New mothers are often given conflicting advice when it comes to breastfeeding and fertility. After giving birth, it’s common to have “the chat” with their ob/gyn, lactation consultant or midwife about what birth control method they’re interested in, if they want to avoid getting pregnant.
But as time goes on, more questions tend to come up about fertility while breastfeeding.
For some women, the concern about fertility involves wanting to prevent pregnancy too soon; others wonder if they need to wean to be able to conceive again.
Can you get pregnant while breastfeeding?
Short answers: Yes, you can get pregnant while breastfeeding. No, you don’t need to wean to conceive.
Some women take advantage of a natural birth control method known as Lactational Amenorrhea Method (LAM).
LAM is when you don’t have a regular menstrual cycle because you’re exclusively breastfeeding.
For some women it takes time for fertility to return.
But for the majority, it can return while still breastfeeding.
What is the Lactational Amenorrhea Method?
Exclusively breastfeeding has been shown to be a very effective form of birth control; however, there are certain criteria that must be met if LAM is to be used effectively.
When the following criteria are met, LAM is 98-99.5% effective at preventing pregnancy:
• Your menstrual cycle has not returned
• Your baby is under 6 months old
• Your baby is exclusively breastfeeding which means no formula and no solids (except negligible exploring tastes)
• Baby is fed on cue at the breast, both during the day and at nighttime
When is the Lactational Amenorrhea Method not very effective?
When the above criteria are met, LAM is quite effective (although not guaranteed).
If you deviate from any of them, your risk of pregnancy increases, even if you haven’t had your first menstrual cycle yet.
The following can increase your risk of pregnancy:
- Having a regular menstrual cycle – often an indication you are ovulating and can conceive
- Exclusively pumping with a breast pump, or pumping on a regular basis while away from baby – pumping doesn’t suppress fertility in the same way feeding on cue at the breast does. One study found the risk of pregnancy went from 0.5-2% when meeting the above LAM criteria to 5.2% for women who were regularly pumping – even when they provided 100% of their baby’s milk needs.
- The introduction of solid foods, bottles, pacifiers or anything else that will decrease time at the breast
Are there ways to reduce the risk of pregnancy with LAM?
Women who practise ecological breastfeeding are likely to be less fertile than mothers that utilise modern feeding and soothing tools such as pacifiers and bottles.
To practise ecological breastfeeding:
- Avoid pacifier use and soothe baby at the breast
- Keep baby close – skin-to-skin, babywearing, etc
- Co-sleep and feed on cue throughout the night
- Feed only from the breast
- Avoid bottle use
For women who practise ecological breastfeeding:
- In the first three months postpartum the risk of pregnancy is almost non-existent
- In months 3-6 postpartum the risk is less than 2%
- If their menstrual cycle has not returned, after 6 months the risk of pregnancy is around 6%
- Only 7% experience a return of their menstrual cycle in the first 6 months
- 37% see a return of their menstrual cycle during months 7-12
- 48% will see the return of their cycle during the second year postpartum
- 8% won’t see their cycle return until after the second year postpartum – making ecological breastfeeding tempting just for this chance!
Do I need to wean to get pregnant?
While ecological breastfeeding delays the return of your fertility, weaning isn’t usually necessary when it comes to getting pregnant.
If you want to conceive but your menstrual cycle hasn’t returned you can make changes to your breastfeeding pattern and see what happens.
Every mother and baby pair is unique and there isn’t a tried and true method to guarantee a return of fertility.
If you want to conceive within the first year postpartum but you don’t want to wean, any steps you take away from the LAM criteria might increase your fertility.
Using a pacifier, pumping feeds, night weaning, etc can all reduce LAM effectiveness.
Some women choose to wean in order to conceive, but it’s important to remember that even weaning can’t guarantee a return of your fertility, or conception.
Even for the healthiest of couples it isn’t abnormal for conception to take 6-12 months.
Take that into consideration when deciding whether weaning is right for you.
Will you be disappointed you weaned if it still takes several months to conceive?
There isn’t a right answer, of course, just what is right for you and your family.
If you’re unsure about when might be a good time to try to get pregnant again, check out BellyBelly’s article, When Is The Best Time To Have A Second Baby?
Should I use LAM for birth control?
Birth control and family planning is a very personal decision.
It’s also important to make a fully informed decision.
Evaluating your openness to another pregnancy, your ability and desire to practise ecological breastfeeding, and any health concerns might help you make a decision.
If you meet all the criteria, as mentioned, LAM is 98-99.5% effective as birth control.
When we look at other forms of contraception such as the pill and IUDs which are 92-99.9% effective, LAM is a comparable option.
If avoiding pregnancy is very important to you, speak with a healthcare provider to discuss the best options for your situation.
They can help you decide if LAM is a good option for you, or if you should consider additional forms of contraception.
If you’re hoping to conceive while still breastfeeding, using LAM and other natural family planning methods in the early postpartum months might help you become more in tune with your body and menstrual cycle. This could help in planning conception.
What do experts say about using breastfeeding as birth control?
BellyBelly’s IBCLC (International Board Certified Lactation Consultant), Renee Kam, says, “While the Lactational Amenhorrhea Method is recognised as a very effective method of contraception, different breastfeeding mothers resume their menstrual cycle at various times after giving birth. Some breastfeeding mothers might begin menstruating as early as a few weeks after giving birth while for others it can take years. Once you are back to experiencing your regular menstrual cycles (and you haven’t had previous difficulty falling pregnant), it’s likely you have returned to your normal fertility.”
No matter if you’re trying to avoid getting pregnant or want to become pregnant, understanding what factors prevent pregnancy can help. If you are concerned about having a bonus baby too soon, you can always speak to your health care provider (such as your ob/gyn, family doctor or midwife) about an alternate or additional form of birth control.