What Is Lactational Amenorrhea Method? (LAM)
Article By Sarah Day, CNM, RN, Bc.S., IBCLC
LAM is natural birth control. It is a well known fact that breastfeeding suppresses a woman’s fertility in the early months after delivery. However, many women do not feel comfortable relying on breastfeeding as a form of birth control because they have been told it is unreliable, or perhaps because they know someone who became pregnant while breastfeeding.
The Lactational Amenorrhea Method (LAM) a natural birth control method was created to allow women to safely rely on breastfeeding as a family planning method. Based on scientific research, the method uses three measures of a woman’s fertility: 1) the return of her menstrual period, 2) her patterns of breastfeeding, and 3) the time postpartum.
How Does It Work?
When a baby suckles frequently at the breast it stimulates the nipple, sending signals to the brain, which then releases hormones that interrupt a woman’s normal ovulation cycle. This effect is particularly strong in the early months after delivery when the baby is breastfeeding often. As the baby grows and starts to eat other foods (around 6 months) the time suckling at the breast decreases. When this happens the woman’s body begins to return to its regular cycling and ovulation and menstrual periods return.
In more technical terms, LAM is based on the hypothalamic-pituitary-ovarian feedback system. As the baby suckles at the breast neural signals are sent to the hypothalamus which mediates the level and rhythm of secretion of the GnRH hormone. GnRH influences pituitary release of follicle stimulating hormone (FSH) and luteinizing hormone (LH), the hormones responsible for follicle development and ovulation. Regular and frequent breastfeeding results in disorganization of follicular development.
Who Can Use LAM?
A woman can use LAM if:
Her menstrual period has not returned since delivery (Bleeding or spotting during the first 56 days is not considered menstrual bleeding.)
AND
She is breastfeeding her baby on demand, both day and night and not feeding other foods or liquids regularly (Occasional tastes of foods or other liquids are permitted, but they should never replace a feeding at the breast.)
AND
Her baby is less than six months old.
When all three of these conditions exist, she has less than a two percent chance of becoming pregnant. However, the woman is encouraged to begin using a complementary family planning method when any of the three conditions changes, or whenever she chooses.
When Is LAM No Longer Effective?
A woman who chooses to rely on LAM should be advised that the method is short-term (up to six months) and is no longer effective when any one of the three criteria changes.
The LAM user should be counselled to use another contraceptive method for continued protection when:
1. Her menstrual periods return.
Menstrual bleeding is the most important indicator of fertility. After the initial 56 days postpartum, two consecutive days of bleeding/spotting or the woman’s perception that her period has returned, whichever of the two comes first, should be considered an indication that fertility is returning. A woman can ovulate before her period returns, however, studies indicate this rarely occurs when the woman is breastfeeding intensively and less than six months postpartum.
OR
2. She begins feeding her baby other liquids or foods regularly, or her baby sleeps through the night.
Ovulation is suppressed in the breastfeeding woman as the baby suckles at the breast. When the baby begins taking other foods or liquids she/he generally suckles at the breast less, thus reducing the fertility-suppressing effect of breastfeeding. This is also true when the baby begins sleeping through the night–long intervals between breastfeeds (more than four hours during the day and six hours at night) should be avoided.
OR
3. Her baby is older than six months.
At about six months, the baby should begin eating other foods, as their nutritional needs change at this time. Usually the baby will breastfeed less when this happens, thus, LAM becomes less effective.
Any one of these changes will reduce LAM’s high efficacy. At this time, the LAM user should be counselled about complementary family planning methods that do not interfere with breastfeeding.
Medical Conditions When LAM Would Not Be Advisable.
Medical conditions that affect the use of LAM are few. Generally, the conditions listed below make breastfeeding inadvisable, which in turn makes LAM use impossible.
LAM should not be used under the following conditions:
Specific infant metabolic disorders.
Maternal use of mood-altering drugs.
Maternal use of reserpine, ergotamine, antimetabolites, cyclosporine, bromocriptine, radioactive drugs, lithium, or anticoagulants.
LAM usually is not recommended under the following conditions, except on the basis of careful clinical judgement, taking into account the severity of the condition and the availability and acceptability of other methods.
AIDS or confirmed HIV+. The HIV virus can be passed through breastmilk. According to the World Health Organization, if a safe alternative to breastfeeding is available and affordable, a woman who is HIV+ or has AIDS should be informed of the risks of breast and bottle feeding.
Active tuberculosis. Tuberculosis does not spread through breastmilk but through direct contact with the mother. If the mother has an active case of tuberculosis, breastfeeding increases the risk of infection due to the frequent and intimate contact with the infant.
About the Author:
Sarah Day is a certified nurse midwife, mother of 2 children.