25 June 2011

You Know That Doesn't Work, Right?

After I had Charlotte, I was of course asked about contraception on multiple occasions, by midwives and GPs.  I'd respond about Billings, but the response back was more often about breastfeeding, as they misunderstood me to be talking about breastfeeding.  The response, of course, was along the lines of "you know that doesn't work, right?"  Actually, this began in the antenatal classes with Kieran, where the midwives were quick to point out that breastfeeding didn't suppress fertility.  I beg to differ.

The midwives and GPs are correct if one culturally breastfeeds.  In our society, breastfeeding is often scheduled to some degree instead of feeding completely on demand, which often means the child feeds little and often.  Co-sleeping is frowned upon, so many babies are moved into their own rooms after the first 6 months.  Since prolactin levels are highest at night, cutting out night feeds can often bring about the return of fertility.  If a woman is returning to work, fertility is likely to return more quickly, since the child isn't nursing as much.  Dummies are often used, and babywearing isn't all that common.

Seeing  as these things are quite common, I do understand why the midwives and GPs might think that breastfeeding doesn't suppress fertility.  However, fertility is less likely to return with either the Lactional Amenorrhoea Method (LAM) or Ecological Breastfeeding.  There are seven standards for Ecological Breastfeeding:
  • Breastfeeding must be the infant’s only source of nutrition – no formula, no pumping, and (if the infant is less than six months old) no solids or water at all.
  • The infant must be pacified at the breast, not with pacifiers or bottles or by placing a finger in the mouth.
  • The infant must be breastfed frequently. The standards for LAM are a bare minimum; greater frequency is better. Sucking should include non-nutritive sucking when the infant cues the mother, not just breastfeeding as a means of nutrition. Scheduling of feedings is incompatible with LAM.
  • Mothers must practice safe co-sleeping as it is the proximity of the child to the mother that increases prolactin.
  • Mothers must not be separated from their infants. This includes substitutes for mother such as babysitters and even strollers or anything else that comes between mother and physical contact with her child. Babywearing (using cloth carriers) means tactile stimulation between mother and child and increases access to the breast. Any separation from the mother will decrease the efficacy of ecological breast feeding.
  • Mothers must take daily naps with their infants.
  • A mother must not have had a period after 56 days post-partum (bleeding prior to 56 days post-partum can be ignored).
Now, these are rather strict rules, but if you follow them, there's less than a 1% chance of falling pregnant in the first 6 months, and 6% before her first post-partum menstruation.  The average return of menses is 14 months.  I can't say I've followed all of these guidelines.  I used a pram with Kieran some of the time and I certainly haven't taken a daily nap with either of them (more often with Kieran than with Charlotte, though).  Kieran was quite a comfort-nurser.  Following the average, I ovulated again around 14 months with Kieran, though I wasn't fertile for a few more months due to a short luteal phase.  While Charlotte doesn't comfort-nurse nearly as much as Kieran did, the fact that I'm tandem-feeding makes up for that.  At nearly 15 months post-partum, I'm still experiencing lactational amenorrhoea.  Far from not working, I'd say that breastfeeding certainly can and does suppress fertility, depending on how you breastfeed.

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