For the nursing mother who wants to space her pregnancies, there are many birth control options to choose from. Each method offers advantages and disadvantages. Lactation Consultant Anne Smith explains.
Nature's birth control
It is important to understand that as soon as there is a decline in breastfeeding, due to the baby eating supplemental feedings or nursing less often, the contraceptive protection decreases and other methods should be considered.
Fertility is most effectively suppressed when the baby goes no longer than four hours during the day and six hours at night between feedings. The pattern of breastfeeding is a key factor, but the mother's own body chemistry also has an influence. Some mothers nurse without supplements and still start having periods within the first few months of nursing. Others whose babies sleep through the night or have supplemental feedings will not have a period for 12 months or longer. Some women go as long as two years or more without menstruating.
After the initial flow of lochia (the bleeding experienced for two to four weeks after birth) has stopped, nursing mothers will usually experience no vaginal bleeding for several months. Often, the first period occurs without ovulation. Many women refer to this as a "warning" period, and take it as a sign that they are fertile from that point on. Often light bleeding or spotting is the first indication of the return of fertility. Any bleeding or spotting that lasts more than a couple of days should be considered a sign that the mother is fertile again. It is not unusual for a mother to have irregular periods during the time she is nursing. Some (but not all) mothers notice a slight decrease in their milk supply during their periods, but after a few days the supply will increase.
What follows is a list of family planning options as they relate to breastfeeding women. It is important to emphasize that hormonal methods containing estrogen should be avoided whenever possible.
Changes in the mother's body during lactation may include vaginal dryness due to low levels of estrogen. Intercourse may be more comfortable if a water-based lubricant such as K-Y jelly is used. The release of oxytocin during orgasm may cause the mother's milk to leak or spray and surprise both partners. Feeding the baby or expressing some milk before lovemaking by applying pressure as the milk lets down can help prevent this. Keep a towel handy to catch the leaks may be helpful.
Vasectomy, tubal ligation
Natural family planning
The third and last choice of birth control for nursing mothers is methods that contain estrogen, such as the standard combined oral contraceptives. These methods are very effective, but often decrease milk supply, and some of the hormone may pass into the mother's milk. Although there is no evidence of a direct negative effect on the babies of mothers taking the combined pill, there is strong evidence that in many women, estrogen can lead to a decrease in milk supply and early weaning. If the other methods of birth control can't be avoided, and the combined pill is the only option, then breastfeeding can and should be continued, since it offers many health and nutritional benefits which are important for the nursing infant or toddler.
If the mother chooses to use this method, the baby's weight should be monitored carefully so that adequate intake is ensured. For many mothers, a slight decrease in milk output is insignificant, and in any case, the benefits of breastfeeding far outweigh the disadvantages.