Original research articlesUsing complete breastfeeding and lactational amenorrhoea as birth spacing methods
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.
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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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