Can you conceive while breastfeeding?

When you first embraced your little one, you felt that your family was complete.

But now that your baby is crawling around and beginning to interact with others around her, you may start to have this feeling inside telling you that maybe it’s time for a younger sister or brother for your firstborn?

Or maybe you are not quite ready yet so feel worried that you might get pregnant when your first child is still so tiny?

If you are still breastfeeding or your period has yet to return after giving birth, will you be able to get pregnant just yet?

Dr Dana Elliot Srither MBSS (Singapore), Grad Dip Family Medicine, is a certified Family Physician who believes in the principles of “Get Well” and “Stay Well”, offers some great insight and advice for all mums.

How breastfeeding affects your fertility

In 1988, a group of scientists met in Bellagio, Italy to define a set of guidelines that a woman could use to predict her return to fertility during breastfeeding.

The scientists reviewed data from studies regarding return to fertility and determined that breastfeeding can provide up to 98% effective contraception if three criteria are met:

1) The mother has not experienced the return of her menstrual periods (bleeding up to the 56th postpartum day is considered part of the postpartum recovery process and is not counted as menstrual bleeding)

2) The mother is fully or nearly fully breastfeeding

3) The baby is less than six months old

Is it an effective form of birth control?

Conceiving while breastfeeding is still possible.

These guidelines later defined a new method of family planning called the Lactational Amenorrhea Method (LAM), which is a natural birth control technique based on the fact that breast milk production causes lack of menstruation.

Clinical trials have shown that LAM is at least as effective as the Bellagio scientists predicted it would be.

Fewer than 1% of LAM users in three clinical trials became pregnant when all the three LAM criteria were met.

Of the three LAM criteria, the return of menses is the most important indicator of fertility.

The studies conducted by Family Health International in Pakistan and the Philippines have shown that pregnancy is rare even beyond six months and the end of full breastfeeding among women who do not experience vaginal bleeding.

Only 1.1% of the women in Pakistan and 2.6% of the women in the Philippines conceived during 12 months of lactational amenorrhea.

The Lactational Amenorrhea Method (LAM) is only a temporary method of family planning.

What is full breastfeeding?

The pattern of breastfeeding exerts a strong effect on the resumption of menstruation and fertility.

However, defining what is meant by “full” breastfeeding can be difficult.

The following definitions are currently being used by family planning counsellors who are teaching LAM:

1) Full breastfeeding can be exclusive (no other liquid or solid is given to the infant) or almost exclusive (vitamins, water, juice or ritualistic feeds are given infrequently to the infant).

2) Nearly full breastfeeding means that the vast majority of feeds (at least 85%) are breastfeeds. There can be some supplementation with another liquid or food, but supplementation never replaces or delays a breastfeed.

3) The Lactational Amenorrhea Method is, however, a temporary method of family planning. To continue effective pregnancy protection, a woman who uses LAM must be ready to switch to another family planning method when any one of the LAM criteria changes. She should be made aware that:

4) Once a mother’s periods return, breastfeeding will no longer protect her from a new pregnancy. She should consider any vaginal bleeding (after the 56th postpartum day) to be a warning that her fertility is returning, even if that bleeding does not resemble her regular menses.

5) If she starts to give the infant any food or drink on a regular basis or experiences disruptions in her breastfeeding routine, such as returning to work or ceasing to breastfeed at night, she is no longer protected from pregnancy.

6) Once the infant is older than six months, the chance of becoming pregnant, even before her periods return, is increased.

If any of these changes occur, a woman should choose another contraceptive method if she wants to be protected from pregnancy, but there is no need to discontinue breastfeeding.

There are many forms of natural birth control which are safe for breastfeeding mums.

Other family planning methods

Family planning methods that are recommended for breastfeeding women include:

1) Barrier methods

2) IUDs

3) Male or female sterilization

4) Hormonal methods that contain only progestin, such as progestin-only pills (“minipills”)

5) Injectables

6) Norplant

Contraceptive pills containing both estrogen and progestin (the most common kind of birth control pill) have been associated with reduced breast milk production and should be considered a last-choice method.

If you are breastfeeding according to the Lactational Amenorrhea Method without the intention of contraception, then the other ways to determine your fertile period is to use your body’s physiological changes during your normal menstrual cycle.

Ovulation tends to occur just before a spike in body basal temperature, which is the temperature just before getting out of bed in the morning.

This is due to the heat-producing hormone progesterone created by the corpus luteum.

Therefore to increase the chance of pregnancy, you and your partner should act as soon as you see the rise in temperature.

So whether you are trying to conceive baby number two, or you are not quite ready to expand your family just yet, be sure to chart your body basal temperature to figure out when you are ovulating, and use other family planning methods which are safe for breastfeeding mums.

Are you a breastfeeding mum who is trying to conceive? Or are you worried about getting pregnant when your first baby is still so small? Share your comments with us below!