Breastfeeding is one of the most important practices a mother can do to ensure her baby’s health and development. Breast milk is the most complete food in the world, able to provide the newborn with everything necessary for development. Breastfeeding isn’t only beneficial for the baby; it also offers a series of advantages for the mother besides strengthening the mother-baby bond. The World Health Organization (WHO) recommends exclusive breastfeeding with only breast milk for the first six months of life, introducing other foods after this age but maintaining breastfeeding for the first two years of life.

Breastfeeding should be encouraged within the first hour of the baby’s life, regardless of the delivery method
Unfortunately, in Brazil, the culture of early weaning is still very strong and there is a lack of public policies to ensure that mothers can not only meet WHO recommendations but also understand the effects of breastfeeding on their bodies. Because of this, many people believe that simply breastfeeding is enough to prevent a new pregnancy. This information is, at the same time, correct and incorrect. In reality, it is possible to get pregnant while breastfeeding. As you can see, this topic is more complex than it seemed at first, but don’t worry, we’ll explain everything so you can understand under what circumstances breastfeeding is truly a contraceptive method and when it does not prevent a new pregnancy.

  1. How breastfeeding works
  2. Benefits of breastfeeding
  3. Lactational Amenorrhea Method (LAM)
  4. Best contraceptive methods for those who are breastfeeding

How breastfeeding works

Breastfeeding is a natural process of the body, common to all mammals. During pregnancy, but especially once the baby is born, the mother’s body starts to prepare to feed her baby. This process, in addition to involving various hormones, has a high caloric cost, requiring a lot of energy and resources, drawn directly from the mother’s body. Unlike what many people think, breast milk is not stored in the breast until it’s time for the baby to feed. In reality, the breast is a factory that produces milk, and its production occurs according to the baby’s demand. That is, the more the baby nurses, the more milk the mother will produce. How milk is produced During pregnancy, progesterone levels are very high, which, in addition to maintaining pregnancy, inhibits milk production. After birth, with the placenta expelled, these hormone levels drop and prolactin—the hormone responsible for milk production—begins to increase. The period from the placenta’s expulsion until milk “comes in” (lactogenesis) takes some time. For women who had a vaginal delivery, this time is usually up to 3 days, while for those who had a cesarean it can take up to 7 days. This difference happens because women who delivered vaginally have much higher oxytocin levels, which aids breastfeeding. While the milk hasn’t come in yet, women release a secretion (often during pregnancy) called colostrum. Colostrum is highly caloric and nutritious and should be the only food offered to the baby until milk comes in.

Milk production works like a cycle: the more the mother breastfeeds, the more milk she produces.
Putting the baby to the breast from birth is very important for establishing breastfeeding, since it’s through sensory stimulation (suckling) and visual stimulation that the brain will receive signals for milk production. Upon receiving stimulation via receptors on the areola, the pituitary gland releases two hormones: prolactin and oxytocin. Prolactin is the hormone that will stimulate milk production, while oxytocin will trigger the let-down reflex. The mother, while breastfeeding, is stimulating the cycle again—in other words, as long as there is stimulation, milk production will keep happening regardless of the baby’s age. The belief that breastfeeding works as a contraceptive is due to the fact that prolactin acts as a progesterone inhibitor. However, this effect is not well understood or controllable enough for breastfeeding to be relied on as a contraceptive method at any moment during the postpartum period.

Benefits of breastfeeding

That breastfeeding is extremely beneficial for both baby and mother is almost universally known, but did you know these benefits begin right in the delivery room? When breastfeeding starts within the first hour of life, besides helping to establish the mother-baby bond, it aids in expelling the placenta and reduces the risk of postpartum hemorrhage. This happens because breastfeeding stimulates the release of oxytocin, the hormone responsible for uterine contractions.

The Montgomery tubercles (bumps on the areolas) are glands that protect the breasts and prepare them for breastfeeding.
In addition to helping after birth, breastfeeding promotes the baby’s growth and weight gain, strengthens the immune system, and matures the digestive system. For the mother, besides aiding postpartum recovery, breastfeeding on demand helps women return to their pre-pregnancy weight more quickly, because producing milk burns a lot of calories. From an economic perspective, breastfeeding is much cheaper than providing formula and spending on bottles and nipples. More than that, it’s extremely practical, as it doesn’t require any form of container for transporting or preparing. All you need is you and your baby.

Lactational Amenorrhea Method (LAM)

For many years, it was believed that the hormones released during breastfeeding were sufficient to suppress progesterone, thereby preventing ovulation. Based on this belief, the Lactational Amenorrhea Method (LAM) was developed, which consists of a contraceptive method based on breastfeeding. However, over the years, there is no conclusive scientific evidence to recommend using LAM as a contraceptive method, since there is no way to determine how long a postpartum woman will go without menstruating and the influence of factors related to breastfeeding, sexual activity, diet, and others are unknown.

Examining current literature, we can say that practicing the Lactational Amenorrhea Method as a contraceptive is not recommended.

Contraceptive methods for those who are breastfeeding

Many women stop using contraceptive methods, especially hormonal ones, after giving birth because they believe that using them can harm the baby and breastfeeding. While the use of hormone-based methods (mainly estrogen) is not recommended, there are other ways to prevent an unwanted pregnancy.

The condom is the only contraceptive method that also protects against sexually transmitted infections (STIs).
The main non-hormonal contraceptive methods are:

  • Copper IUD
  • Male and female condoms
  • Diaphragm
  • Withdrawal
  • Fertility awareness
  • Vasectomy

There are some hormonal contraceptives that can be used alongside breastfeeding, but before starting any of them, consult your gynecologist to ensure that use will not harm breastfeeding. Now that you know how breastfeeding works and the relationship between its hormones and fertility, you surely understand why it is possible to get pregnant while breastfeeding. So, if you want to avoid a new pregnancy, always remember to use a non-hormonal contraceptive method during sexual intercourse. Breastfeeding is good for your health, but it is not enough to prevent ovulation from occurring.