The lactational amenorrhea method (LAM) works on the basis that exclusive breast-feeding suppresses a woman's fertility, preventing pregnancy while she is caring for a young infant.
For some women, LAM can be a very effective family planning method as long as certain conditions are met:
- the woman's period has not returned since she gave birth
- the baby is exclusively breast-feeding on demand and is not eating any other foods or liquids
- the baby is less than 6 months old
If the mother and baby meet all of these conditions, then the chance of pregnancy is very low, less than 2 percent according to World Alliance for Breastfeeding.
Once the woman stops exclusively breast-feeding and the baby starts taking supplemental foods, such as formula or baby cereal, the woman's body will begin preparing for pregnancy and ovulation will begin.
If any of the factors listed above change, the woman should consider using additional birth control to prevent pregnancy.
These range from readily available and relatively inexpensive options, such as condoms, to devices requiring a prescription and surgical options. Some of these options include:
Physical barriers to conception, such as condoms, diaphragms, or the cervical cap, are still an effective method of contraception.
Barrier contraceptives do not contain any hormones so do not affect a woman's milk supply or her ability to breast-feed.
Doctors usually advise women to wait until their first postpartum check before inserting anything into their vagina. This is because there is a higher risk of infection until the cervix has closed and any tears have healed.
Also, many women find that they need to be resized for a new diaphragm or cervical cap, due to the cervical and vaginal changes that occurred during pregnancy, delivery, and recovery.
Copper intrauterine device (IUD)
There are two different types of IUDs: copper and hormonal. Copper IUDs are a highly effective form of birth control that do not have any effect on the milk supply. The IUD is a small coil that is, in this case, wrapped in a small amount of copper.
It prevents implantation, sperm movement, and fertilization. A doctor needs to insert an IUD, which is effective in preventing pregnancy for up to 10 years. If a woman decides that she wants to get pregnant again, the IUD can be easily removed.
This method is a permanent form of birth control and involves cutting the fallopian tubes, which connect the ovaries to the uterus. Tying up or blocking the tubes then completely prevents sperm cells from meeting with an egg.
Like the other forms of non-hormonal contraception, this method will not have any effect on a woman's milk supply. Many women choose to have this procedure done during a planned cesarean delivery.
According to the Infant Risk Center, most forms of hormonal contraceptives are probably safe and will not affect a nursing infant. However, the bigger concern is the effect that these forms of contraception will have on a woman's milk supply.
While some women may tolerate hormonal contraceptives without an issue, sometimes the estrogen in these products can cause a woman's milk supply to dry up completely. This is a bigger risk in women who are nursing an older baby, or those who are already dealing with low milk supply issues.
As a result, most doctors will recommend using a progesterone-only option:
Progestin-only pills (POPs)
POPs are similar to a traditional birth control pill but only contain progesterone. These types of pills do not contain any sugar or placebo pills, so each of the pills the woman takes will be active.
This option is less likely to affect a woman's milk supply adversely.
Depo-Provera is a progesterone-only injection that will protect against pregnancy for up to 3 months.
Some women can be sensitive to progesterone, however, and there is no way to reverse the medication once injected. As a result, the doctor may suggest a woman takes POPs for a month or two to see how the progesterone affects her and her milk supply before taking a longer-acting dose.
In addition to the copper IUD, some IUDs are coated in progesterone. This type of IUD works in the same way as POPs and the Depo-Provera injection.
In some women, however, the hormonal IUD has been found to decrease milk supply. Hormonal IUDs are effective for 3 to 5 years, depending on the brand, and can be easily removed if a woman changes her mind about pregnancy.
Hormonal forms of birth control do not protect against the transmission of sexually transmitted infections. Women who have multiple sexual partners should also consider using a barrier method.
It is important for a woman to discuss her options with her doctor and her partner, if applicable.
Sterilization or insertion of an IUD may or may not be covered by medical insurance and can be quite expensive.
These options are also permanent or for long-term use, so may not be appropriate for someone looking to expand their family in the near future.
Other options, such as the condom or female condom, are less expensive and readily available. These do not have the same level of effectiveness as other options, however.
Finally, it is important for a woman to consider her breast-feeding goals and how her milk supply tolerates the use of hormonal options. If she notices that her milk supply is decreasing with POPs, she should seek ways to increase milk supply. This may be a temporary drop in supply.
Breast-feeding for longer and more frequently will increase milk supply. Pumping after feeding will also help to increase the amount of milk.