Can Breastfeeding Mothers Use Contraceptives?

A 27 year old lady comes to the consulting room to inquire whether she can use contraceptives as she breastfeeds her child since her husband is demanding for sex and she has no plans of getting pregnant anytime soon.

Answer:

The first choice of birth control for nursing mothers is non-hormonal methods. This includes condom use, which has the advantages of being readily available, and having no effect on breastfeeding. In addition, Condoms offer some protection against STDS (sexually transmitted diseases) and have no risks to the mother or child, but can be irritating to vaginal tissue and may require additional lubrication. Methods of contraception that women use are not considered to be harmful to their breastfed children, but some combination contraceptives can be very harmful to milk supply since they contain both progesterone and estrogen. Estrogen-containing contraceptives have been linked to low milk supply and a shorter duration of breastfeeding even when started when baby is older, after milk supply is well established. Progestin-only contraceptives are the preferred choice for breastfeeding mothers when something hormonal is desired or necessary. For certain women, taking the mini-pill while breastfeeding may increase the risk of chronic, non-insulin-dependent diabetes. This study concentrated on Hispanic women, and thus it is not clear whether the results can be applied to all ethnic groups.

Here’s the bottom line… Use any hormonal type of birth control with caution (particularly the forms that contain estrogen). Use as low a dose as possible. If you experience breast milk production problems (or if baby’s weight gain slows more than expected or stops) and are using any type of hormonal birth control, it’s a good idea to discontinue using it for a time and see if your breast milk production rebounds as a result. Though breastfeeding can work well as a natural method of birth control, it isn't foolproof. Breastfeeding delays the return of your periods. However, you'll ovulate before you have your first period. So there's a chance that you could become pregnant if you rely on your periods returning as a sign that you're fertile again.

Frequent and regular breastfeeding as a form of contraception is referred to as lactational amenorrhoea method (LAM). LAM is about 98 per cent effective. However, LAM will only work for you if: Your baby is younger than six months old, Your periods have not returned and You are exclusively breastfeeding your baby on demand, both night and day. Exclusive breastfeeding on demand usually means a minimum of six long breastfeeds every 24 hours. If you want LAM to work, don't leave a gap between feeds of longer than four hours during the day, or six hours at night. And either don't give other fluids or solid food to your baby at all, or only give your baby other liquids from time to time. With LAM, your breasts need to supply all your baby's suckling needs, so your baby shouldn't have a dummy or use a bottle. Your baby's suckling stimulates the hormones that suppress ovulation.

Once your baby stops exclusively breastfeeding and suckling at the breast for comfort, breastfeeding becomes less effective as a method of contraception. So if you start combining breastfeeding with formula feeds or solid food, even if your periods still haven't returned, you could be fertile. Once you've stopped breastfeeding, and your periods have settled back into a pattern, you could try natural family planning (NFP). NFP means avoiding unprotected sex on the fertile days of your menstrual cycle. However it’s best to have some training in NFP before you start using it, though.

You can get a birth control shot at your six-week postpartum visit, but you have to go back every 12 weeks for another dose. This method doesn't wear off right away when you stop using it; and may not make you fertile for a year or longer after discontinuing the shots. Take this into account when you make your choice. Injectable progestins have been associated with a reduction in bone mineral density, and that women should not use injectable progestin for longer than two years.

The World Health Organization and other health institutions consider progestin-only contraceptives compatible with breastfeeding. If you are exclusively breastfeeding, there's no reason to start taking hormones before your six-week postpartum visit. It is recommended that you delay the use of oral contraceptives until at least six weeks postpartum. There are two reasons for this: your milk supply and breastfeeding pattern should be well established by time, and an older baby is better able to metabolize hormones that may appear in the milk. If you do de to use the combined estrogen/progestin pill, you should wait until six months postpartum, when other foods baby’s diet can make up for any drop in your milk supply.

Fertility is most effectively suppressed when the baby goes no longer than 4 hours during the day and 6 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 twelve 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 2 to 4 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.

Overall, the best birth control choice for breastfeeding mothers is not one of these hormonal methods, but if you must choose between the two types, you and your child would be better off if you choose a progestin-only course.

By Dr (MH) Ernest Aggrey, 0543999776/[email protected]