N,31, was slightly taken aback when I showed her the ultrasound image of the moving foetus inside her womb. She had just delivered a girl seven months ago and was still breastfeeding.
“Doc, how can it be?” she asked. “My mum told me that I would not get pregnant if I am breastfeeding.” Myths concerning fertility after delivery are common: from old wives’ tales that it is impossible to get pregnant while breastfeeding to beliefs that the body will not get pregnant until it is “ready.”
When would ovulation occur after delivery?
Ovulation is a prerequisite for pregnancy. Research studies have found that women ovulate for the first time between 45 to 94 days after giving birth. Most women do so around 6 weeks after childbirth. However, if they breastfeed, ovulation will be delayed as the elevated levels of milk producing hormone, prolactin, will suppress another pituitary hormone, follicular stimulating hormone (FSH), which will then inhibit the development of eggs in the ovaries. Breastfeeding thus has a contraceptive effect.
How effective is breastfeeding as a contraceptive method?
Using breastfeeding as a method for birth control is known as lactational amenorrhea method (LAM). Its effectiveness depends on the intensity and frequency of infant suckling and the extent to which supplemental food is added to the infant's diet. If the mother breastfeeds exclusively at regular intervals, the method is 98% effective for the first 6 months after delivery. To achieve such high effectiveness, certain criteria must be met. They are:
Supplemental food to the infant should not exceed 5% to 10% of total feedings.
Breastfeeding must be done every four hours during the day and every six hours at night.
Supplementing with other forms of nutrition, expressing the breast milk by hand or by pump will reduce the effectiveness of LAM as prolactin levels may not be high enough to suppress ovulation.
After 6 months or with the resumption of menstruation, the contraceptive efficacy of LAM is lower and is estimated to be around 94% at one year after birth. With weaning, prolactin levels decline and ovulation resumes within 14 to 30 days.
How useful is LAM?
LAM is useful as a temporary method of contraception and for child-spacing. It is most appropriate for women who plan to fully breastfeed for at least 6 months. Women who choose to use this method require proper counseling during pregnancy to improve efficacy. If the mother decides to supplement breastfeeding or if she begins menstruating before 6 months postpartum, other methods for contraception should be used.
N decided to continue with the pregnancy but was apprehensive whether breastfeeding would cause her to have a miscarriage or premature birth. I reassured her that it would not be a problem to continue doing so. With the support of her husband, N continued to breastfeed her daughter and is awaiting the arrival of her new baby in a few months’ time.