The lactational amenorrhea method (LAM) is a method of avoiding pregnancies which is based on the natural postnatal

Postnatal

Postnatal is the period beginning immediately after the birth of a child and extending for about six weeks. Another term would be postpartum period, as it refers to the mother...

 infertility that occurs when a woman is amenorrheic and fully breastfeeding

Breastfeeding

Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts rather than from a baby bottle or other container. Babies have a sucking reflex that enables them to suck and swallow milk. It is recommended that mothers breastfeed for six months or...

. If not combined with chemicals or devices, LAM may be considered natural family planning

Natural family planning

Natural family planning is a term referring to the family planning methods approved by the Roman Catholic Church. In accordance with the Church's requirements for sexual behavior in keeping with its philosophy of the dignity of the human person, NFP excludes the use of other methods of birth...

.

Breastfeeding infertility

For women who meet the criteria (listed below), LAM is 98% - 99.5% effective during the first six months postpartum.

• Breastfeeding must be the infant’s only (or almost only) source of nutrition. Feeding formula, pumping instead of nursing, and feeding solids all reduce the effectiveness of LAM.
• The infant must breastfeed at least every four hours during the day and at least every six hours at night.
• The infant must be less than six months old.
• The mother must not have had a period after 56 days post-partum (when determining fertility, bleeding prior to 56 days post-partum can be ignored).

Ecological breastfeeding

Ecological breastfeeding is a stricter form of LAM developed by Sheila Kippley, one of the founders of the Couple to Couple League

Couple to Couple League

The Couple to Couple League is an international, non-profit organization based in Cincinnati, Ohio dedicated to teaching and promoting Natural Family Planning. Specifically, CCL promotes the sympto-thermal method of fertility awareness and also promotes exclusive and continued breastfeeding...

. Studies have shown it has a 1% failure rate in the first six months postpartum, and a 6% failure rate before the woman’s first postpartum menstruation. The Seven Standards of ecological breastfeeding are slightly different from the LAM criteria:

• Breastfeeding must be the infant’s only source of nutrition – no formula, no pumping, and (if the infant is less than six months old) no solids or water at all.
• The infant must be pacified at the breast, not with pacifiers or bottles or by placing a finger in the mouth.
• The infant must be breastfed frequently. The standards for LAM are a bare minimum; greater frequency is better. Sucking should include non-nutritive sucking when the infant cues the mother, not just breastfeeding as a means of nutrition. Scheduling of feedings is incompatible with LAM.
• Mothers must practice safe co-sleeping
  Co-sleeping
  Co-sleeping is a practice in which babies and young children sleep close to one or both parents, as opposed to in a separate room. It is standard practice in many parts of the world, and is practiced by a significant minority in countries where cribs are also used...
  
   as it is the proximity of the child to the mother that increases prolactin
  Prolactin
  Prolactin also known as luteotropic hormone is a protein that in humans is encoded by the PRL gene.Prolactin is a peptide hormone discovered by Henry Friesen...
  
  .
• Mothers must not be separated from their infants. This includes substitutes for mother such as babysitters and even strollers or anything else that comes between mother and physical contact with her child. Babywearing
  Babywearing
  Babywearing is the practice of wearing or carrying a baby or child in a sling or other form of carrier. Babywearing is far from new and has been practised for centuries around the world...
  
   (using cloth carriers) means tactile stimulation between mother and child and increases access to the breast. Any separation from the mother will decrease the efficacy of ecological breast feeding.
• Mothers must take daily naps with their infants.
• A mother must not have had a period after 56 days post-partum (bleeding prior to 56 days post-partum can be ignored).

Return of fertility

Return of menstruation following childbirth varies widely among individuals. A strong relationship has been observed between the amount of suckling and the contraceptive effect, such that the combination of feeding on demand rather than on a schedule and feeding only breast milk rather than supplementing the diet with other foods will greatly extend the period of effective contraception. The closer a woman's behavior is to the Seven Standards of ecological breastfeeding, the later (on average) her cycles will return. Average return of menses for women following all seven criteria is 14 months after childbirth, with some reports being as soon as 2 months while others are as late as 42 months. Couples who desire spacing of 18 to 30 months between children can often achieve this through breastfeeding alone.

Although the first post-partum cycle is sometimes anovulatory (reducing the likelihood of becoming pregnant again before having a post-partum period), subsequent cycles are almost always ovulatory and therefore must be considered fertile. However, some women find that breastfeeding interferes with fertility even after ovulation has resumed. Luteal phases being too short to sustain pregnancy is a common example.

Further reading

• Kippley, Sheila. Breastfeeding and Natural Child Spacing: How Ecological Breastfeeding Spaces Babies. Cincinnati: Couple to Couple League International, 1999. ISBN 0-926412-20-5
• The Use of Contraception During Lactation - A Fact Sheet - Alberta Medical Association.