Physiology of breast-feeding
Following childbirth, all women produce large amounts of the hormone prolactin,
which stimulates the production of breast milk. Prolactin also effects the hormones
which control the fertility cycle. Prolactin acts on the pituitary gland interfering
with the action of follicle stimulating hormone (FSH) and luteinising hormone (LH)
and thereby reducing the production of oestrogen. The low level of oestrogen during
breast-feeding suppresses the maturation and ripening of the follicles and thus prevents
ovulation. Within hours of delivery, there is an increase in the sensitivity of the
nerve endings in the nipple so that each act of suckling stimulates the secretion
of prolactin. The level falls again after 3-4 hours, but if the baby suckles frequently,
including short spells of comfort suckling, the high level of prolactin is sustained
thus preventing ovulation.
LAM is based on WHO sponsored research. At a conference held in Bellagio
in 1988 a consensus document was produced which concluded that a woman is 98% protected
from pregnancy when :-
Lactational Amenorrhoea Method (LAM) of child spacing
The following algorithm shows the criteria for successful application of this method and the
action to be taken when criteria no longer apply.
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The criteria for breast-feeding have to be clearly defined to ensure the suppression of fertility. Fully breast-feeding means that the baby is fed by his mother on breast milk alone without the addition of other milk, fruit juices or solid foods. Water may be given. Almost fully breast-feeding means that the mother is giving no more than one or teaspoonfuls of other foods. In either case the baby will be fed on demand and will suckle for nourishment and comfort instead of having a dummy or pacifier. This frequent suckling is important to maintain infertility during lactation. The following definition summarises patterns of breast-feeding. Successful use of LAM demands full or almost full breast-feeding.
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The video ‘Fertility‘ has a section where Chloe Fisher, the International Breast-Feeding Specialist demonstrates using a mother and baby, techniques for effective breast-feeding. Good breast-feeding technique and full breast-feeding will ensure the suppression of fertility.
Any reduction in breast-feeding from full or almost full breast-feeding will increase the chances of pregnancy.
The return of menstruation, or six months post-partum also signals the end of protection from LAM.
An appropriate method of family planning should be chosen in conjunction with a health professional.
Couples who choose to use a natural method will find a useful chapter on fertility awareness during / after breast-feeding in the book ‘Fertility‘.
Support will be required from a fertility awareness teacher to observe the signs indicating returning fertility and the transition from the reduced state of fertility during full breast-feeding to normal fertility.
| Acknowledgement |
Breast-feeding intro picture - Excerpted from 'Bestfeeding', copyright ©1990 by Mary Renfrew, Chloe Fisher, and Suzanne Arms. Reprinted by permission of Celestial Arts, P.O. Box 7123, Berkley, CA 94707 |
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