How Does Breastfeeding Prevent Conception And How Effective Is It?

The exact mechanism of how breastfeeding prevents pregnancy (lactation amenorrhea) is poorly understood. However, it is thought that during breastfeeding there is inhibition of the normal release of luteinizing hormone from the anterior pituitary.

Breastfeeding therefore provides a contraceptive effect, but it is not totally reliable, as up to 10% of women conceive during this period. Recently, it has been shown that there is less than 2% chance of conceiving in the first 6 months for a mothers who are still in the phase of postpartum amenorrhea while fully breastfeeding their babies.

Although this is comparable to some other forms of contraception, most women in developed countries use some sort of additional contraception, such as barrier methods. If an intrauterine contraceptive device is preferred, it is best to wait for at least 4-8 weeks to allow for involution. The combined oral contraceptive pills enhances the risk of dislodgement of clots (thrombosis) in the early post-delivery and can have an adverse effect on the quality and constituents of breast milk. The progesterone only pill (the minipill) is therefore preferable and should be commenced about 21 days following childbirth. Injectable contraception, such as depot medroxyprogesterone acetate (Depo-Provera) given three-monthly or norethisterone enantate (Noristerat) given two-monthly, is also very effective. It is preferable to give injectable contraception 5-6 weeks postpartum as they can cause breakthrough bleeding when given earlier or within 48 hours of delivery.

Sterilization can be offered to mothers who are certain that they have completed their family. Tubal ligation can be performed during caesarean section, by mini-laparotomy in the first few postpartum days or delayed until after 6 weeks when it can be done laparoscopically.

Women who are not breastfeeding should commence the pills within 4 weeks of delivery, as ovulation can occur by 6 weeks postpartum.


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