Breast Feeding and Return of Fertility?

Return of Ovulation & menstruation depends on:-

a)        Frequency and duration of breast feeding per 24 hours

b)       Resumption of menstruation

c)         Initiation of sexual activity

d)       Return of ovulation (arbitary)

All these four factors have been discussed at length in the following pages. The relevance of al these four factors have been explained in details thus enabling couple to initiate contraceptive at a reasonably appropriate time. Admuttedly, till date there is as yet no set guideline about commencement of contraceptive in postpartum period due to inaccuracies fallancies of all these four indices to foretell about the probability of pregnancy.

A.                 Nature of breastfeeding and return of postpatum fecundity :

So far as duration of postpartum insusceptibility to pregnancy is concerned not only the total months for which the infant is breastfed is mportant but frequency and total duration of breast-feeding per twenty four hours are also important. Presumably, many educated couple are aware that frequent breastfeeding practice prevents conception by inhibiting release of eggs from ovaries but only few of them are aware that adoption of this method of natural contraception has been recently renamed as ‘Lactational Amenorrhoea Method (LAM)’ PARA. In LAM there are three factors to be considered. Unfortunately for lack of proper publicity few Indian couple have an clear idea on thest three essential criteria to make LAM method of natural contraception successful. These three criteria are a) exclusive breastfeeding including on or two feeds at night b) Persistence of postpartum ammenorrhoea (nonoccurence of menstruaton) and this contraceptive efficacy of LAM last only for first-six months after childbirth. Contraceptive effieacy fades after six months inspite of continued breastfeeding.

The importance of breastfeeding in preventing contraception can be easily ganzed by following observation. Sevently-five percent of non-lactating Indian women conceive within six to nine months of delivery if effective contraception is not practised as against only 7-10 percent of those who breastfeed as per international norms.

B.                 Partial breastfeeding and early return of fertility :

How vulnerable are women who breastfeed infrequently or for only short duration, ‘Menstruation’, ‘Ovulation’ and therefore ‘fertility’ return sooner than expected in such women and unintended pregnancy can occur quite early say within three or four months after childbirth inspite of continued partial breastfeeding.

Owing to lack of this particular scientific information many women fall prey to unintended pregnancy in lactation period. They are under the false impression that they are immune to pregnancy because of so called breastfeeding. In fact, partical breastfeeding confers little protection against pregnancy as suckling of breasts in infrequent and hence ovulation is not inhibited appropiately. The incidence of ‘escape ovulation’ during partial breastfeeding though not universal but is a distinct possibility.

C.                  What is then partial breastfeeding?

By partial breastfeeding we mean infreqent and short-lived breastfeding that needs to be supported and supplemented by edible extra-milk or non-milk products before six months of age. This practice of providing extra-feeding is the total negation of science. If partial breastfeeding practice is adopted then twenty percent of such women will menstruate as early as two months after childbirth! I wonder, how many partially breastfeeding Indian mothers are aware of this fact before they embark on unprotected intercourse.

In fact, they simply do not know that they are susceptible to pregnancy even as early as two months after childbirth! I am also convinced that majority of such Indian women do not use any contraceptive whats over as this early postpartum phase. It is thus importantto fully breastfeed for first six months to avail and enjoy contraceptive efficacy of breastfeeding. Some scientist however claim that ‘Lactation’ and ‘Ovulation’ are antagonistic but it has now been proved that this principle does not hold good after six months postpartum. What happens is that during lactation prolactin hormone in maternal blood (milk secreting hormone) is high and this hormone suppresses the action of gonadotrophins (hormone responsible for release of eggs from ovaries). To simplify, ovaries of breastfeeding women are to some extent refractory to the actions of gonadotrophin hormones responsible for release of eggs. So elease of eggs from ovaries remain suspended at least for first six months provided no supplementary feed is allowed and menstruation has not resumed. This is exactily what has been called earlier, Lactational Amenorrhoea Method of contraception (LAM).