Elsevier

Contraception

Volume 61, Issue 4, April 2000, Pages 253-257
Contraception

Original research articles
Using complete breastfeeding and lactational amenorrhoea as birth spacing methods

https://doi.org/10.1016/S0010-7824(00)00101-3Get rights and content

Abstract

The aim of this study was to evaluate the effectiveness of lactational amenorrhoea and to determine the relationship between extended breastfeeding and the return of fertility. Breastfeeding pattern, basal body temperature, cervical mucus, salivary ferning, vaginal blood discharge, frequency of sexual intercourse, and the presence of ovulation in the first cycle after the resumption of menses with ultrasonography were evaluated in 40 women. All subjects completed the study with only one case of incomplete breastfeeding. No pregnancies were observed. The mean number of feeding sessions and mean interval between sessions decreased significantly (p <0.01) during the first six months postpartum (7.5 ± 1.3 after 60 days postpartum vs. 5.7 ± 2.1 after 180 days, and 3.6 ± 0.8 vs. 5.1 ± 0.9, respectively). Eight women (20%) menstruated before weaning, but none had an adequate thermal shift, while 32 (80%) had their first vaginal bleeding after weaning with 12 (37.5%) registering an adequate thermal shift. Both basal body temperature and salivary ferning proved to be suggestive of ovarian activity, while mucus characteristics were not reliable in identifying fertile periods. Our study showed that breastfeeding associated with lactational amenorrhoea proved to be a good method of postpartum fertility control. Since the importance of supplementation is still debated, it is recommended that a “complete” breastfeeding program be used.

Introduction

In recent years, the importance of breastfeeding as a natural regulator of human fertility has gained more acceptance1 and encouraging results from preliminary studies have been reported.2 On the other hand, breastfeeding itself does not protect against an unplanned pregnancy, since it has been estimated that 5%–10% of breastfeeding, amenorrhoeic women become pregnant.3

A Consensus Conference held at Bellagio in 1988 indicated lactational amenorrhoea as an appropriate method to control fertility and stated that it should be included in natural family planning programs, especially in developing countries.4

Some authors5, 6 developed a number of “rules” to be obeyed during breastfeeding to avoid unwanted pregnancies and called these rules the “lactational amenorrhoea method” (LAM). In order to achieve a protective effect against the resumption of ovarian activity, the following characteristics must be present: the woman must be amenorrhoeic, breastfeeding must begin as soon as possible, and breastfeeding must be “complete”, i.e., “on demand” or composed of at least five breastfeeding sessions for a total suction time of at least 65 min (>10 min/session). Furthermore, for “complete” breastfeeding, any introduction of supplements to the newborn must be avoided.

The aim of this study was to evaluate the effectiveness of “complete” breastfeeding in prolonging postpartum amenorrhoea in a small group of selected, motivated Italian women and to determine the relationship between extended breastfeeding and the return of fertility in the puerperium.

Section snippets

Materials and methods

Forty women, aged 23–40 years [27.6 ± 8.9, mean ± standard deviation (SD)] were enrolled for the study.

Inclusion criteria were: normal gynecological history (regular cycles, no endocrine or gynecological illness), a physiologic pregnancy with delivery at term of a normal newborn with an appropriate birth weight (>2.5 kg) and a negative history of sterility and/or infertility. All subjects gave their informed consent to use breastfeeding to control fertility and not to use any other

Results

Subjects and breastfeeding characteristics are reported in Table 1.

All the subjects concluded the study. In only one case was there an incomplete breastfeeding (3–4 breastfeeding sessions/day) before 180 days postpartum, starting 75 days after delivery.

Mean daily breastfeeding sessions number and intervals between sessions differed statistically (p <0.01) between the first 60 days postpartum and 180 days postpartum.

In 8/40 cases (20%), the resumption of menses preceded weaning. In these eight

Discussion

The results reported above seem to confirm that breastfeeding delays the resumption of normal ovarian activity. Most of the subjects resumed menses after weaning and the eight women who menstruated before weaning either had no temperature rise or an inadequate thermal shift. This figure is in accordance with the data of a previous study from our group evaluating bone mineral loss during lactation,12 in which only 39.8% of nursing women resumed menses during six postpartum months, and only by

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