The Effectiveness of LAM and Eco-Breastfeeding as Contraceptives

Written by Jodi Cleghorn Thursday, April 30 2009 07:38

Mom Topics - Breastfeeding

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I’ll never forget the joke which dominated my thinking about natural birth control for many years, “Q: What do you call people who use natural birth control? A: Mum and Dad.”  There is a definite assumption that any form of birth control which cannot be purchased from a chemist or supplied by a doctor is inherently unreliable. Women are suspicious and doubtful of the reliability of their bodies in providing accurate information to chart their fertility before falling pregnant, so it is no wonder the myth that breastfeeding is not a successful or guaranteed method of contraception is so pervasive.

In my articles Prolactin and Breastfeeding Styles and Ecological Breastfeeding I introduced the idea that not all breastfeeding is equal and some forms of breastfeeding (exclusive and eco-breastfeeding) lend themselves to natural states of infertility because of heightened levels of prolactin.

But what is the reliability of the two methods of breastfeeding infertility?

Lactation Amenorrhea Method

The Lactation Amenorrhea Method (LAM) is endorsed by the World Health Organisation and is based on the following principles:

• Breastfeeding must be the infant’s only (or almost only) source of nutrition.
• Breastfeeds must occur at least every four hours during the day and at least every six hours at night.
• The infant must be less than six months old.
• The mother must not have had a period after 56 days post-partum (when determining fertility, bleeding prior to 56 days post-partum can be ignored).

The WHO states that exclusive breastfeeding, as per LAM, is 98% effective as a contraceptive. It is also only reported as ‘reliable’ for the first six months of motherhood.

The Kippleys, pioneers of Ecological Breastfeeding state only half the women using LAM experience complete natural infertility in the first six months. The other half return to menstruation before their babies are 6 months old.(1)  They believe this is because LAM has no emphasis on the frequency of feeding (which has been clinically shown to lengthen the return of menstruation) or in keeping mother and baby in close proximity to each other (encouraging frequent feeding).

Despite this, exclusive breastfeeding still has a 98% infertility rate prior to the first menstrual period provided the baby is not yet six months old.

Ecological Breastfeeding

The reliability of EB, when all of the seven standards are followed (and there has been no bleeding after the 8th week post partum) is 100% in the first three months and 99% from three to six months. This is more reliable than the mini pill which is often prescribed as a contraceptive for breastfeeding mothers. The Kippley’s also state that it is the only form of extended natural infertility provided by breastfeeding. (2)

Ovulation and the Return of Menstruation

A common argument put forward against the use of breastfeeding as a form of birth control is the likelihood of ovulating before the return of menstruation – of being fertile without knowing it.

Jen O’Quinn in her article Natural Child Spacing writes:

"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."(3)

Women often get one “warning” period before full fertility returns.

Mothers practicing the seven standards of ecological breastfeeding seem to have a longer delay in the return of their menstruation compared to other forms of breastfeeding, based on the extended elevated levels of prolactin.

An American study in 1999 found mothers with typical western breastfeeding behaviours began menstruating before mothers practicing eco-breastfeeding.  The researchers found the median return time for eco-breastfeeding mothers was 12.9 months compared to 5 months for the mothers in the other group. They also found that eco-breastfeeding mothers increased the delay of menstrual onset by 55% when they had their babies in the bed with them.(4)

The Kippley’s report menstruation returns for mothers practicing the seven standards at the following rates:

• 7% menstruating at six months
• 44% menstruating at 12 months
• 64% menstruating at 18 months

Only 6% of women using eco-breastfeeding conceive before the return of their menstrual cycles. (5)

In Conclusion

With 40 years experience in teaching and charting the return of ovulation and menstruation for women using ecological breastfeeding, it is hard to go past the Kippley’s method for natural contraception. The method’s emphasis on the frequency of breastfeeding, short intervals between breastfeeding, night feeding and the continual close contact of mother and child all support a woman’s ability to maintain high levels of prolactin which suppress ovulation. It also offers breastfeeding women a natural form of birth control beyond the initial 6 month mark.

Granted not all women have the ability to combine on-demand, exclusive breastfeed with natural parenting but for those women who do, they have the chance to create a period of reliable infertility for themselves which does not rely on chemical contraceptives.

References

1. Kippley, J & S Chapter 6: Ecological Breastfeeding from Natural Family Planning: the Complete Approach

2. Kippley, J & S Chapter 6: Ecological Breastfeeding from Natural Family Planning: the Complete Approach

3.  O’Quinn, t Natural Child Spacing published by the La Leche League.

4. Taylor, HM, Va'Zquez-Geffroy, M., Samuels, SJ & Taylor D.M. Continuously Recorded Suckling Behaviour and its Effect on Lactational Amenorrhoea (1999) in Journal Biosocial Science.

5. Kippley, J & S Chapter 6: Ecological Breastfeeding from Natural Family Planning: the Complete Approach

Photo: Breastfeeding Dylan at the Boulders (c) Karen van Harskamp 2005, from private collection

Related Articles at Type A Mom

Ecological Breastfeeding
Breastfeeding and Fertility Myths
Prolactin and Breastfeeding Styles

Jodi Cleghorn is a Brisbane mother. writer, lactivist and natural birth advocate. She is the co-author of the book Reclaim Sex After Birth: the survival guide, creator of the Date Night Challenge and recently appointed third partner in the Australia distributorship of Orgasmic Birth. A camping trip to the Main Range National Park at the start of the week recharged her batteries but annihilated her writing schedule.

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