Breastfeeding As Birth Control After 6 Months

Breastfeeding As Birth Control After 6 Months

Information is widely available about the effectiveness of exclusively and frequently breastfeeding a baby aged six months and under as a method of birth control. This method of contraception is known as the lactational amenorrhea method (LAM). However, there is little information available beyond the scope of 6 months postpartum.  I did some research to see how effective LAM is once a baby is aged six months and beyond.

Breastfeeding is not a reliable method of birth control after six months postpartum if following the lactational amenorrhea method (LAM). Another form of contraception should be considered. The chances of becoming pregnant are 3 percent at nine months and 4.5 percent at twelve months according to a study carried out by the World Health Organization.

The Lactational Amenorrhea Method is a contraceptive method, based on the physiology of breastfeeding. The chances of a mother becoming pregnant are extremely low when exclusively breastfeeding her infant aged six months or under. LAM is more than 98 percent effective during the first six months postpartum. This effectiveness is only valid on condition that three conditions of the lactational amenorrhea method which are met.  This includes: 1) That baby is being fed at least 4 hourly during the day and 6 hourly at night 2) The absence of a menstrual bleed and 3) The infant is less than six months old.  

After this time, all available information suggests that the chances of fertility increase. I have looked at the available pieces of evidence to prove this. Also, other reasons that may contribute to the rise in fertility levels.

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The LAM method has many advantages and suits a lot of mothers. Listed are some of its benefits.

  • No side effects
  • it is very effective
  • free to use
  • does not require insertion or ingestion of any device or pill
  • it contributes to optimal breastfeeding practices leading to better health and nutrition for mom and baby.

Lactational Amenorrhea Method After 6 Months

According to the United Nations Population Information Network (POPIN), a study carried out by WHO found that the rate of pregnancy during lactational amenorrhea remained low with women who breastfed longer than six months, even when given infant supplements.  They mention that the pregnancy rates were about 3 percent at nine months and 4.5 percent at twelve months. The study also indicates that the likelihood of LAM being effective beyond six months increases when women breastfeed intensively during the first six months and when they breastfed immediately before giving a supplement.

However, the experts did conclude that more research is needed on this to establish the conditions under which extended use of LAM should be recommended.  

From the study above it appears the LAM method remains very effective up until 12 months. However, the chances of pregnancy do increase slightly.

Reasons why Chances of Pregnancy Will Slightly Increase

Infant starting on solids.

It is recommended that infants start solids between 4-6 months and by the time an infant has reached six months most babies will have commenced. Commencing solids and then progressing to regular meals means reduced suckling at the breast. This makes it more likely that breastfeeds become less frequent which will, in turn, make the LAM method less effective. One way to help prevent this is to offer baby a breastfeed just before a solid meal.

Baby starting to sleep through the night or receiving a supplement

At six months and over many babies will sleep more than 6 hours during the night which will reduce the effectiveness of LAM. Once this occurs the mothers chance of ovulating increases even before menstruation has resumed. This is due to the extended period where she has not breastfed. Other situations for example if baby is being supplemented with formula at night will also have the same effect.

A woman’s body chemistry

Even with frequent breastfeeding, individual differences occur as to the length of each woman’s period of natural infertility.  Some mothers may resume their menses within the first three months while for others it may not return until 12 months or after. If a mother has had any vaginal bleed after 56 days postpartum she should consider herself fertile.

Mom going back to work or separated from baby for longer periods of time.

The contraceptive protection from LAM will be decreased if mom is away from baby for extended lengths of time.  It has been shown that expressing breast milk may not be as effective as suckling at the breast to suppress ovulation which in turn could cause a pregnancy.

To conclude, LAM cannot be relied upon as a means of contraception after six months as there are many variables that reduce its effectiveness.  La Leche League mentions that after six months there is a higher chance you might ovulate and possibly become pregnant before your first postpartum period.

In addition to this, there are very few studies carried out to know for sure how effective it is as a means of contraception even when nursing frequently.  Moms should consider another method of contraception other than the LAM method when their baby reaches six months old.

Other Forms Of Contraception Compatible With Breastfeeding

Once your baby reaches six months, there are a number of contraceptive methods that are safe to use while you are breastfeeding your baby.  These include:

Natural Family Planning (NFP)

This involves recognizing the signs of fertility in a woman’s body and using that information to prevent a pregnancy.  Signs of ovulation include a change in body temperature and a change in the cervical mucus. It’s important to mention that the signs of fertility are more subtle when breastfeeding.  It may be more difficult for a mom to interpret these signs if she has had no knowledge of NFP beforehand.

Barrier Methods

 These include condoms, diaphragms, cervical caps, and spermicides.  These are considered compatible with breastfeeding and if used correctly offer a high level of protection against pregnancy.

Hormonal Methods

Progestin-only containing contraceptives are considered the most suitable for moms who are breastfeeding after six months postpartum. Studies show that progestin-only contraceptives have no effect on the volume and composition of milk and can be safely started in the 6-8th week postpartum.  Estrogen-containing methods of contraceptives are not considered as suitable while breastfeeding as there have been links with low milk supply even when initiated after milk supply is well established and baby is older.  Not all mothers will experience this, but it is recommended to use these with caution.

Can a period come and go while breastfeeding

Yes, a period can come and then not appear for another few months while a mom is breastfeeding.  In most cases, ovulation has not occurred before the first period, and this is often considered a ‘warning period.’   However, once a period arrives a breastfeeding mother should consider herself fertile again and take the necessary precautions if pregnancy is to be avoided.

Is it possible to get pregnant while breastfeeding and no period

It is possible to get pregnant while breastfeeding with no period.  In some cases, ovulation has taken place even though a period has not occurred yet.  Ovulation is more likely to occur when the baby is nursing less, taking more solids, sleeping through the night or if mom has started weaning.  Studies also show that the younger the baby is when menses return, the more anovulatory cycles the mother was likely to have and therefore reduced fertility

Will Pumping As Well As Breastfeeding Prevent Pregnancy

Pumping or expressing breast milk is not as effective at preventing pregnancy as exclusive breastfeeding with baby nursing at the breast.  This study showed that there were striking differences between natural infant suckling and expressing milk from a pump.  Those expressing showed a reduced ability to produce an acute and sustained prolactin rise in breastfeeding mothers.

Do birth control pills affect breastfeeding

A book called The Womanly Art of Breastfeeding written by La Leche League recommends that breastfeeding mothers avoid all hormonal methods of birth control in the first six months postpartum as they have the potential to affect milk supply.  The possibility of a decreased milk supply is much lower after about six months.

If hormonal methods are being used progestin-only contraceptive pills are recommended as the best choice for breastfeeding mothers.  They do not affect milk supply in the vast majority of women. It is best to avoid estrogen-containing contraceptives as they have been linked to low milk supply.  It is important you discuss your choice of contraception in detail with your doctor to use the one most suitable for you.

Recommended Topics

References

https://www.ncbi.nlm.nih.gov/pubmed/1741218
http://www.un.org/popin/popis/journals/network/network171/lam171.html

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