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Debra Roman, RN, BSN, IBCLC It has long been recognized that breastfeeding has an effect on fertility. The mechanism by which this natural period of infertility occurs is not fully understood, but it is believed to be the result of frequent, around-the-clock suckling, which results in hormone suppression during the early months of lactation.
The Lactational Amenorrhea Method (LAM) is a modern, temporary family planning method that has been developed as a tool to help support both breastfeeding and family planning. It is based on this natural infertility that occurs as a result of exclusive, frequent breastfeeding.
The inhibition of the ovulatory cycle in humans is a complex physiological process, and is just beginning to be understood. It is known that frequent suckling results in high prolactin levels, and is closely associated with altered luteinizing hormone (LH) secretion and amenorrhea. (1) Subsequent infertility is the result of this hormonal suppression during lactation.
A group of researchers in the area of lactational infertility met in Bellagio, Italy in 1988. They endorsed the conclusion that there was a strong correlation between frequency of suckling and the duration of contraceptive protection provided during pregnancy. These conclusions became known as the Bellagio Consensus. (2)
Subsequently, numerous studies were conducted to evaluate the accuracy of the Bellagio Consensus statement. In 1995, the Bellagio Consensus Conference on breastfeeding established LAM as a safe and effective family-planning method. The three criteria defining LAM are that the mother is fully or nearly fully breastfeeding her infant, her menses have not returned, and the baby is six months old or less. (3)
Fully breastfeeding is the term applied to both exclusive breastfeeding (no other food or liquid is given to the infant) and almost exclusive breastfeeding (vitamins, water, juice, or ritualistic feeds given infrequently in addition to breastfeeding). Nearly fully breastfeeding means that the vast majority of feedings given to the infant are breastfeeds.
Although exclusive breastfeeding is not necessary for LAM to be effective, the more frequently an infant nurses around the clock, with no solids added until six months of age, the higher the likelihood of continued amenorrhea. Additionally, the interval between feedings at night should be no more than six hours. (3)
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Amenorrhea is defined as no vaginal bleeding after 56 days postpartum. Bleeding during the first two months postpartum is considered lochial discharge and is not menstrual bleeding. For purposes of LAM, menstruation is considered at least two consecutive days of bleeding, occurring at least two months postpartum.
At about six months of age, the baby may begin receiving complementary foods while continuing to breastfeed. This introduction of other foods and liquids can decrease the amount of suckling time, thus triggering the hormonal response that causes the menstrual cycle to resume.
For women practicing LAM, the efficacy is quite good. If all three criteria mentioned above are met, there is less than a 2% chance of pregnancy, and the woman does not require a complementary family planning method at this time. (1) As soon as the woman no longer meets all three criteria, her chance of pregnancy begins to increase, and she may want to begin using an additional method of contraception.
The World Health Organization has declared that breastfeeding "has been the most effective contraceptive world-wide". (4) Since breastfeeding significantly suppresses fertility, and it is recognized that mothers who breastfeed have longer intervals between births, it is important that healthcare providers educate women on the value of this natural family planning method. The advantages of LAM are many, including high effective rate, no side effects, does not require insertion of any device at the time of sexual intercourse, can be initiated immediately postpartum, is economical, is acceptable to all religious groups, and contributes to optimal breastfeeding practices and therefore enhances both maternal and infant health. (3)
As healthcare providers, we should educate ourselves on the Lactational Amenorrhea Method, so that we can accurately inform our clients about the impact of breastfeeding on fertility. Many women will be delighted to discover that this is yet one more marvelous benefit that comes with exclusive breastfeeding.
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