Updated June 6th 2022
You’ve likely had someone tell you that you can’t get pregnant while breastfeeding only to have someone else tell you they got pregnant 3 months after having a baby
What’s the right answer? Should you be able to rely on breastfeeding as a method of birth control?
You can get pregnant while breastfeeding. Breastfeeding doesn’t fully prevent pregnancy however, breastfeeding within the first 6 months may be used as a method of birth control when specific conditions are being met. Even then, it’s not a method that works for everyone so always talk with your partner and your primary care provider to discuss your options.
Lactation Amenorrhea Method (LAM for short) is considered a non-hormonal method of preventing pregnancy. This method uses 3 measures of fertility:
1. Return of your menstrual period
2. Your breastfeeding patterns
3. The age of your baby
How does LAM work?
Breastfeeding naturally suppress fertility (ovulation) but only when it’s the exclusive method of feeding your baby (more on this below).
Bleeding in the first 56 days after birth is not your period. This is called Lochia and happens when the placenta detaches from the uterus. So if you haven’t had any bleeding after those first 56 days and your cycle has not returned, you’ve met the first criteria for LAM.
How often you breastfeed also affects how LAM works. To be able to use LAM as birth control, a second criteria needs to be met: you have to be exclusively breastfeeding.
This means all feedings are happening at the breast and you’re not using pacifiers or pumping. As soon as pacifiers or pumping is introduced, the effectiveness of this method decreases. You baby also cannot be receiving any other liquids or foods. If solids are introduced prior to 6 months, again, the effectiveness of this method significantly decreases. You also cannot be going longer than 6 hours between feedings which means your baby needs to be feeding at breast during the night. Basically, all boob all the time.
Finally, if you’ve met the above 2 criteria and are nursing a baby under 6 months old, the studies show that the chance of becoming pregnant is about 2%. This means when all 3 criteria are met, LAM can be 98% effective as a method of birth control. Again, this isn’t always the case for everyone.
What are the advantages of LAM?
It can work for up to 6 months after birth which is quite a while. It’s also effective right away (there’s no delay or waiting period) and very convenient. Using this method means there are no added hormones that can affect your breastmilk production. Some birth control methods especially those that age estrogen based can reduce your milk supply. Finally, breastfeeding provides many other health benefits for both you and your baby.
Your baby has a reduced risk of allergies and asthma, reduced risk of future obesity and diabetes and your risks of breast and ovarian cancer are decreased. You also have a reduced risk of future cardiovascular disease when you breastfeed.
What are the disadvantages?
The reality is that it may be difficult for some to fully or nearly-fully breastfeed. It’s common to face challenges as breastfeeding is a learned skill for both you and your baby.
Situations such as your baby not latching, oral ties or separation may require you to pump and supplement that milk to your baby in another way. Some circumstances require supplementation with formula. Any of these situations would affect the effectiveness of LAM because the frequency your baby is at the breast would be reduced.
It’s also only effective for up to 6 months after you have your baby after that, you and your partner need to have a plan.
When is LAM no longer effective?
If any of the 3 criteria/conditions are not met, the effectiveness of LAM is reduced and you can no longer rely on this method.
Anything that would reduce prolactin levels (the milk making hormone) can lead to your period returning sooner because it increases the chances of ovulation happening.
This would include:
- Pacifiers
- Pumping
- Bottles
- Scheduled feedings
- Sleep training
- Not feeding during the night
All of these space out feedings and reduce the frequency of prolactin being stimulated because baby is not at breast.
Prolactin, the milk making hormone, inhibits two hormones needed for ovulation: FSH & LH. When feedings at breast are spaced out (as mentioned above) there is more opportunity for the ovulation hormones to rise because prolactin levels aren’t remaining as high.
Night time feeds have a big impact on how quickly ovulation returns as well because prolactin levels actually rise overnight.
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What happens when your cycle returns?
Everyone’s body and feeding journey is different so there is quite a range for when your period may return. It may happen as early as 6 weeks after birth and for others, they have no period for 2+ years while breastfeeding.
When your cycle does return, you might experience a temporary dip in milk production. This can lead to your baby displaying fussy behaviour and suddenly clinging to you and feeding around the clock. This dip is often temporary and it’s is normal and very common if it happens.
For some, after a few cycles they don’t notice a dip anymore and for others, every months they notice a dip in their supply.
You will still continue to make enough milk for your baby. Continue to feed your baby when they display hunger cues and work with a lactation consultant if you’re finding it difficult.
You can also check out this blog I wrote about 4 ways to tell if your baby is getting enough milk.
Can you take hormonal birth control while breastfeeding?
Hormonal birth control has the potential to impact your milk supply especially when taken within the first 2 months of giving birth.
Many doctors will suggest a progestin-only form of birth control as it’s less likely to have a negative impact on milk production. Progesterone (a hormone) inhibits prolactin (the milk making hormone). Higher levels of progesterone can cause a reduced milk production for some people.
Even though these hormonal birth control methods are considered to be low risk for your baby – they may not be low risk when it comes to your feeding goals. Keep in mind everyone’s body is different. Some see no impact on their production while others do
If you had a previous breast reduction, have thyroid issues or any challenges with infertility you are at an increased risk for lower supply and hormonal birth control could further reduce your supply so always review your options with your care provider and work with a lactation consultant to support your feeding goals.
References:
Bonyata, Kelly. (2018, March 17).Breastfeeding and fertility. Kellymom.com. https://kellymom.com/ages/older-infant/fertility/#:~:text=The%20Exclusive%20Breastfeeding%20method%20of,not%20menstruating%20due%20to%20breastfeeding.
Coly, Shirley. (n.d). LAM – The Lactation Amenorrhea Method. World Alliance for Breastfeeding Action. https://waba.org.my/resources/lam/index.htm
My Health Alberta, (2018, November 2). Lactation Amenorrhea Method. MyHealth.Alberta.ca.https://myhealth.alberta.ca/sexual-reproductive-health/birth-control/natural-methods/lactation-amenorrhea
Vekemans M. (1997). Postpartum contraception: the lactational amenorrhea method. The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception, 2(2), 105–111. https://doi.org/10.3109/13625189709167463