Throughout the ages of humankind breastfeeding has been a form of birth control, but is it really effective? Medical science has found that women generally ovulate following a delivery prior to having a regular menstrual cycle. Most have heard, known, or even had first-hand experience in getting pregnant while nursing and wonder how it could have happened when they didn’t even have a menstrual period. (That is why I try and remind my patients that “the egg will come first” prior to a period while nursing.) So should birth control be used if one is nursing?
It is well-known that women experience what is termed amenorrhea while breastfeeding. This means a lack of the menstrual blood flow. This occurs because of the physiological effect of the sucking by the baby on the breast, causing an increase of hormones necessary for further milk production. This hormone stimulates milk but blocks ovulation or production of eggs. But can you really put all your money on this as birth control? That question has been studied and observed in many countries over the past ten years. They found that if women met three criteria, then breastfeeding alone was over 99% effective as birth control. And that is as good or better then most any form of hormonal or barrier birth control methods. The only one better would be a sterilization procedure.
The three criteria are: (1) Have your menstrual cycles returned? (2) Are you regularly supplementing your breastfeeding? (3) Is your baby over 6 months of age? If you answered “no” to all three, then you can be assured of over 99% birth control effectiveness from breastfeeding.
This is termed the lactational amenorrhea method (LAM) of birth control. Thousands of women in over 40 countries have been followed prospectively and none fell below the 99% level. But what counts as a period? The experts indicate that any bleeding up to 56 days from delivery does not count as a period, since women rarely ovulate that rapidly following delivery. Otherwise a period is 2 days of bleeding or spotting that occurs after 56 days. Also, some nursing mothers wonder if they need to worry if the baby sleeps 6-8 hours through the night without nursing and if this decreases the birth control effectiveness. This apparently has no effect since there have been no reported case of pregnancies if nursing is delayed that long, though the experts recommend that breastfeeding occur at least every 6 hours.
After 6 months of nursing, the numbers start to rise as most women begin to have their periods. Their ovulation thus resumes at an ever increasing percentage each month past six, though some may continue to have amenorrhea for 9 to even 12 months or longer. But I usually recommend some backup form of birth control beyond the 6-month time span if the patient wants to be especially cautious of conceiving. Remember that “the egg comes first”, before the periods ever start up again.
So next time you have a postpartum visit with your physician you may save yourself some anxiety and even money by avoiding other birth control methods if you fit the criteria for LAM. Think of it as the original birth control method following the birth of a child. (Well, at least for the first 6 months).