Can breastfeeding really prevent pregnancy?

For many women, pregnancy is something they never think about when breastfeeding and have not had a period yet. Even the happiest and proudest parents might like to wait a while after the birth of one child before welcoming another, considering that they are juggling both family and work.

Apart from being the natural and ideal way of feeding the infant and a unique emotional basis of child development, breastfeeding is known to work as a form of birth control to delay the resumption of ovulation, particularly when coupled with sexual abstinence. This is called the lactational amenorrhoea method (LAM), meaning the lack of periods due to breastfeeding.

No doubt, many women may have heard from a friend that breastfeeding can serve as a form of natural birth control — and while that is not entirely untrue, it is not the whole story either. What is more, the misconception that any amount of breastfeeding will prevent pregnancy, regardless of the frequency of breastfeeding or whether the mother’s period has returned is also common.

There are many options for birth control, and breastfeeding is a natural birth control option that appeals to many people. Dr Sunday Omoya, consultant obstetrics and gynaecologist at the State Specialist Hospital, Ikare, Ekiti State, assure that from research it is shown that breastfeeding as a birth control option can be an effective method during the months when a woman is yet to start her menses and frequently and exclusively breastfeed her infant.

According to him, breastfeeding a baby regularly helps prevent ovulation, which is the release of an egg from the ovary. Ovulation must occur in order to conceive a pregnancy. The woman’s menses is suspended by the process of lactation.

Dr Omoya stated that, “The moment breastfeeding is appropriate, the tendency is that the woman will not ovulate and if she does not ovulate, the tendency is that she does not get pregnant. But I would not want to encourage women to stay only on breastfeeding. She may not be able to really say at what point the ovulation will start.

“Every birth-control option has its own failure rate, including what we call bilateral tubal ligation which is what we call permanent contraception. So, lactation amenorrhea as the only birth control in a woman may not be advisable. If she is breastfeeding appropriately, it only gives her enough time to make a decision and to institute a modern means of family planning once they start supplementing breastfeeding,” he said.

Dr Omoya stated that the failure rate of lactation amenorrhea tends to increase from six months when the child is exposed to supplementary feeding and the frequency of breastfeeding begins to reduce.

He added that, “the effectiveness of breastfeeding as a way of preventing ovulation also depends on the response of every woman to the prolactin, a hormone that causes the breasts to grow and make milk during pregnancy and after birth. It varies from one woman to another. If the prolactin levels are high, ovulation may be suppressed.”

Dr Omoya, however, declared that many breastfeeding mothers who do not get pregnant after a prolonged period of unprotected sex, who are not on any birth-control method and not having their menses may have some level of infertility problem.

According to him, “with regular unprotected sex and no contraception, close to 80 to 85 per cent of women will have been pregnant within the first one year. To determine women that we should treat for infertility, we advise them to be on regular sexual exposure for one year.

“Such breastfeeding women that despite no contraception and regular unprotected sex only get pregnant say after two years needs to be investigated. We need to find out how high her body’s prolactin level is and if she did not ovulate during that period. Such a woman has a background of sub-fertility,” he said.

Howbeit, there are also ways women can keep a tab on whether they might be at risk of getting pregnant while breastfeeding, like using ovulation kits, monitoring body temperature, which usually gets higher when ovulating, or checking the cervical mucus, which tends to get thinner at that time of the month.

In the meantime, experts in a study say that women should consider using contraception as soon as three weeks after birth in a review published in Obstetrics and Gynecology. They had tried to determine at what point after a woman gives birth the benefits of using contraceptive pills again begin to outweigh the risks.

They reviewed four studies that have examined when non-breastfeeding women begin to ovulate again after giving birth, and whether women had a good chance of getting pregnant during that first ovulation.

In all of the studies combined, ovulation started, on average, between 45 and 94 days after a woman gave birth.

However, in two studies women started ovulating as early as 25 and 27 days after giving birth.

The studies also found that most of those first ovulations probably wouldn’t result in pregnancy, so concluding that the benefits of starting contraceptive pills containing both oestrogen and progestin probably outweigh any risks starting at three weeks after birth.

Medical experts agree that it is totally fine to use birth control while a woman is breastfeeding, although it is recommended to avoid hormonal birth control for about six weeks after the baby is born to reduce the risk of developing blood clots.