What is the best method of birth control while breastfeeding?

The Lactation Amenorrhea Method (LAM) you can use if you are less than 6 months post-partum, are exclusively breastfeeding, and have not had a menstrual period. Though these characteristics have little to do with typical fertility awareness methods, LAM is often grouped with fertility awareness methods. What I want to explore today is whether LAM is the best method of birth control while breastfeeding.

 

Should you use the LAM?

The LAM has been studied as 98% effective, which is decent. The problem with the LAM is that many women do ovulate before their first post-partum period, and if you ovulate and have enough progesterone to sustain a pregnancy you may be in for a surprise.

Progesterone is a hormone that is needed for pregnancy and often interfered with by hormones in abundance while breastfeeding.

While 98% effectiveness is pretty good odds you won’t get pregnant, oftentimes 6 months post-partum is not a time that you want to get pregnant again at all.

In addition, many LAM effectiveness studies took place in cultures very different from our own, so propensity to ovulate before the first post-partum period and before six months could be very different.

 

The conventional birth control conundrum

Maybe you don’t want the extra hormones circulating while you are breastfeeding, maybe you don’t want something as long term as an IUD, maybe barriers are uncomfortable or undesirable. It’s definitely not an easy task to choose a method while breastfeeding!

 

How does the sympto-thermal method of fertility awareness fit in?

The sympto-thermal method of fertility awareness can often step in where others will not suffice. With this method, you can not worry about charting until you notice what you typically would in any cycle using the method – cervical fluid. As long as you are familiar with your cervical fluid, or are trained well in the method and have someone available to ask questions, you will be able to not worry about a possible ovulation until the onset of a cervical fluid change. When you notice this change you can then begin using the method in full and catch your first ovulation, even if it happens before your first post-partum period.

 

The tricky part about FAM while breastfeeding

Many women have multiple episodes of seemingly fertile cervical fluid that do not end in ovulation. These will often subside only to have cervical fluid return a couple of days later, not enough time to have “safe time”. If this is true for you, you may consider fertility awareness while breastfeeding hard.

When your body is telling you “Fertile, fertile, fertile!” and you have no ovulation, you don’t generally enjoy the method. But, remember this is a temporary time, and soon enough your cycles will get back to normal and you will have more safe time than unsafe.

You can also choose to use this time for alternate or barrier sex.

 

So how do you get great effectiveness with minimal effort?

If possible, learn fertility awareness before getting pregnant and have the background knowledge, if not, take a class and have a teacher that you can ask questions to. Begin by using LAM until you notice cervical fluid, rather than until you get your first post-partum period, and you will have a that peace of mind that comes with great contraception while not having to worry about another method from only a couple of weeks after your baby is born.

For anyone who has not yet begun breastfeeding or is in their early weeks, you may want to read The Seven Standards of Ecological Breastfeeding by Sheila Kippley*. She has done surveys on women who have breastfed in that way and it generally delays ovulation longer. The added benefit of a longer delay in ovulatory cycles is that you tend to go back to regular cycles faster, meaning less cycles with long periods of possible fertility with delayed or absent ovulation.

* Note from Hannah: Ecological breastfeeding promotes bedsharing. While its’ every family’s choice to make, it’s important to me to disclose that bedsharing, even if done following all safety guidelines, is LESS SAFE than having a baby on their own sleep surface (and following all proper rules of safe sleep). Room sharing, however, is protective against SIDS.