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Breastfeeding & Birth Control

The arrival of a newborn baby is a joyous moment of delight in your life, but with the joy and celebration comes the reality that being parents, especially to a tiny newborn, is hard work. As you stare down at your bundle of joy, its very normal to think, as much as we are loving this little baby, we definitely don't want to start thinking of the next one for a long time – or even ever!

Well guess what, not only are you normal for thinking this, mother nature is on your side. Because parenting a newborn takes so much vital energy, the body naturally suppresses fertility while you are breastfeeding. This type of birth control, called Lactational Amenorrhea Method or LAM for short can be relied upon to prevent pregnancy as long as a certain number of requirements are met. Read on to learn more about the stages of a women's fertility and when LAM comes into play.

Fertility Awareness And Breastfeeding Key Points

    • You body will naturally suppress ovulation while breastfeeding because a pregnancy while sill having an exclusively breastfeeding infant can overburden the body.

    • Relying on this lack of ovulation while breastfeeding for contraceptive purposes is called the Lactational Amenorrhea Method or LAM.

    • The period between childbirth or LAM and the return to fertility is not an easy one for contraceptive planning and should be carefully discussed with your doctor or midwife.

    • Your main indicator that ovulation and fertility has returned will be the return of your menstrual period. However, getting your first period means you were fertile for two weeks before the arrival of that period, and unprotected sex during that time could result in an unexpected pregnancy.

  • Once fertility has returned completely, FAM and NFP can be used as an incredibly reliable method of contraception, even if you continue breastfeeding.

A Fresh Look At Postpartum Contraception

If a the woman was using any type of hormonal contraception prior to pregnancy this would have been stopped or removed a long time ago so from a contraceptive perspective there is the chance for a new start. During pregnancy the mother-to-be learns a huge amount about her reproductive system from countless visits to Obstetricians, Gynecologist, Midwives and Doctors which is why many women take a fresh look at their contraceptive options after birth. Since at this point they are 'hormone free', it's logical that the Fertility Awareness Method (FAM) or Natural Family Planning (NFP) comes up for consideration.

The ability to predict your fertility window through knowledge of your own cycle is empowering for any woman and keeps things natural. If a barrier contraceptive is used during the fertility window the method would be referred to as the Fertility Awareness Method (FAM) since pure Natural Family Planning (NFP) calls for abstinence during those 6-8 fertile days. The way both methods work are fundamentally the same and depend upon identification of ovulation.

Since sperm can live for a maximum of 5 days within a woman, intercourse 5 days prior to ovulation could pose a risk of pregnancy. Upon ovulating the woman's egg could be fertilized for 18-24 hours. That 6 day span, maybe cushioned out a day either side for safety is the fertility window and the days when intercourse could lead to pregnancy. But what if there's no ovulation? What if my cycle hasn't returned after child birth?

Well if there's no egg there can be no conception so therefore there's no fertility window and every day is a 'safe' day!

It sounds great. No need for contraception. No risk of pregnancy. It's actually the case for over half of a woman's life.

Your Reproductive Life

Before adolescence and the arrival of her first period, a young girl will actually have no risk of pregnancy. Where as we wouldn't expect such a young girl to be sexually active it's still a medical fact. Later on in life the menopause brings about the end of ovulation and therefore the end of any risk of pregnancy. Somewhere in between those two milestone of fertility, hopefully the woman will become a mother, putting her reproductive system and fertility into use for what it does best, making babies.

During pregnancy the woman experiences another period of time when she doesn't have to worry about contraception since she's already pregnant. Upon becoming pregnant no more eggs are produced as it would be incredibly complex to sustain two growing fetuses a few months apart, this concept isn't as daft as it sounds when you think that gestation of twins is normal enough but it's a good job ovulation does get switched off at that point!

So ovulation is turned off during pregnancy to prevent a second, parallel conception but when does it get turned back on again?

Fertility After Child Birth

In many cases ovulation returns as early as six weeks after giving birth and it's quite common for it to result in successful full term pregnancies so there can't be any major medical argument against pregnancy at that point. That said, many mothers who have just completed a 9 month pregnancy followed by a delivery might not wish to sign up again so quickly and there are definite benefits in separating consecutive pregnancies by a year or two.

But ovulation and therefore fertility doesn't always return so soon. We return to the logic that your body knows best. The key factor is dependency on breastfeeding.

Breastfeeding Naturally Suppresses Fertility

Your body knows that a huge effort is needed to produce enough good quality breast milk on demand for the new born, another pregnancy while that dependency exists would be a disaster.

Not all women breastfeed where as others continue to produce and give milk even up to 3 or 4 years old. This is quite common in some cultures. On the other hand, some women try to breast feed but need to supplement it with a bottle and others only give breast milk for a few months until the practicalities of a busy life kick in and the baby is moved to bottle feeding. What ever the case is, as all Doctors and mothers will tell you, if your baby isn't breast feeding your body stops producing milk. Why? Because it knows. Your body also knows according to the volume and frequency of feeding and suckling, when there is a dependency upon breastfeeding. Apart from full time breastfeeding there is no clear cut way to know when your body will decide that the quantity of milk consumed demonstrates 'dependency', but whilst your body identifies a 'dependency' it will not allow ovulation to take place.

Pregnancy whilst there is a dependency on breastfeeding is not good so your body knows best and removes the risk.

This is another infertile period in a woman's reproductive life, it's referred to as Lactational Amenorrhea, meaning a woman is amenorrheic (her ovulation is suppressed) due to breastfeeding. Knowledge and management of this allows it to be used as a method of NFP called the Lactational Amenorrhea Method (LAM).

What is inevitable is that ovulation should be expected to return at some point and with it the risk of pregnancy. Every woman is a unique case and advice from her Midwife or Doctor should be sought about when this will happen, but the assumption should be made that it will return and that opens up special scenario. The most common way to recognize the return to 'normality' would be menstruation. However menstruation occurs as a result of the process of ovulation, not a precursor to it. So reverting to contraception when menstruation arrives would leave a potential gap in the 2 or 3 weeks before hand. In actual fact when the body is trying to return to it's 'normal' ovulatory cycle it tends to misfire a lot, like starting a car which has been standing for a few weeks. So spotting of blood might not actually be menstruation and even though the hormones are kicking back in and could provoke menstruation it's quite common that ovulation didn't take place. But from a contraceptive point of view there is still a risk and the usual fertility indicators won't be back to normal yet.

Birth Control After The Return Of Ovulation

After giving birth a month or so of abstinence is normal but after that a midwife will usually recommend a condom as a first choice of contraception. Tissue damage and other delivery related issues mean that the risk of vaginal infection is higher than usual so a sterile condom seems logical.

Hormonal methods are avoided as there will be an impact on breast milk.

Natural Family Planning and Fertility Awareness are not viable options at this point as they require the return of the normal ovulatory cycle. For example, postpartum, cervical mucus observations might be unreliable as the body repairs itself and there has not yet been a menstruation to take a starting point for fertility charting. What day of your cycle are you on if you don't have a cycle? The use of urine based hormone tests to detect the LH surge may help identify when ovulation has returned even before your first real menstruation but the fertility window begins a good few days before the first positive test result might appear.

The period between childbirth or LAM and the return to fertility is not an easy one for contraceptive planning and should be carefully discussed with your Doctor or Midwife.

Once fertility has returned, NFP and FAM can be used again as incredibly reliable methods of contraception even if you are still breast feeding. Cervical mucus, LH levels, Basal Body Temperatures, menstruation and other fertility indicators will be back to normal and your body's natural rhythm can be monitored again. Waking up in the middle of the night to feed a baby raises a few questions with those who rely on waking temperatures but that can be accommodated within the rules of NFP and FAM. {{widget type="cms/widget_page_link" anchor_text="Click here to read about accurate BBT measurements.

So as you can see, the return to fertility after childbirth is one of the most challenging periods for contraceptive planning but understanding the basics of how your reproductive system works and regular consultation with your Doctor or Midwife can help you make the correct decisions.

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