Sarah Panzetta looks at whether breastfeeding really can stop conception

Contraception will probably be the last thing on your mind when you’ve just had a baby. Midwives are all too familiar with thehollow laughsthey get in response to queries about what method new mothers are planning to use.And indeed your first priority is usually to look after yourself and your baby and to get your lives into your new version of normality.

A few weeks or months down the line, however, things might be different. Your body is recovering. You’ve established a routine – or non-routine – and you’ve worked out how/whether you can make breastfeeding work for you and your baby. You might even be ready for a bit of conjugal union with your other half, especially if he’s been doing his bit with the household chores.

Condoms are the contraceptive choice of 50% of those who are breastfeeding, but you can also use the mini-pill, a “fit it and forget it” method, like the coil, or an implant. Or you could even consider sterilisation for yourself or your partner.

A temporary but effectivealternative for breastfeeding mothers is the Lactational Amenorrhoea Method (LAM).Only about one in ten people know about this method of contraception, and a recent survey from BPAS (the British Pregnancy Advisory Service) complained of “particular inconsistencies” in the advice given to breastfeeding women by healthcare professionals. This ranged from, “Oh, you’re breastfeeding, no need to worry about contraception,” to, “You’re breastfeeding, that means you’re extra fertile.” Neither are very helpful, or accurate, responses.
Breastfeeding alone does not work as reliable contraception. However,according to the Royal College of Obstetricians and Gynaecologists,breastfeeding and following the LAM rules is over 98% effective as contraception.

The (rather strict) LAM rules are:
Rule 1. You are fully breastfeeding. And I mean fully. This means your baby gets no formula at all, or any other food, and is still breastfed at night. You also need to avoid dummies orsoothers, andfeeding your baby anything from a bottle – even expressed milk or water -as this can reduce the amount of breastfeeding your baby does. There’s no need to worry if your baby occasionally sleeps through the night, or sucks their thumb, or has a longer nap than usual. Just be aware that the more you feed, the better it works. If you need any help with breastfeeding, contact the National Breastfeeding Helpline (0300 100 0212).
Rule 2. Your periods haven’t returned. This means any bleeding lasting more than two days. So long as your baby is less than six months old (see Rule 3), your first period is likely to be an infertile one. This is either because you didn’t ovulate before your period, or because you ovulated but the luteal (post-ovulation) phase was too short to allow the egg to implant in your womb.
Rule 3. Your baby is less than six months old.
You might not want to use LAM for the duration of this time, but it can be a useful interim method for a few weeks or months. According to the Infant Feeding Survey of 2012, while 17% of women are still fully breastfeeding at 3 months, only 5% are still doing so when their baby is five months old.

This is a temporary method, so be ready with alternative contraception for when any of these things change. For more information about your contraceptive choices, see the fpa (Family Planning Association) website

If you don’t want to return to your old method of contraception, then consider using fertility awareness (also known as natural family planning). This can be up to 99% effective, according to the fpa, as long as you learn it from a specialist teacher.

Contact me if you have any questions about this. I’d be happy to help you decide whether this method is for you.

Sarah Panzetta is a fertility awareness 07931 127 473.