LAM has worked well-past 6 months even though I’m not following the seven principles?
That’s a long story and more fitting for another post, but google “reverse cycling breastfeeding” and I think that’s my partner in crime.
Have you been able to use LAM to suppress your cycles? How long did it last for you?
*This post contains affiliate links. Read my full disclosure here.