Breastfeeding and Fertility Myths
Michal Schonbrun, MPH, CHES
MYTH No. 1 Breastfeeding women do not ovulate or get pregnant
Studies show that the majority of women who are fully or near fully breastfeeding up to six months, will not get pregnant before their first, post-partum period. Yet 20 -30% will get pregnant- if they are not relying on an additional method of contraception. This means that up to 30% of nursing mothers are having a proper ovulation before their first or second menstrual bleeds,therefore conception and pregnancy are possible outcomes. For the remaining 70% of women, the “infertile time” is characterized by annovulation (no proper ovulation before the first bleed) or by an inadequate (usually short) luteal phase (less than 12 days between ovulation and next bleeding).
MYTH No. 2 All forms of breastfeeding provide a contraceptive effect.
Not exactly. Studies show that women who are fully breastfeeding or nearly fully breastfeeding (according to the baby’s desires) and at a high frequency, day and night, have the best chance of postponing a first ovulation until after the six month mark. This means that supplements of any kind do not exceed 10-15% of total feeds. Partial breastfeeding infers that there are longer intervals between feeds and that the baby is getting other forms of nutrition. In this case, the hormonal mechanism which prevents ovulation, is not working at full capacity and the chances are good that a woman’s fertility will return before the six month mark.
MYTH No. 3 Breastfeeding women cannot know when their fertility will resume.
Women who learn to observe, chart and interpret changes in their cervical secretions and sensations can know in advance when their bodies are trying to ovulate. Most but not all women who breastfeed frequently (every 1-3 hours, day and night) experience prolonged intervals (even months) of relative dryness and infertile secretions. Once they learn to accurately identify these secretion changes (with a qualified teacher), then a women can use this information as a contraceptive method.
MYTH No. 4 The Lactational Amenorrhea Methodis 98% effective in preventing pregnancy if a woman is fully nursing up to six months, has seen no bleeding, and gives no supplements to her baby.
The Lactational Amenorrhea Method (see link to LAM)is widely promoted around the world as an effective contraceptive method. It is based on the practice of frequent nursing and suckling by the infant. LAM is purported to carry a 98% effectiveness rate up to six months. Unfortunately, the method doesn’t guarantee equal results in all women. The method was tested primarily in developing countries, where breastfeeding is not only more culturally appropriate, but it is practiced in a way which enables frequent stimulation of the breasts by the newborn. As a group, western women are not able to reap the contraceptive benefits of breastfeeding because they do not breastfeed long enough or frequently enough. Even if a woman nurses round the clock and at high frequency, she has no guarantee that her first ovulation will be delayed beyond six months. Therefore the method is much less reliable in western countries.
MYTH No. 5 Natural contraceptive methods are not effective during breastfeeding, especially when a woman has not yet had a menstrual bleed.
Breastfeeding women can be fertile. The only way one can try to prolong the period of post-partum infertility is by frequent nursing (1-3 hrs) day and night, and the minimal use of supplements (milk, water, solids) and pacifiers.
Women who learn to observe, chart and interpret their secretion patterns can know their fertility status. Women’s natural secretions communicate if and when their bodies are trying to ovulate. This ‘language’ can be learned and practiced easily. Effectiveness is highest among women who learn the method with a qualified teacher, and remain in follow-up with them until their periods resume.
MYTH No. 6 Progestin-only pills are just as effective as combined-pills (estrogen and progesterone) among breastfeeding women
Progestin-only pills are usually prescribed for breastfeeding women and taken daily without a break. Usually, these pills do not interfere with the quality and quantity of breast milk that a woman’s body produces. Contrary to popular belief, these pills succeed in suppressing ovulation in about 50% of the cases, so they are less effective than the combined pills. Progestin-only pills are known to cause amenorrhea (no periods) and increase the incidence of spotting and bleeding.
MYTH No. 7 The main factor which delays ovulation in breastfeeding women is the length of time a woman nurses until weaning her baby.
The main factor thought to delay ovulation is not the length of time that a baby suckles on the breast, but the frequency of stimulationof the breast. Every act of suckling (regardless of length of time) suppresses the hormones that cause ovulation. A one-minute ‘sip’ twice an hour is more effective than a twenty- minutefeed every four hours, especially at night. Longer intervals between feeds will induce an earlier first ovulation. In traditional cultures where the baby is carried on a sling attached to the mother’s body- a baby will suckle more frequently than when nursed according to a ‘schedule’, a practicewhich results in the natural spacing between births of two-to-three years, on average. This type of breastfeeding practice is difficult to follow in western cultures, where it is rare indeed when a woman succeeds in delaying her first menstruation beyond the one-year mark.
MYTH No. 8All post-partum bleeding is menstrual bleeding
Bleeding experienced up to 2.5 months post-partum in a fully breastfeeding woman is almost always related to the after-birth. It is not menstruation. This distinction is not easily recognized, causing many women concern and anxiety. If a second bleed occurs 4-6 weeks later, only then can it be assumed that actual menstruation has resumed.