Pregnancy possible soon after giving birth —Experts

IT was a group of women talking in the staffroom. Central to their discussion was the reliability of exclusive breastfeeding in preventing pregnancy.

One of them was Mrs Anne Akosile. After the first baby, her menses did not start until a year after. Her nurse had told her that by exclusively breastfeeding her baby in the first six months, she might not get pregnant.

Unfortunately, Mrs Akosile got pregnant with her third pregnancy when her second son was six months old.

“I could not understand why I got pregnant when my second baby was six months. It was really disturbing to know I was pregnant,” she retorted.

Mrs Aminat Haruna’s case is different. She found herself pregnant two months after her first baby. She was breastfeeding and could not fathom how she had gone pregnant although her period was yet to return

For many women, pregnancy is something they never think about when breastfeeding and haven’t had a period yet. Some women actually use breastfeeding as a form of birth control. This is called the lactational amenorrhoea method (LAM), meaning the lack of periods due to breastfeeding.

Of course, benefits of breastfeeding are numerous. From supplying critical nutrition to boosting immunity, breastfeeding benefits a newborn baby in countless ways, while speeding up the mother’s recovery after childbirth. One of the ways in which it does this is by lowering the chances of pregnancy in nursing mothers.

No doubt, many women may have heard from a friend that breastfeeding can serve as a form of natural birth control — and while that’s not entirely untrue, it’s not the whole story either.

What’s more, the misconception that any amount of breastfeeding will prevent pregnancy, regardless of the frequency of breastfeeding or whether mother’s period has returned is also common.

Interestingly, at a media training by the Breakthrough ACTION-Nigeria (BA-N) on Thematic and Technical Workshop in Uyo, BA-N’s assistant state coordinator, Family Planning, Akwa Ibom, Mrs Pascaline David-Edim said it is common to hear women say they had gotten pregnant although they exclusively breastfed their babies.

“I have seen one woman in the health facility that exclusively breastfeeding and then pregnant, she was crying as if she had lost someone. You do not want to be that kind of woman because it is very disastrous,” she declared.

“You had planned your life and so when the pregnancy comes, it is a challenge. Nobody can say pregnancy may not occur in that first six months of exclusively breastfeeding, that is why we now have mothers’ pills to avoid such pregnancies,” she declared.

According to David-Edim, different methods, including exclusive breastfeeding, have their times of returning to fertility, but some have a faster returning to fertility than the other.

Unfortunately, pregnancy occurring in the first six months after a baby is born cuts across women of different social classes, including health workers, which many people presume are knowledgable about the benefits of child spacing.

“I have a former colleague, after her first baby, before you knew it, she was pregnant with the second one. She was always fainting. Immediately she delivered the second baby, she requested for contraception,” she added.

Professor Oladapo Olayemi, a consultant obstetrics and gynaecologist, University College Hospital (UCH), Ibadan, Oyo State stated that exclusive breastfeeding is 60 to 80 per cent effective in the first six months so long as all of the criteria are met.

He declared that during the period, such a woman will be breastfeeding on demand, including at night, not given the baby any water or other supplementary feeds and the baby must be six months of age or less.

Of course, the periods haven’t started again. Periods are an important signal of a woman’s fertility and indicate a high chance of pregnancy.

The more often the baby feeds, the longer it may be before fertility returns. This is because breastfeeding curbs the hormones that trigger ovulation, so delaying the return of menstruation.

However, the longer the baby goes between feeds, the more likely it is that the woman could become pregnant again.

Current research indicates that nursing frequency and the total amount of time at the breast per 24 hours are the most important factors, rather than the time of day that the suckling occurs.

Professor Olayemi, however, declares: “Once you see your period, it means that the lactational amenorrhoea method is no longer effective. The danger here is that the woman may not even see her period before she finds out that she is again pregnant.

“Once a woman sees her period, it means that the lactational amenorrhoea method is no longer effective. So, the woman needs to start to use contraception as soon as she starts having sex again.

“Certainly, to start with, it encourages women to be aware of contraception. It also encourages them to breastfeed which is also beneficial to the baby aside its lactational amenorrhoea method benefit.”

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

Some anecdotal evidence suggests hormonal birth control could affect milk supply in the early weeks of breastfeeding.

In addition, doctors don’t recommend that mothers who are breastfeeding take contraceptive pills with oestrogen, because of a controversial potential risk that those could also slow infants’ growth.

Mrs David-Edim said it’s important that all women, including women who are breastfeeding, speak to health experts in family planning clinics about their best option for contraception.