Of all the contraceptive methods available, some are compatible with breastfeeding and others are not recommended. Do you know the Lactational Amenorrhea Method, LAM?
You just had a baby. You are in heaven, you adore it, you are already dreaming of the future of this beautiful and growing family. However, you are not ready to continue expanding it just yet! So you have to think about contraception… But which method to choose?
Of all the contraceptive methods available, some are compatible with breastfeeding and others are not recommended. Several questions must therefore be asked before choosing a method. Are you breastfeeding? What efficiency are you looking for? Do you have any incompatibilities with certain methods (latex allergy, side effects with hormonal methods)? What are your values in the face of the different methods offered? And many more questions…
For those who are breastfeeding, you have probably heard of LAM (Lactation Amenorrhea Method). But is it a reliable method? How many people tell us that they have fallenpregnant while breastfeeding? How many doctors say breastfeeding is not birth control? Who to believe?
Basic Criteria for LAM (Breastfeeding Amenorrhea Method)
First of all, it is important to make an important distinction. Breastfeeding is not a means of contraception in itself, it is first and foremost a means of feeding your child and creating emotional bonds with him. However, for a long time we have noticed that it results in spacing births. It is for this reason that researchers from several countries have come together to study the question and have found that certain conditions must be present for breastfeeding to become an effective method of contraception, and this has been called The mother. Therefore, LAM is indeed a method of contraception that involves following specific rules, but not breastfeeding itself.
Researchers compiling their data found that it takes three (3) conditions for breastfeeding to achieve 98% effectiveness
These conditions are:
- full breastfeeding day and night;
- baby under the age of six (6) months;
- mother not returning from period.
The international researchers then did prospective studies and refined their criteria. The results were surprising. Instead of the 2% pregnancy rate as expected, the rates were much lower, even being 0% in several countries! Incompiling the results, the pregnancy rate was adjusted between 0.5% and 1% when LAM was well respected. In short, this method has proven to be highly effective, even much more effective than most other contraceptive methods available.
Clarifications should be made to the criteria above
What is meant by fully breastfeeding?
Full breastfeeding means exclusive (no introduction of solids or drinks), on demand day and night, at least 6 feedings per day with no intervals of more than six hours in 24 hours between feedings. Note that expressing milk to replace a feeding is not considered a breastfeeding. A feed is defined as active sucking for at least five (5) minutes.
What do we mean by “rules”?
After childbirth, there is normal bleeding called “lochia” which is not menstruation. It's just the uterus getting back into shape. It is also common for occasional bleeding to occur during the first 8 weeks. These bleedings, occurring in the first 56 days after childbirth, are not considered periods and do not have to be considered. Finally, after 56 days, two (2) or more days of bleeding, three (3) or more days of spotting, or a combination of the two will be considered as periods terminating LAM.
As soon as these criteria are not met, consider another method of contraception. It should be noted that the simple fact of breastfeeding, even if you do notno longer meets the criteria, is sufficient in some women to inhibit ovulation. However, since it is not possible to predict whether this will be the case when breastfeeding for the first time, we recommend the use of another method of contraception.
It is also interesting to note that for the same woman, if breastfeeding is done under the same conditions, we notice that the return of menstruation generally occurs around the same period. Therefore, a woman who has breastfed several times could extend the period when LAM is applicable. However, it is important that she consults a couple-instructor from Serena to be certain of the duration of this extension of the method.
It has also been noticed that certain elements influence the return of periods: not using a pacifier, practicing shared sleep and babywearing as well as respecting the natural weaning decided by the child. Although these elements are not mandatory, they seem to lengthen the duration over which LAM is applicable. When this form of breastfeeding, known as “ecological”, is practiced, it has been noticed that the first periods have occurred on average after 14.6 months.
For mothers who choose LAM as a contraceptive method, it is important to follow up systematically to ensure that the criteria are always met, from week to week. At Serena, we have developed a grid to be completed to ensure this systematic follow-up. Moreover, what if a mother decides to express milk?If baby decides to do a 7 hour night? What if baby is 7 months old, but the return of periods for other children always happened when the children were at least 1 year old? Should LAM be terminated in these cases?
There are rules of exceptions. But these rules must be interpreted well by knowledgeable people. We recommend that, if similar cases apply to you, you call on certified Serena instructor couples who will know how to interpret the exceptional conditions.
How does breastfeeding affect fertility?
What makes breastfeeding have contraceptive value? When a woman breastfeeds, each latch triggers prolactin secretion. Prolactin is the hormone that produces milk, but it also has the effect of blocking ovulation because the brain inhibits the secretion of estrogen, the hormones responsible for ovulation. Thus, the more intensive breastfeeding, the stronger its signals are sent to the brain and the greater the chances that ovulation will be inhibited. Similarly, if feedings are spaced or few, the chances of estrogen activity returning increase.
Another question also arises… What comes before, ovulation or menstruation? For there to be menstruation, there must have been ovulation. This is also why we often hear that breastfeeding is not effective, because we do not know when ovulation will take place. However, the first bleeding, called return of diapers, is not necessarily true menstruation. Thus, one can ovulate before or after the return of layers. The likelihood that ovulation will occur before the return of menstruation increases with postpartum time. Thus, a woman having a return of childbirth before six (6) months will have much less chance of having ovulated before compared to one who had her return of childbirth at ten (10) months.
But what if there was ovulation? Is it enough to conceive? Not necessarily… For conception to be possible, the corpus luteum must be sufficient. The corpus luteum is what nourishes the egg and, if present, the fertilized egg. If it is not durable enough and does not provide enough progesterone, implantation will be impossible. So the probability that ovulation will occur before the return of diapers during full breastfeeding is already very low, but moreover, it is very rare that the corpus luteum is sufficient.
As for the period of absolute infertility, does it exist? Yes, after childbirth, whether there is breastfeeding or not, there is a period when conception is impossible. For a woman who does not meet the LAM criteria, this period is three (3) weeks following childbirth. For a fully breastfeeding woman, this period extends to the first five (5) weeks after childbirth.
Natural breastfeeding methods
For the breastfeeding mother, LAM is a veryeffective and easy to follow. It is therefore the method of choice for those who want a natural method of contraception. However, those who no longer meet the LAM criteria, but who have not had a return of childbirth can also use a natural method. There is the Billings method in breastfeeding which is based on the observation of mucus and the sympto-thermal method in breastfeeding.
If you are interested in the mucus method, refer to the Life-Love Service. For those interested in LAM or the sympto-thermal method in breastfeeding, refer to Serena. Do not hesitate to contact its organizations if you have any questions.
With that, happy breastfeeding and lots of fun with baby!
