“Oh no, it’s positive! How did this happen? Am I not still nursing my baby?” Aina thought to herself while holding the pregnancy test kit. She is worried as her first baby is only 4 months old.
This scenario may have been or may be experienced by mothers who are still nursing their babies. Surely a lot of assumptions will be running through their minds.
As is generally known, breastfeeding greatly benefits the growth and health of babies. Breastfeeding also helps to create gaps between pregnancies as an effective contraceptive. However, there are nursing mothers who find themselves pregnant. How does this happen and do nursing mums require contraceptives?
Breastfeeding as an effective contraceptive
Most mothers are aware that one of the benefits of breastfeeding is as a natural contraceptive. The medical term for it is ‘Lactational Amenorrhea Method’ (LAM). However, there are 3 main conditions that needs to be fulfilled for mothers to use breastfeeding as an effective contraceptive. The conditions are:
- Baby is less than 6 months’ old
- The mum has not had her period after giving birth
- Practice exclusive breastfeeding regularly during night and day
Therefore, if the mother does not adhere to the conditions stated above, such as the baby is more than 6 months old, she has had her period, and is not able to breastfeed her baby exclusively and frequently, she will need to think of other contraceptive methods that would be more effective. This is important to preserve her physical, mental, and emotional health.
How does Lactational Amenorrhea Method (LAM) perform among working women? Does it help? In a study involving working women who pump breast milk to supply to their babies, it is found that 5.2% of them became pregnant within six months. Therefore, women who are working and are temporarily separated from their babies during the day must keep in mind that the chances of them becoming pregnant is higher.
Ovulation cycle during breastfeeding and the probability of pregnancy
During the breastfeeding period, a mother may not have her period and yet to return to original fertility level. The time taken to return to fertile state will differ among mothers. This is because the frequency and number of suckling sessions during nursing plays a role in delaying a mother’s menstrual cycle.
Research shows that babies who feed less at night and babies who are given pacifiers to sleep increases the probability for the mother’s fertility levels to recover more quickly. Therefore, it is important for mothers to ensure stimulation by infant’s suckling continues during the day and night to ensure the success of birth control by ‘Lactational Amenorrhea Method’ (LAM). However, there will be mothers whose ovulation cycles have already returned to fertile levels before their first period after the birth of the baby.
Return of the period after giving birth gives the possibility of the ovulation cycle having returned to fertile levels. However, keep in mind that waiting for the first period after giving birth may put the mother at risk to become pregnant again. Therefore, it is better for these mothers to practice a more effective contraceptive method to create a gap between pregnancy.
Types of contraceptives suitable for nursing mothers
There are many methods for birth control whether natural or modern. Modern methods can be found in both public and private health clinics.
Usage of birth control containing contraceptive hormones
Hormone-containing birth control methods can be found in the forms of pills, implants, injections, and vaginal rings. Generally, the use of hormones as a method of birth control for nursing mothers are safe and there is a possibility of reduced milk production at the early stage.
There are two types of hormonal contraceptives; a combination of estrogen and progesterone and progesterone only contraceptives. Contraceptives containing the combination of two hormones are available in the form of pills and vaginal rings. Contraceptives containing estrogen is linked to reduced breastmilk production and a shorter breastfeeding period.
Progesterone only contraceptive is more suitable for nursing mothers. It is available in the forms of pill, implants, intrauterine contraceptive devices and injections. Research shows that progesterone only methods do not affect breastfeeding, growth, or development of the baby.
Non-hormonal birth control methods
Copper based intrauterine contraceptive devices (IUCD) are also suitable for nursing mothers. This device does not contain any hormones. It is inserted into the uterus to prevent fertilization and can last 3 years.
Apart from that, condoms can also be used as a contraceptive. However, the chances of getting pregnant is higher if not used correctly compared to the other methods listed above.
Breastfeeding can create gaps between pregnancies and is an effective birth control method when certain conditions are met. All mothers would want to give the best for their infants and breastfeeding is recommended until the baby is two years old. For those interested to find out more about suitable birth control methods for nursing mothers, do visit and have a discussion with a doctor at the nearest clinic.
Dr. Nurjasmine Aida Bint Jamani is a specialist and lecturer in Family Health in IIUM. This article is translated from the original piece at https://www.mmgazette.com/penyusuan-kesuburan-dr-nurjasmine-aida-binti-jamani/by Nur Nadhirah.
References
- Academy , Breastfeeding of, Committee P. ABM clinical protocol #13: contraception during breastfeeding. Breastfeed Med. 2006;1(1):43–51.
- Valdes V, Labbok MH, Pugin E, Perez A. The efficacy of the lactational amenorrhea method (LAM) among working women. Contraception. 2000;62(5):217–9.
- Guthmann RA, Bang J, Nashelsky J. Combined oral contraceptives for mothers who are breastfeeding. Am Fam Physician. 2005;72(7):1303–5.
- Statement F, The F, Effectiveness C. Faculty of Sexual and Reproductive Healthcare Clinical Effectiveness Unit. 2009;(1).
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]