This article summarizes the relationship between breastfeeding (BF) and fertility and discusses the non-hormonal/non-invasive methods which can be effectively used as birth control during BF. While BF itself is not considered reliable contraception, there are evidence-based methods, developed following decades of research, which demonstrate how BF affects our hormones which in turn affects our natural secretions.
THIS IS NOT AN ALGORITHM!!
After learning how to identify one’s own secretion pattern, any woman can begin trusting her body and know on a daily basis when she is and is not fertile. During BF (as well as during regular menstrual cycling), our bodies communicate in a clear “language” when we are fertile, e.g. on what days is pregnancy possible? This knowledge becomes an awesome tool that can be used as a highly effective method of contraception! Knowing your fertility status means you can BF with ease, a sense of control, and peace of mind without the hassles, side effects, and costs of hormones and IUDs. All new moms and others of reproductive age can benefit from “body literacy,” because it enables them to make informed choices about their sexual health, fertility, and quality of life. So let’s jump in.
FACT 1: Breastfeeding (BF) can be used to prolong the time of “postpartum infertility”.
BF is a partial method of birth control. If you enable your baby to suckle very frequently (every 2-3 hours- day and night), avoid bottle feeds, maintain physical closeness, give minimal supplements, and do not experience menstrual bleeding, your chances of getting pregnant during the first six months are relatively low. This method works best if you live in a non-western culture where ecological breastfeeding is practiced by traditional, tribal societies. Ecological BF is not “full” BF. Traditional BF implies continuous physical closeness, 24/7 between mother and baby.
FACT 2: There is a direct relationship between a woman’s BF pattern and her natural secretion pattern. All women experience discernible changes in the quality and quantity of their natural secretions throughout their reproductive years. These changes are caused by fluctuating hormone levels. Most women notice their secretions as stains in their panties and as sensations of wetness vs. dryness at the vulva. BF moms can learn how to monitor and interpret their secretions and use this information as highly effective contraception. This method works best when learned from an experienced teacher.
FACT 3: Three primary fertility signs enable a BF woman who is cycling to identify her fertile and infertile days: basal body temperature, cervical secretions, and cervical position. Whether a woman is BF without menses, menstruating regularly; perimenopausal; in transition coming off the Pill, or following a miscarriage -she can know on a daily basis if and when she is fertile.
FACT 4: Many natural methods (not all) can be highly effective and reliable, but like most contraceptive methods, effectiveness depends on the degree of correct and consistent use by the woman/couple.
Many scientifically validated and researched methods of natural contraception exist. They are endorsed and promoted by the International Planned Parenthood Federation, the World Health Organization, and many other health organizations throughout the world (see links at the end of the article).
Natural methods offer women an opportunity to acquire “Body Literacy” and enable them to understand their own unique fertility patterns. Despite what many physicians and laypeople still believe, BF mothers do not have to resort to birth control pills or IUD’s in order to effectively prevent pregnancy. Natural methods work by informing you when your body is trying to ovulate and when your hormone balance is shifting. All you need to do is develop awareness, understand your “baseline” secretion pattern (your body’s unique language for communicating your fertility status), apply the method rules, and start trusting what your body conveys- day by day.
What Happens to our Body Before and During Pregnancy?
During our 35-year fertility journey, our bodies are ‘programmed’ every month/cycle to create the conditions necessary for ovulation and potential pregnancy. Our hormones act as chemical messengers that instruct the body to prepare for these two events. Our fertility is cyclical and limited to approximately 5-7 days per cycle. There are four primary hormones responsible for creating our fertility cycle- FSH, Estrogen, LH, and Progesterone. During pregnancy, this mechanism is suspended.
What Happens After Childbirth?
If a woman does not BF, her first period will likely return within 4-6 weeks of delivery. In two out of three women, the first bleed will occur in the absence of proper ovulation because the body is in a state of hormonal transition. It is highly unlikely that a woman would get pregnant so soon after giving birth and before getting her first period. By the second and third post-partum cycles, approximately 85% of women will be ovulating normally.
BF helps extend the period of infertility while suppressing ovarian function. While FSH level return to normal after two months, LH stimulation and release is suppressed in the brain, thereby confusing the body and preventing proper ovulation. 70-80% of BF women will have one or more anovulatory (non-ovulating) cycles before their fertility resumes completely.
The frequency of BF is what stimulates the body to secrete high levels of two hormones:
- Prolactin stimulates and controls milk production. The more the baby sucks, the more milk and prolactin are produced.
- Oxytocin helps regulate the milk flow or ‘let-down’ reflex.
A woman’s BF pattern determines her secretion pattern. Daily observation of secretions and vaginal sensations enable you to identify your in/fertility pattern. With the help of a qualified teacher, anyone can learn to recognize true vaginal dryness (no secretion), unchanging dry secretions, and wet secretions, using five different techniques. Once a BF mom determines her basic infertile pattern (BIP), rules are applied which allow long periods of sexual freedom without having to use additional protection. On days where the secretion is ambiguous/unfamiliar a couple can choose to either rely on abstinence /non-penetrative sex or use other backup methods. The transition from infertile to fertile secretions almost always occurs when the BF pattern changes. Women can know in advance when their fertility is returning.
When Secretion Patterns Change
The BIP continues as long as the BF pattern is constant and stable. Eventually, the hormonal triggers from BF will decrease and weaken. Nursing mothers can expect a change in their secretion pattern when:
- The baby begins to sleep longer intervals or through the night (more than 5-6 hours)
- The mother returns to work or is separated from the baby for parts of the day
- Solid foods and supplements (even pacifiers) are introduced
- BF schedule and pattern change due to travel, illness, stress, medications, etc.
Regardless of these changes, a woman has the tools to diagnose her ‘fertility status’ every day.
Fertility Awareness Method (FAM)
FAM provides an additional tool once menstrual cycles resume. BF moms who want to avoid pregnancy when their fertility returns can observe and chart two additional fertility signs, which signal when the window of fertility opens and closes. These signs are basal body temperature (BBT) and cervical position (CP). BBT refers to the temperature of the body at rest. When measured and charted for one minute upon waking, it is possible to confirm that ovulation occurred- because BBT rises for 10-14 days on average before the next period, regardless of cycle length. Safe and unprotected sex can take place during this time, approximately 10-12 days on average. The second sign, CP, also changes at the time of ovulation, By checking internally with the middle finger, one can feel her cervical opening (os) rise (toward the uterus), open and soften during her “fertile window”. These changes miraculously allow sperm to enter and travel up the reproductive tract with the goal of fertilizing a ripe egg in the fallopian tube. Immediately after ovulation, CP lowers, closes and hardens. FAM can also be used to plan your next pregnancy and slightly increase your chances of choosing the sex of your baby.
Other Contraceptive Options for Breastfeeding Women
Almost all contraceptive methods can be highly effective when used perfectly- meaning consistently and correctly. Unfortunately, for many reasons, contraceptives are often used imperfectly. All couples should carefully consider the advantages and disadvantages of each method, as well as their own values, priorities, and lifestyle, before choosing a method.
Barrier Methods & Spermicides (for fertile days)
- The Diaphragm is a physical barrier that should be fitted for size with instruction for proper use before purchasing. (There are a few types available today, mostly made from medical silicon. They are used together with either a spermicide or a natural gel (Caya Gel) which immobilizes the sperm.
- FemCap is a smaller version of a diaphragm, it sits directly on the cervix creating a vacuum effect. It is also used together with a spermicide.
- Spermicides such as VCF (vaginal contraceptive film), VCF foam, Gynol gel, Today Sponge, and other ovules like Encare or Pharmatex are available without a prescription.
- Condoms and withdrawal (pull-out method) can also be used as back-ups together with spermicides.
One of the most compelling benefits of FAM is that you don’t need to worry about contraception every day. Once you learn to identify your “window of fertility,” then back-up methods are only needed approximately 7 days of the month. Using two methods simultaneously during the fertile days ensures a close to 100% effectiveness rate. Used separately, these methods are 75-90% effective. This is a huge gap and it is important to know what explains the margin of difference. Personal/user characteristics are what ultimately determine if efficacy will be high or low. They all require a degree of skill (perfected by practice), motivation and partner cooperation. When learned properly from a certified FAE (Fertility Awareness Educator) and when used consistently and correctly, effectiveness will be naturally higher.
Why Doctors Don’t Recommend Natural Methods
- Although FAM has been known for decades, most gynecologists confuse it with the ineffective rhythm method (based on calculations of past cycle lengths) or they are misinformed and biased about them.
- Although scientifically-validated and researched, FAM is not taught in medical schools.
- FAM is a tool which can be learned and implemented without medical intervention and pharmaceutical companies don’t profit from their use.
- Many physicians do not believe that someone would choose to “bother” taking her temperature and checking her secretions when it is just easier to “swallow a pill” every day. Most people prefer ‘quick fixes which may also explain the popularity of more than 1000 period trackers, fertility apps, ovulation urine sticks and fertility devices on the market today. And while nearly all of these “products” are not approved as contraceptive methods, they are being used by more and more women.
- A growing number of holistic and complementary practitioners, rabbis, niddah advisors and breastfeeding counselors are informed about FAM.
Natural methods are not for everyone. They take time to learn and are not easily implemented from a friend, a book of when self-taught. They require the guidance and support of a certified teacher. A mom can choose to learn one-on-one (with/without her partner) or in a small group setting. The process requires a few learning sessions, personal follow-up, and couple cooperation.
Will FAM work for you?
- Yes- if you are eager and motivated to learn something new, and gain a tool for life
- Yes- if you want to forge a more empowering relationship with your body, which can give you control, trust, confidence and peace of mind
- Yes- if you are open and curious about your natural secretions (your body’s best-kept secret)
- Yes- if you are responsible, diligent and fairly confident in your abilities/self
- Yes- if you believe that you deserve hassle-free quality of life when it comes to your sexual health
- Yes- if your partner supports you
Back to Nature
We live in a world where “external experts” are expected to know more about our bodies than we do. It is ironic that in an age where we have free, unlimited access to information, so many women are in the dark, having lost touch with themselves, but knowing how to critique everything that is “wrong” with their bodies instead of appreciating everything that is “right” with their bodies. Self-love and acceptance begins “at home,” in the bodies we inhabit our entire lives. Women deserve to have a healthy and nurturing connection to their bodies, cycles and sexuality. They deserve to be empowered on all levels, because only with knowledge, self-confidence, control and autonomy can we create healthy relationships- with ourselves and with others.
Any natural approach involves time, effort, commitment, responsibility and discipline. While the payoffs can be of great worth and have a positive, direct impact on quality of life, each woman/couple must weigh the advantages and disadvantages that different methods offer, based on their personal values and present needs. Natural methods require a few minutes of ‘work’ per day. They are not recommended for couples in non-monogamous or casual relationships. They can be used during a woman’s entire reproductive life.
You are invited to deepen the historic connection to your natural rhythms, bodies and feminine essence. Learning to tune in to the hormonal ebbs and flows of female cycling can help all women better trust their instincts, make wiser choices, and ultimately take fuller responsibility for their sexual health and well-being.
- Taking Charge of Your Fertility, (20th Anniversary Revised Edition), Toni Weschler, 2015
- Postpartum Contraception and Lactation, in: Contraceptive Technology, (18th Revised Edition), Ardent Media Inc. NY.2004
- The Art of Natural Family Planning, John and Sheila Kippley. Couple to Couple League Int’l. 2013
- Breastfeeding and Contraception, in:Harefuah (Israel Journal of Medicine) Vol. 140, June 2001 (Hebrew)
- On Fertile Ground, A Natural History of Human Reproduction. Peter T. Ellison. Harvard University Press, 2001
- Breastfeeding Handbook for Physicians, R. Schanler (ed). Second Edition, 2013.
- Consensus statement on the use of breastfeeding as a family planning method 1989
- A Brief History of Fertility Charting
- Lactational Amenorrhea Method (LAM)
- Billings or Ovulation Method (BOM)
- Applied research linking women’s fertility with their cervical secretions.
- Fertility Awareness Method (FAM) and Fertility Awareness-Based Methods (FABM’s)
The following international organizations have conducted research about breastfeeding and fertility:
- International Planned Parenthood Federation
- Institute for Reproductive Health, Georgetown University, Washington, D.C.
- The Population Council