Sex After Delivery: Birth Control For Breastfeeding Women

You've just given birth, you're breastfeeding, and you decide to resume having sex, possibly even before the recommended rest time of 6 weeks postpartum is up (tsk, tsk).

What method of birth control should you choose if you're breastfeeding? And do you even need to use birth control if you're breastfeeding?

First, what's going on in the early postpartum period, sexually speaking?

Women become sexually active early in the postpartum period. Researchers have reported that 66% of postpartum women are sexually active in the first 4 weeks postpartum, and 88% become sexually active within the first 8 weeks postpartum....Although lactation can suppress fertility if a woman exclusively breastfeeds for 6 months postpartum, by that time, fewer than 14.3% of new infants are exclusively being breastfed.

Second, if you're breastfeeding, how do you choose an appropriate birth control method?

In choosing a method of contraception, a woman who is breastfeeding and her clinician must consider how frequently she has sex, whether she is exclusively breastfeeding, and what type of method would be acceptable to her and her partner. You both must also remember that an unplanned pregnancy is possible if a sexually active woman breastfeeds and does not use contraception. Should the patient become pregnant, it may influence her desire and ability to continue breastfeeding.

Here's a handy table you can use as a reference when going over postpartum birth control options with your doctor [yet another thing to pack in your delivery bag, before you go to the hospital]:

Birth Control Choices for Breastfeeding Women

Keep in mind that, for breastfeeding women:

• The preferred method is the progestin-only birth control pill.

• The risk of perforation with intrauterine device (IUD) insertion is increased.

• The effectiveness of the Lactational Amenorrhea Method is greatly influenced by the breastfeeding schedule.

Third, if you wan to use breastfeeding as your birth control method (medspeak: Lactational Amenorrhea Method), do you know how to go about it?

Here's a brief overview.

What is the Lactational Amenorrhea Method (LAM)?

Lactational Amenorrhea Method (LAM) is a natural, temporary birth control method. It is based on the natural fertility reduction that occurs in most women after giving birth. The fertility reduction usually lasts up to 6 months after a delivery.

How does LAM work?

LAM prevents ovulation. Since the ovary doesn't release an egg you cannot get pregnant.

A bit more detail. Most women after giving birth do not ovulate, and do not have menstrual periods in the months immediately after delivery [medspeak for the lack of periods: physiological amenorrhea]. This happens because the hormonal processes involved in breast milk production also affect the ovarian and the uterine (menstrual) cycles.

This is a natural process called lactational amenorrhea--breast milk production (lactation) causes the absence of menses (amenorrhea).

How do you use LAM?

If you have just given birth and would like to use LAM as your temporary method of birth control you need to observe these guidelines:

• You must breastfeed exclusively and continuously (day and night).

• You must be less than 6 months postpartum.

• You should not be menstruating (you should be amenorrheic) after the first 56 days. Bleeding or spotting during the first 56 days is not considered menstruation. However, after that, if you have two or more consecutive days of bleeding your menstrual periods have probably returned.

It is important that you follow all these guidelines to insure that you are protected against an unintended pregnancy. Because ovulation may return before the menstrual period does, simply waiting for the first menses is not reliable enough, and is risky.

How well does LAM work?

LAM is a temporary method and can only be used for up to 6 months after giving birth. The failure rate is 2% during the first 6 months after delivery, with perfect use. By 6 months after giving birth, the failure rate increases to over 5%.

The efficacy of breastfeeding decreases when:

• you start giving your baby formula or foods other than breast milk

• your menstrual periods return

• 6 months have passed since delivery

Who should use LAM?

If you are less than 6 months postpartum, and you are willing to abide by the LAM guidelines, you can use this method.

Who shouldn't use LAM?

Don't use this method if:

• You cannot or do not want to observe the associated guidelines (more than 6 months have passed since the delivery, you do not plan to breastfeed continuously and exclusively, your periods have returned).

• Your ovulation returns immediately after giving birth. In about 6% of women, ovulation returns with the first cycle after delivery, so if you are one of these women, you cannot use LAM.

What are the advantages of using LAM?

• It's naturally-occurring.

• It's immunologically and nutritionally advantageous for the newborn. Breast milk is especially beneficial for the newborn because it allows passage of antibodies (infection-fighting agents) from the mother to the baby. This gives the baby greater protection against certain types of infections.

• There's minimal user involvement (other then continuously breastfeeding, of course).

And the disadvantages of using LAM?

• It's a restricted and temporary method. LAM can only be used by women who have just given birth.

• Breastfeeding continuously and exclusively may be difficult and/or impractical.

• You must be willing to adhere to a healthy diet regimen and you might not be able to take certain medications. Because most of the substances you ingest are passed to the baby in the breast milk, you have to carefully monitor what you eat and drink, and what medications you take. [If you need to take a medication on a regular basis, don't just discontinue the medication on your own; please consult with your doctor first.]

• It's difficult to tell when breastfeeding no longer provides effective birth control. Because each woman is different, it is hard to determine exactly when your fertility returns after giving birth.

• The natural reduction in fertility is not seen in all women who have given birth. Although the fertility reduction in breastfeeding women is a natural process, some women will begin to ovulate almost immediately after a delivery. Unfortunately, it is not possible to predict who will have a reduction in fertility, and who will not.

Like most of the other methods of birth control, LAM does not protect against sexually transmitted infections (STIs).

When does fertility return?

The return to fertility is hard to predict. In general, once you start having menstrual periods (approximately 6 months postpartum), you're fertile.

The problem is the menstrual period is not a very accurate indicator of fertility: it's possible to ovulate before menstruation returns. Once the mature egg is released from the ovary, you can become pregnant, period or no period. Moreover, even the 6 months interval isn't absolute--ovulation can return with the first cycle after delivery.

Bottom line: If you're breastfeeding and sexually active, it's best to use a birth control method. Set some time aside to discuss with your Ob/Gyn which method would best suit you. Last, but not least, LAM works best if you observe the guidelines.