Natural Child Spacing and Breastfeeding
Augusta, Georgia USA
From: LEAVEN, Vol. 34 No. 6, December 1998 - January 1999, p. 128
A natural consequence of breastfeeding is the spacing of births. However, in some cultures, especially those that practice a variety of nursing styles, misconceptions about breastfeeding and fertility abound. A 1997 edition of Healthy Pregnancy magazine states, "Contrary to popular belief, breastfeeding does not halt ovulation, so it is not an effective birth control method."
As many fully breastfeeding mothers know, lactational amenorrhea (absence of menstrual periods as a result of breastfeeding) does affect their ability to get pregnant. Scientific data supporting this has been mounting for years. The Bellagio Consensus Conference on "Breastfeeding as a Family Planning Method" established that fully breastfeeding mothers who remain amenorrheic have less than a two percent chance of becoming pregnant in the first six months postpartum. "Fully breastfeeding" is defined as supplementing no more than one or two mouthfuls a day and waiting no more than four to six hours between nursings. A woman who is practicing the Lactation Amenorrhea Method (LAM) relies on exclusive or nearly exclusive breastfeeding for postponing or avoiding pregnancy during the first six months after childbirth or until her periods return, whichever occurs first.
Many breastfeeding mothers find they remain amenorrheic longer than six months, especially mothers who practice a style of nursing that Sheila Kippley calls "ecological breastfeeding." In Breastfeeding and Natural Child Spacing, Kippley describes ecological breastfeeding as the kind of nursing that most effectively spaces babies: nursing on cue, keeping baby close, providing all nourishment and liquids at the breast for the first five to eight months, and nursing to comfort the baby. It does not include the use of bottles or pacifiers, mother-baby separation, parent-imposed feeding schedules or restriction of night nursings. All of these practices limit the nipple stimulation that suppresses ovulation.
The chance of pregnancy occurring during the first three months of ecological breastfeeding are practically nil. During the second three months, there is a less than 2 percent chance of becoming pregnant before the first menstrual period. After six months postpartum there is a six percent chance of becoming pregnant before the first period. That means that an amenorrheic woman who is relying on ecological breastfeeding alone has a 94 percent chance of not becoming pregnant during the second six months postpartum.
Women who practice ecological breastfeeding average 14.6 months of amenorrhea. Seven percent experience a return of their menses in the first six months following childbirth. Thirty-seven percent get their periods back during months seven to twelve. Forty-eight percent get their periods back sometime during the second year after childbirth. Eight percent go longer than two years without periods.
Despite the variability in the return of menses, there is not as much variation in the return of fertility as might appear. Women who experience a return of their periods in the first six months tend to be infertile for a few cycles, while the early cycles of women experiencing a longer period of amenorrhea are often fertile.
A Leader may be one of the few people a nursing mother knows who is willing to help her find information about breastfeeding's effects on contraception and other natural methods of child spacing. Women differ in their reasons for using LAM, from concerns about hormonal methods to religious beliefs. However, quite often these women are similar in their need to be reassured that LAM's effectiveness has been thoroughly established by scientific study.
A Leader can refer a mother to THE WOMANLY ART OF BREASTFEEDING or Breastfeeding and Fertility' (No. 87). Breastfeeding and Natural Child Spacing, available through the LLLI Catalogue, is the pre-eminent work on the subject and will be helpful to any mother interested in mothering through breastfeeding. Organizations such as the Couple to Couple League can be a resource about LAM as well as other methods of natural family planning. The BREASTFEEDING ANSWER BOOK lists additional resources and organizations.
More on Fertility and Breastfeeding
Additional resources are available from LLLI for those who wish to explore this topic in greater depth.
Toni Weschler's Taking Charge of Your Fertility is newly approved for use in Group Libraries. This comprehensive book describes the menstrual cycle and the signals a woman's body provides to indicate fertility. It includes chapters on reproductive health, natural birth control, achieving pregnancy and the benefits of charting as well as information on fertility awareness during breastfeeding, premenopause and other special circumstances.
For a more scholarly approach to the subject, Leaders may wish to examine Stuart-Macadam and Dettwyler's Breastfeeding: Biocultural Perspectives (No. 334). In Chapter 11, "Breastfeeding, Fertility and Maternal Condition," anthropologist Peter T. Ellison blends information from a variety of disciplines and cultures to explain the interplay between fertility and lactation. The author provides historical information to describe how we came to our current level of understanding and points out the areas that require further investigation.
In Your Fertility Signals (No.376), author Merryl Winstein employs clear diagrams and step-by-step instructions to describe the physical and emotional changes a woman may experience as she moves through her monthly cycle. The effects of special circumstances such as breastfeeding, stress and premenopause are thoroughly discussed. Sus Signos de Fertilidad, the Spanish version of this book, is also available from LLLI (No. 376SP). German and Chinese versions, although not reviewed by the LLLI Book Evaluation Committee (BEC), may be ordered directly from Smooth Stone Press, P.O. Box 19875, St. Louis, Missouri 63144 USA. Any Leader interested in reviewing the German or Chinese edition is encouraged to contact Diane Beckman, BEC Chairman, 319 Dixon Avenue, Cary, North Carolina 27511-3259 USA or DiBeckman at aol.com (email).
Breastfeeding and Fertility . LLLI. Jan 1991. Publication No. 87.
Kippley, J. and Kippley, S. The Art of Natural Family Planning. Cincinnati, Ohio: Couple to Couple League, 1996; 333-72.
Kippley. S. Breastfeeding and Natural Child Spacing," 2nd edition. Cincinnati, Ohio: Couple to Couple League, 1989.
Mohrbacher, N. and Stock, J. BREASTFEEDING ANSWER BOOK, revised edition. Schaumburg, Illinois: LLLI, 1997;356-62.
THE WOMANLY ART OF BREASTFEEDING, 6th edition. Schaumburg, Illinois: LLLI 1997; 364-68.