Tuesday, August 11, 2009

The Lactation Amenorrhea Method

Ah, Birth control. I didn't really like being on the pill. At all. It made my periods really gross and didn't even regulate them how it's supposed to. I don't ever want to go back to artificial hormones again. Ever. Period.

So after having Margaret I read up on more natural ways to prevent pregnancy. I was very afraid that any sort of hormonal birth control (even the mini-pill) would wreck havoc on my supply, so I wanted to avoid that. After some research, I figured I was a good candidate for the Lactation Amenorrhea Method (LAM), it has been our primary form of birth control with some FAM mixed in.

The LAM method is actually more effective than barrier methods like condoms for the first 6 months. In general, the LAM method includes:

  • Exclusive breastfeeding. Exclusively breastfeeding means the baby needs to be at the breast for all nutritional needs. Pumping does not stimulate as much oxytocin as an actual baby does. While pumping is a wonderful way to ensure your baby has the best nutrition when you're away, it isn't the best way to prevent pregnancy.
  • Feeding at least every 4 hours in the day at and least 6 hours at night.
  • Being less than 6 months postpartum.
  • Not having any bleeding after 56 days postpartum- thought I don't agree with this considering I bled lochia up to about 70 days postpartum. The "56 days" is just to let you know that lochia bleeding doesn't affect fertility.
When I was about 4 months postpartum, I read Kippley's Breastfeeding and Natural Child Spacing: How Ecological Breastfeeding Spaces Babies. Kippley developed something she calls "ecological breastfeeding" which takes the LAM and adds more bullet points to our list including:
  • No artificial nipples. This includes any bottles (even for pumped breastmilk) or pacifiers.
  • No food or water besides breastmilk for the first 6 months of life.
  • Breastfeeding every 4 hours in the day and 6 at night is a bare minimum. The baby should nurse for comfort, not just nutrition, and on-demand. Scheduling feedings hurts this method.
  • Co-sleep* so the baby has unrestricted access to the breast at night.
  • Limit mother/infant separation as much as possible. This can mean that you babywear instead of using a stroller- the physical contact between baby and mother is to help keep the hormone levels so that ovulation can't occur.
  • Take a daily nap with your baby.
Now, I don't follow all of these (nap? daily? what?) but I do a lot. We waited 6 months before Margaret received a pacifier. Of course, by that point she didn't know how to suck on it. She decided it was a great teether, though. We did give her a pinky to suckle on when she was upset about being in the car as a newborn, though by 3 months she started rejecting that. We bedshare and babywear a lot. We do own a small stroller now, but I've only used it twice. Margaret loves it because of the novelty factor. For most circumstances babywearing is easier for me.

In her book, Kippley mentions a study she did with her ecological breastfeeding method- and on average it took about 14/15 months for fertility to return. I'm at over 16 months of infertility. I guess you could say I'm "above average."

Of course the LAM isn't feasible for everyone, probably not even most moms, but it's there for the few who have the option of it.

Books I read in studying this:
Taking Charge of your Fertility. This is like the fertility bible and teaches the basics of fertility and FAM and charting. I didn't find its breastfeeding chapter to be very good, though.
Breastfeeding and Natural Child Spacing
Your Fertility Signals
Much shorter than TCOYF and simpler, but I think it had nicer information on fertility and breastfeeding. Since it is so short, this would be a great introduction to menstruation and fertility for a girl learning about her menses.
Also kellymom.com has some good information too.

*I wanted to note again that co-sleeping doesn't always mean bed-sharing. Cosleeping includes any sleeping arrangement where the baby is in the room with you- where you can hear and respond to your baby's needs quickly.


  1. This is a huge part of my life right now. My husband and I really want to get pregnant, but my body still isn't back to fertility, because I am still nursing frequently. It is one of those things that I struggle with, because I want both (nursing and another pregnancy). I guess I need more patience and faith. But, I'm right at 15 months...so we'll see how average I am! :D

  2. I know how you feel Mallory. I'm kind of in the same boat. Margaret still needs me (sometimes I'm 90% of her nutrition in a day) so much and I want to give that to her because I feel she deserves it. I actually have a lot of thoughts about this- probably enough for another post. Maybe I'll start one for later this week.

  3. The ecological breastfeeding didn't work for me. I became pregnant when Sariah was 7 months old. She never had a bottle until I started giving her some water at 6 months old and she co-slept with us until she was 9 months She didn't even want to eat solids until I was 2 months pregnant...but I'm not complaining, I love that they are so close.

    Someone I know who did everything you listed never became pregnant until her first was 21 months old.

  4. I'm definately looking in to this -- I kept meaning to ask you how you track your cycle, following one of your earlier posts.

    I guess I fit the bill, except I'm not sure if W feeds as frequently at night... I'm only aware of being woken once last night... can you tell I'm the exhausted mother of a 4week old and 2 and a half year old. LOL.

    I never trusted this method after we had Eve, our MWs always tell us how it's not effective. Maybe I should write and show them this!! Having said that, I'm not sure I want to test it out by falling pregnant... can you imagine me as the exhausted mother of a 10month old, 3 year old and newborn? No, me either... I mean, when would I get time to knit and write crazy comments on your blog (let alone post on my own!)

    Thanks again for an interesting and informative post :D If I only have time to read one blog, it's generally yours!!

  5. I think using LAM and tracking your cycles are a great way of spacing children. Though I see nothing wrong with using a contraceptive if you can't risk pregnancy. That's me. I can't risk it.

    I know I a lot of women who got pregnant while breastfeeding because they thought they couldn't. I am pretty sure they weren't using the method correctly. Even if I had wanted to, I couldn't with M because I had to pump for two months, and he often went long periods without eating, anyway. I bet if I had been able to nurse him in those early weeks my menstrual cycle wouldn't have returned so quickly!

  6. Lisa, for me I just really didn't want to use a chemical birth control after how it affected me the first time.

    I also know LAM can work differently even for different times in a woman's life. I know one mom who had kids 14 months apart even though she was exclusively breastfeeding on demand. Then a couple of kids later, she had to fully wean her 2.5 year old before she could get pregnant again. Same mom, different experiences.

  7. I've wondered about this, mainly to try and figure out how to BF exclusively but still *GET* pregnant! My DH and I got a late start on starting our family and we want several more kiddos, before I hit 35. I don't know how to keep BFing (at LEAST until DD is a year+) and start my ovulation so we can get the next baby "rolling"... Maybe I'm being selfish? Have you read or heard anything about how to increase my fertility while BFing?

  8. Big Mama Morgan,
    Actually there are a few things. Eating a lot of dairy can increase the chances of you getting pregnant earlier. Even if the milk doesn't have any added hormones, it still has the cow hormones that just comes with it. Those hormones can affect your own hormones and bring fertility with it.
    There are also creams and herbs you can use. Vitex is a popular one- I've heard it can affect supply a bit. It is supposed to limit prolactin levels. Prolactin is the hormone that is produced when your baby suckles and it prevents ovulation. I've also heard RRL tea can help, too. I know it's good for toning the uterus- I don't actually know too much about how it affects fertility though.
    Night weaning can help. Margaret has always been a long night sleeper- I think that's why my period came back at 5.5 months even though my full fertility hasn't returned.

    Maybe I'll do a post on this sometime.

  9. What amazes me is how some ladies manage to get enough opportunities to even risk pregnancy in the first six months! They must have sleepy babies :-)

    I think the big prob with LAM is that people do not breastfeed frequently enough for it to work. It's interesting that you've written about this because I posted something about it last week - how LAM helps women in the third world, without access to conventional birth control, to space their babies.


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