Breastfeeding As a Contraception Method: Does It Really Work?

How does breastfeeding prevent conceiving?

Over the last twenty five years, medical research has begun to shed light on how breastfeeding affects a woman’s fertility levels. It is widely documented that, in the first few months after childbirth, breastfeeding reduces chances of pregnancy by preventing ovulation and delaying the return of menstruation.

This phenomenon is called Lactational Amenorrhea, meaning the lack of periods due to breastfeeding. This happens because nursing a baby round the clock releases high levels of prolactin, the milk producing hormone, in the mother’s body. Interestingly, the high levels of prolactin interfere with the hypothalamic-pituitary-ovarian chain, preventing estrogen secretion and blocking ovulation. This can be seen as our body’s natural method of spacing out pregnancies to ensure the health and safety of the mother - a way for mother nature to look out for mothers!

After scientific research and clinical trials, the Lactational Amenorrhea Method, or LAM, has been developed to help women use breastfeeding to prevent pregnancy, under certain conditions. When all the conditions required by LAM are met, clinical trials have resulted in a 98% rate of success in preventing pregnancies. But what are the conditions that have to be checked off the list for LAM to work? Let’s find out!

LAM - medical trials and success rate

Over the last twenty five years, numerous studies to demonstrate the contraceptive effectiveness of LAM have been carried out in countries such as Chile, Ecuador, and Philippines. The women in the studies were healthy, had one or more children, and had delivered healthy babies. The women planned to fully breastfeed and in most cases anticipated no regular separations from their infants greater than four to six hours. In each study the six-month failure rate of LAM was found to be less than one percent.

3 conditions that should be met to make breastfeeding effective

If you’re a nursing mother and are planning to use breastfeeding as a birth control method, it is important to make sure that three crucial conditions are all met for it to be successful. 

• You breastfeed around the clock it means your baby is fed “on demand” exclusively from your breast and no other food, water, or liquids are given to the baby.
• Your baby must be six month of age or less.
• Your periods (including spotting) haven’t returned since childbirth.

It’s very important to keep in mind that if any one of these three conditions is not met, then it is time to start using other forms of contraception. Let’s find out about each condition in detail, and the role it plays in preventing pregnancy.

You're fully breastfeeding.

Full breastfeeding, defined as exclusive, round the clock nursing (no other solid or liquid given to the baby) or near exclusive (water, juice etc. in addition to breastfeed). But supplemental food should not exceed 5% to 10% of total feedings.

During full breastfeeding, the constant suckling of the baby causes the progesterone levels to stay suppressed, which delays the return of menstruation.

And even expressing milk by hand or by pump can increase the risk of ovulation and fertility. For the LAM method to successfully work, it is important to keep the pattern as close to full breastfeeding following these pointers.

• Nursing the baby both during day and night.
• Breastfeeding as much as needed, upon request, and not a fixed schedule.
• No gap in feeding longer than four hours during day and six hours at night. 

Your baby must be 6 months of age or younger.

When the baby turns six months old, their diet begins to grow and include more and more foods, liquids, making the mothers less likely to continue with full breastfeeding. This can reduce the constant suckling pattern that is crucial for LAM to work, and can cause the mother’s periods to return.

That’s why this method works best when the baby is under six months old and still relies almost fully on breastfeed for their nutrition. 

You haven't had periods after you gave birth.

Periods are an important signal of a woman’s fertility, and indicate a high chance of pregnancy. If your periods, which is a minimum of two days of continued bleeding, have returned after childbirth, this means that your reproductive system is again gearing up to resume full function. This would mean that your ovulation has or is about to happen. In this case, the LAM method will no longer be enough to prevent pregnancy. 

Additional birth control methods

There is a number of options available for safe birth control while breastfeeding, both hormonal and non-hormonal options. However, if using hormonal methods, it is important for breastfeeding mothers to go for options that do not have estrogen in them, as the presence of estrogen has been linked to reduction in the production of milk. 

Hormonal contraception

Hormonal birth control methods use synthetic versions of a woman’s body's reproductive hormones to prevent ovulation, thicken the cervix’s mucus lining and thinning the uterine lining. While some hormonal pills have both estrogen and progestin, breastfeeding moms should choose one that only contains progestin, as estrogen can make it more difficult to produce enough breast milk. 

• Minipills

The mini pill, also known as progestin-only birth control pill, are oral contraceptives that work by suppressing ovulation, and thickening the cervical mucus, preventing sperms from reaching the egg. They have been reported to be 88% effective if used typically ( the way most women use) and about 99,7 percent effective when taken correctly - at the same time every day. Unlike combination birth control pills, the minipill doesn't contain estrogen, making them a safe birth control for breastfeeding moms.

• Birth control injection

Depo-Provera, or DMPA is a hormonal birth control injection that prevents pregnancy for three months at a time. The progestin in the injections works in the same way as progestin-only pills do, which is by thickening the cervical mucus and preventing ovulation. This method has been reported to be over 99% effective in preventing pregnancy. It is important to note that return of ovulation may be delayed for about a year after stopping the injection.

• Hormonal IUD

A hormonal intrauterine device, or IUD, is a T shaped device made of polyethylene that can be inserted immediately after birth, and works by releasing low doses of levonorgestrel to work by preventing the egg from developing normally. Hormonal IUDs have been found to have a success rate of 99.9 percent, and are effective for about three to five years.

Non-hormonal / Barrier methods

There are hormone-free options that prevent pregnancy as well as protect from sexually transmitted diseases, or STDs. These methods are physical or chemical barriers that are designed to prevent sperm from entering a woman’s uterus. The effectiveness of non hormonal methods is reported to be lower than that of hormonal options and depends on whether they are used correctly, but when used as a supplement to breastfeeding, they are quite effective in preventing pregnancy.

• Condoms

Latex condoms are an inexpensive widely available method of preventing pregnancy, which also offer protection against Sexually Transmitted Diseases, or STDs. When used correctly they have a success rate of 98% in preventing pregnancy.

• Spermicides

These chemicals, designed to kill sperms before they reach the uterus, are available as foams, jellies, or vaginal suppositories. They have a failure rate of 28% which is high, hence they should always be used in addition to another barrier method, such as diaphragms or cervical caps. Besides  they can cause burning, irritation and allergic reactions.

• Diaphragm

A diaphragm is a rubber dome used with spermicide to cover the opening of the uterus before intercourse, with a failure rate of around 6 to 12%, which makes it a moderately effective form on birth control. They work best when used with spermicide — a cream or gel that kills sperm. But even if they are used in combination their effectiveness is from 94% to 88 % depending on how correctly its used. A woman would have to wait until after six weeks of delivery to be fitted with a diaphragm, which must be done by a medical professional.

• Cervical cap

This device is also used along with a spermicide, and is similar to  women who never had children get pregnant when using the cervical cap. About 30% of women who have had children get pregnant.

• Copper IUD

Copper intrauterine devices (IUDs) are a form of long-term reversible contraception, and have a low failure rate of 1.1 to 2%. A doctor places the device in the woman's uterus and it can be used for upto 10 years. But its known to cause longer, heavier periods, and it wont suit women who already suffer from heavy periods.

Afterword

While breastfeeding can be used as a safe birth control option after childbirth with a high success rate of 98%, but it is important to ensure that all the three conditions as listed by the Lactation Amenorrhea Method, or LAM, are fulfilled for it to work as expected.

If you notice any one of three situations happening - completing six months after childbirth, return of your periods, or longer gaps in breastfeeding - it is strongly recommended that you use an alternate form of birth control alongside, to successfully prevent pregnancy.