Isn’t it true that breastfeeding is a reliable form of contraception?

Answered by Michal Schonbrun, MPH, CHES www.poriutivit.com

Breastfeeding (BF) can provide a limited contraceptive benefit to nursing mothers under certain conditions, but it cannot be relied upon exclusively. For women desiring a natural method with higher effectiveness than BF alone, Fertility Awareness Method (FAM) is a liberating alternative to pills and hormones. FAM is a valuable tool which enables a woman to know on a daily basis when she is and is not fertile- even during breastfeeding and in the absence of a menstrual cycle. FAM is based on three fertility signs: basal body temperature (temperature of body at rest), cervical fluids or secretions, and cervical position. These signs produce discernible changes when a woman is fertile. Most women can learn to observe and monitor these signs, in order to know their fertility status.

Let’s examine a few other common myths about BF and fertility:

MYTH No. 1
Breastfeeding women are not supposed to ovulate or get pregnant.

The majority of women will not get pregnant before their first period. Breastfeeding generally prolongs a woman’s infertile time when practiced in a certain way. Very frequent nursing (every 1-3 hrs day and night), and a minimal use of supplements (milk, water, solids) and pacifiers are key conditions for this delay. Frequency of BF is more important than duration of BF. Each act of suckling (regardless of length of time) helps to suppress the hormones that cause ovulation. A one-minute ‘sip’ twice an hour is more effective than a twenty- minute feed every four hours, especially at night. Longer intervals between feeds will induce an earlier first ovulation.

In traditional cultures where the baby is carried on a sling 24/7 close to the mother’s body- more frequent suckling will take place, a practice which results in the natural spacing of 2-3 years between births. This type of breastfeeding practice is difficult to follow in western cultures.

It is important to remember that there are other factors besides frequency of breastfeeding which play a role in determining when a woman’s fertility returns during the breastfeeding time. These include a woman’s general health, her diet and nutritional status, fat reserves, energy reserves; her metabolic load, as well as levels of stress (emotional and physical).

MYTH No. 2
The Lactational Amenorrhea Method (LAM) is 98% effective in preventing pregnancy.

LAM was developed by scientists twenty years ago. It is based on a simple formula: If a woman has no menses, is frequently nursing with little if any supplements, and her baby is under six months old- then additional contraception is unnecessary because her risk of getting pregnant is 2%.

In western societies, it is extremely difficult for women to meet the criteria of LAM. The method was tested primarily in developing countries, where breastfeeding is not only more culturally appropriate, but it is practiced in a way which enables frequent stimulation of the breasts as mentioned above. Yet regardless of frequency, a western woman has no guarantee that her first ovulation will be delayed beyond a certain time. Many women who are fully and frequently breastfeeding get their periods way before the six month mark, rendering LAM a less reliable and safe method of contraception.

MYTH No. 3
Breastfeeding women cannot know when their fertility will resume.

Women who learn to observe, chart and interpret changes in their secretions and sensations can know in advance when their bodies are trying to ovulate. Most but not all women who breastfeed frequently (every 1-3 hours, day and night) experience prolonged intervals (even months) of relative dryness and infertile secretions. Once they learn to accurately identify these secretion changes (with a qualified teacher), then a women can use this information as a contraceptive method.

This question was answered by Michal Schonbrun, MPH, CHES, a women’s health educator who utilizes a holistic approach to feminine empowerment during the life cycle. She has a master’s degree in public health (MPH) and is a certified health education specialist (CHES). She promotes “body literacy” and is a certified instructor and trainer in Fertility Awareness Methods. For more information write to her or visit her website at www.poriutivit.com.