In partnership with SimpleHealth, a reproductive wellness brand making birth control more accessible, we sat down with their Chief Medical Officer, Dr. Lisa Czanko to ask her some questions about breastfeeding and birth control methods.
Below, Dr. Czanko discusses the methods that can be used for birth control in your postpartum journey and what kinds of birth control options are available for breastfeeding moms.
Let’s start by defining our terms: what is the lactational amenorrhea method (LAM)?
When breastfeeding a baby regularly and exclusively (that means no formula and no breast pumping), the body usually stops ovulating and menstruating. This effectively serves as a form of birth control since a person needs to ovulate (release an egg from an ovary) in order to get pregnant.
You may be wondering what is actually happening on a hormonal level that can prevent ovulation during the 4th Trimester (and immediate postpartum period)
Feeding a baby from the breast (specifically, having a baby suckle at the nipple) leads to rises in the level of the hormone prolactin, which is the hormone that promotes breast milk production. Regular feeding from the breast (again, pumping does not count) keeps the prolactin level high. High prolactin inhibits ovulation and leads to absent periods. This is the body’s built-in way to prevent pregnancies from occurring too close together, allowing it time to recover, and increasing the likelihood of healthy subsequent pregnancies.
Okay, so how long can breastfeeding be used as “birth control” and are there any caveats?
Typically breastfeeding can be used as an effective form of contraception up until six months after delivery. However, breastfeeding is only an effective form of birth control during this six month period if the following two requirements are met.
- First, a person must not be having any periods.
- Second, a person must feed a baby directly from their breast with adequate frequency, which means at least every 4-6 hours.
If this is not occurring, then other forms of contraception should be used instead. If a person is using the lactational amenorrhea method and skips a breast feeding, they should consider using emergency contraception if they had recently had unprotected vaginal intercourse with a male partner.
Considering birth control is (mostly) hormonal, is there any reason someone that is breastfeeding shouldn’t be on birth control?
There is some concern that hormonal contraceptives can affect milk production. However, there isn’t a lot of good research on this topic. When making the decision whether to start them or not, the risks and benefits should be discussed with a doctor on an individualized basis.
The medical guidelines on the topic help demonstrate the controversy. For instance, the globally-reaching recommendations of the World Health Organization (WHO) recommend against starting hormonal contraceptives right away given that breastfeeding is especially important as a nutrition source for infants in impoverished countries. However, the recommendations from the US-based Centers for Disease Control and Prevention (CDC) do not advise against any hormonal contraceptives while breastfeeding.
So what are some of the recommended birth control options available to breastfeeding moms?
The CDC recommends that combined hormonal contraceptives (CHCs), which are medications that contain both estrogen and progesterone and include traditional birth control pills, the patch, or the ring, should not be used for 3 weeks following delivery for most people, whether breastfeeding or not. These also should not be used for at least 7 weeks after delivery in people who have an increased risk of blood clots.
Progesterone-only contraceptives can be started immediately after giving birth. Progesterone-only options include pills, an injection, or an implant.
Other contraceptive options include IUDs, condoms, internal condoms, diaphragms, cervical caps, or even sterilization (getting tubes tied).
It’s important to note…
It’s important that each individual takes the time to discuss all the options that are available to them with their medical provider. This can help you feel empowered in your post-pregnancy journey and arm you with information and solutions that are best for your individual needs.
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