BREASTFEEDING AS A NATURAL CONTRACEPTIVE For the nursing mother who wants to space her pregnancies, there are many

birth control options to choose from. Each method offers advantages and disadvantages. As long as the nursing mother is exclusively breastfeeding, (nursing frequently day and night with no supplemental feedings), the baby is younger than 6 months of age, and the mother has not started having periods, she is more than 98% protected against pregnancy. This period of exclusive nursing means not only no supplemental feedings of water or formula, but also little or no pacifier use. All of the babys sucking needs are met at the breast, which means demand feedings around the clock. As long as the mother has had no vaginal bleeding after 56 days postpartum, and the baby receives no supplemental feeds, she has only about a 2% chance of becoming pregnant (this compares to the combined birth control pill, which is about 98%-99% effective if taken every day without missing a dose). It is important to understand that as soon as there is a decline in breastfeeding, due to the baby eating supplemental feedings or nursing less often, the contraceptive protection decreases, and other methods should be considered. Fertility is most effectively suppressed when the baby goes no longer than 4 hours during the day and 6 hours at night between feedings. The pattern of breastfeeding is a key factor, but the mothers own body chemistry also has an influence. Some mothers nurse without supplements and still start having periods within the first few months of nursing. Others whose babies sleep through the night or have supplemental feedings will not have a period for twelve months or longer. Some women go as long as two years or more without menstruating. After the initial flow of lochia (the bleeding experienced for 2 to f4 weeks after birth) has stopped, nursing mothers will usually experience no vaginal bleeding for several months. Often, the first period occurs without ovulation. Many women refer to this as a warning period, and take it as a sign that they are fertile from that point on. Often light bleeding or spotting is the first indication of the return of fertility. Any bleeding or spotting that lasts more than a couple of days should be considered a sign that the mother is fertile again. It is not unusual for a mother to have irregular periods during the time she is nursing. Some (but not all) mothers notice a slight decrease in their milk supply during their periods, but after a few days the supply will increase. It is important to think about birth control options well before the time a mother becomes fertile again. What follows is a list of family planning options as they relate to breastfeeding women. It is important to emphasize that hormonal methods containing estrogen should be avoided whenever possible. Changes in the mothers body during lactation may include vaginal dryness due to low levels of estrogen. Intercourse may be more comfortable if a water-based lubricant such as K-Y jelly is used. The release of oxytocin during orgasm may cause the mothers milk to leak or spray and surprise both partners. Feeding the baby or expressing some milk before love-making, applying pressure as the milk lets down, and keeping a towel handy to catch the leaks may be helpful.

The first choice of birth control for nursing mothers is non-hormonal methods. This includes condom use, which has the advantages of being readily available, and having no effect on breastfeeding. Condoms can be very effective if used correctly. Condoms offer some protection against STDS (sexually transmitted diseases) and have no risks to the mother or child, but can be irritating to vaginal tissue and may require additional lubrication. Diaphragms also have no effect on breastfeeding, and can be very effective if used correctly. Their effectiveness depends on use with a spermicide, and they must be re-fitted after the baby is born and the uterus has returned to its pre-pregnancy size. Spermicides have no effect on breastfeeding, and can be very effective if used according to instructions. They may be irritating to the vagina and to the male partner. Spermicides are not known to pass into the milk and affect the baby in any way. IUDs have no effect on breastfeeding, and are very effective. There is a possible risk of expulsion or uterine perforation if the device is not properly placed or is inserted before 6 weeks postpartum. Permanent methods such as vasectomy and tubal ligation have no effect on breastfeeding and are nearly 100% effective. These methods are considered irreversible, and should only be considered if no more children are desired. If these methods are considered, counseling is recommended for couples. Vasectomy is considered minor surgery with minimal side effects. Tubal ligation may involve short-term mother-infant separation, and has risks, as all surgery does. Anesthesia may pass into breastmilk and sedate the baby. As a general rule, tubal ligation has more risks for the mother and is considered more complicated surgery than vasectomy is for the father. The other non-hormonal method of birth control is fertitilty awareness-based methods (FAMs), sometimes referred to as natural family planning. These methods involve learning the signs and symptoms of fertility, and may require extended periods of abstinence. It has no effect on breastfeeding, and can be very effective if used correctly. Because it may be difficult to interpret signs of fertility during breastfeeding, this method may require additional training in order to interpret the symptoms of fertility during lactation. There are three FAMs used to predict when you ovulate. The temperature method involves taking your temperature every morning and charting it; the cervial mucus method means learning the changes in your cervical mucus so than you can avoid intercourse during ovulation; and the standard calendar method, where you chart your menstrual cycles on a calendar and avoid unprotected sexual intercourse on your most fertile days. None of the FAMs are as effective as the other methods when used alone, but are extremely effective when all three methods are combined the Sympthermal Method. This site has information about all types of birth control, including FAMs and Symptheremal Methods: http://www.plannedparenthood.org/health-topics/birth-control/fertility-awareness4217.html

If the nursing mother chooses to use a hormonal method of birth control, the second choice is progestin only methods, such as Norplant (implants), mini-pills, or injectables (Depo-Provera). All of these methods can be very effective, and may even increase milk volume. Although some of the progestin hormone may enter the breastmilk, there is no evidence of adverse effects from the small amount of hormone that passes into the milk. It is recommended that the use of progestin-only hormones be delayed for at least six weeks post-partum due to the possibility of the hormones interfering with the early establishment of lactation. The third and last choice of birth control for nursing mothers is methods which contain estrogen, such as the standard combined oral contraceptives. These methods are very effective, but often decrease milk supply, and some of the hormone may pass into the mothers milk. Although there is no evidence of a direct negative effect on the babies of mothers taking the combined pill, there is strong evidence that in many women, estrogen can lead to a decrease in milk supply and early weaning. If the other methods of birth control cant be avoided, and the combined pill is the only option, then breastfeeding can and should be continued, since it offers many health and nutritional benefits which are important for the nursing infant or toddler. If the mother chooses to use this method, the babys weight should be monitored carefully so that adequate intake is ensured. For many mothers, a slight decrease in milk output is insignificant, and in any case, the benefits of breastfeeding far outweigh the disadvantages.

Contraceptive Benefits of Breastfeeding

If you are pregnant or have just given birth, you may be considering breastfeeding your child. Breastfeeding is one of the healthiest things that you can do for your baby. Your breast milk is designed specially to provide your baby with all of the vitamins, nutrients, and antibodies that she needs to stay healthy. But breastfeeding is not only beneficial to your baby. It can also be very healthy for you as well. In addition to helping you recover from pregnancy more quickly, breastfeeding can also be used as a natural family planning method. Known as the lactational amenorrhea method (LAM), this method is highly effective in preventing pregnancy in the months after childbirth. What is the Lactational Amenorrhea Method? The lactational amenorrhea method is just one of a variety of highly effective natural family planning methods. This method is used after childbirth, and involves breastfeeding your child exclusively for at least six months in order to prevent pregnancy. The LAM method has been around for thousands of years but declined greatly in popularity over the past century. In 1988, however, the LAM method was reintroduced thanks to new studies that proved its effectiveness in preventing pregnancies during the postpartum period. How Does the Lactational Amenorrhea Method Work? The LAM method works by changing the way in which your body produces your reproductive

hormones. In order to ovulate and menstruate, your pituitary gland (a small gland inside of your brain) produces two hormones: follicle stimulating hormone (FSH) and gonadotropin releasing hormone (GnRH). These hormones send signals to your eggs to mature and subsequently be released during ovulation. When you breastfeed, though, this process gets interrupted, thereby interfering with the production of both FSH and GnRH. As your baby suckles, nerve impulses travel through your body and are received by your brain. This signals the production of a hormone called prolactin, which works to inhibit both FSH and GnRH. As a result, ovulation does not occur and menstruation stops, making it almost impossible to become pregnant. Who Can Use the Lactational Amenorrhea Method? Any woman who is dedicated to exclusively breastfeeding her child after birth can use the LAM method to protect against pregnancy. It is most effective in women who:

are exclusively or almost exclusively (85% of feeds) breastfeeding have not experienced the return of their menstrual periods are less than six months postpartum

How Do You Use the Lactational Amenorrhea Method? LAM is one of the simplest natural family planning methods to use. It involves no complex calculations or calendars and requires little preparation or planning. Simply follow these steps when feeding your baby for the first six months of life:

begin breastfeeding as soon as possible after delivery breastfeed between six and ten times a day, upon request avoid long intervals between feeds avoid the use of bottles and pacifiers don't give any supplemental food or liquids to your baby (such as juice or water)

How Effective is the Lactational Amenorrhea Method? The LAM method is actually highly effective in preventing pregnancy when used correctly during the first six months of the postpartum period. If you continue to breastfeed regularly and exclusively and your periods do not return, LAM is between 98% and 99% effective. Most women have trouble maintaining such a rigorous breastfeeding schedule, though. These women should use an alternate form of birth control in addition to LAM. Advantages of the Lactational Amenorrhea Method There are a number of advantages of breastfeeding for contraceptive purposes:

LAM is highly effective in preventing pregnancy when used correctly. LAM is easy and simple to use. LAM is inexpensive and causes no side effects. LAM doesn't interfere with intercourse. LAM is acceptable in most cultures. There are numerous health benefits of breastfeeding for both you and baby.

Disadvantages to the Lactational Amenorrhea Method As with any birth control method, LAM is not without its drawbacks:

LAM is most effective in the first six months of postpartum. After six months, LAM becomes less effective. It can be difficult to maintain regular breastfeeding schedules, especially for working mothers. LAM does not protect against STDS.

Lactational Amenorrhea Method after Six Months LAM can be continued after your baby has turned six months of age, though it will be less effective than it is during the early postpartum period. After six months, your baby will require supplemental feeding, and this may interfere with breastfeeding. As long as your baby continues to breastfeed for more than 65 minutes a day, and your periods have not returned, LAM should still be quite effective in preventing pregnancy. With perfect use, the LAM method is between 90% and 96% effective in guarding against pregnancy after six months. However, it is recommended that women use an additional type of birth control after their baby turns six months of age.

CONTRACEPTIVE EFFECT OF BREASTFEEDING Breastfeeding can work well as a method of birth control, but, like any other type of contraceptive, it is not foolproof. Breastfeeding delays the return of your periods. However, you'll ovulate before you have your first period. This means there's a chance that you could become pregnant if you rely on your period returning as a sign that you are fertile again. Frequent and regular breastfeeding as a form of contraception is known as the lactational amenorrhoea method (LAM). LAM is said to be more than 98 per cent effective. However, LAM will only work for you if:

your baby is younger than six months old your periods have not returned you are exclusively breastfeeding your baby on demand, night and day

Exclusively breastfeeding on demand usually means a minimum of six long breastfeeds every 24 hours. If you want LAM to work for you, don't leave a gap between feeds of longer than four hours during the day or six hours at night. And don't give other fluids or solid food to your baby. With LAM, your breasts need to supply all your baby's suckling needs. In other words, your baby shouldn't have a dummy. Your baby's suckling stimulates the hormones that suppress

ovulation. Once your baby stops exclusively breastfeeding, breastfeeding becomes less effective as a method of contraception. So when you start giving your baby solid food, even if your periods still haven't returned, you could be fertile. You may want to use another form of contraception, to be on the safe side. If you like the idea of using the rhythms of your body to prevent pregnancy, there is another option. Once you've stopped breastfeeding and your periods have settled back into a pattern, you could try natural family planning (NFP). The idea with NFP is that you don't have unprotected sex on the days of your menstrual cycle when you are likely to be fertile.