Family-Planning Methods

These birth control methods are completely safe and won't interfere with a mother’s milk supply. 

LAM is the technical way of saying she won’t have a period while breastfeeding. Many women don't experience a period until they are no longer breastfeeding — some for a year or more. Others may experience a period after reducing the number of times they nurse each day.

LAM is a temporary form of natural family planning that can be used by women who have recently given birth and are breastfeeding. To use LAM as effective birth control, a mother must be able to say yes to all four statements:

• She only breastfeeds her baby. (She does not give her baby any other food, formula or drinks.)
• She breastfeeds her baby at least every four hours during the day and every six hours at night with no exceptions.
• Her baby is less than six months old.
• She has not noticed any spotting or started her monthly period.

LAM is 98% effective for moms who can say yes to all four statements. If she cannot say yes to all four, it's important for her to choose another method of birth control to prevent a pregnancy. It is unclear if the effectiveness is reduced in mothers who are pumping compared to mothers that are directly breastfeeding. 

• Condoms (The only method that may also prevent STD infections including HIV/AIDS.)
• Diaphragm
• Cervical Cap
• Sterilization (vasectomy or tubal ligation)
• Natural Family Planning (A method that only works if your period has returned.)
• Spermicides
• The contraceptive sponge
• Copper intrauterine device (IUD)

These methods contain the hormone progestin, and are typically safe to begin immediately after birth:

If the mother has had low milk supply concerns in the past, you may want to refer her to a lactation support professional for additional discussion and optimization of milk supply.

• Depo-Provera (an injectable progestin) 
• The minipill (a birth control pill with progestin but no estrogen)
• Hormonal intrauterine device (progestin releasing IUD)
• Single-rod progestin releasing implant (typically placed under skin in upper / inner aspect of non-dominant arm)

These methods contain the hormones progestin and estrogen. 

As they include estrogen they should not be started within 21 days of delivery due to an increased risk of maternal blood clots irrespective of mother’s feeding choice.

Early use of estrogen containing methods may delay or decrease milk production while breastfeeding.

The mother should wait 4 to 6 weeks after birth before beginning:

• The combined hormonal ring 
• The combined hormonal patch
• The pill (with progestin and estrogen)

There are different pill options available for emergency contraception (to be started within 72 hours of unprotected sex). One option includes both estrogen and progesterone while another option is progesterone only. The effectiveness of both hormonal options is similar.

Due to the concern related to estrogen on milk supply, the option containing only progesterone is likely preferable in the breastfeeding mother. A copper IUD can also be effectively used as emergency contraception but requires placement by a qualified provider within 5 days. The copper IUD is compatible with breastfeeding.

Clinical Guidelines

• Berens, P., Labbok, M., & Academy of Breastfeeding Medicine (2015). ABM Clinical Protocol #13: Contraception During Breastfeeding, Revised 2015. Breastfeeding Medicine, 10(1), 3–12.

 References

1. Bouchard, T., Blackwell, L., Brown, S., Fehring, R., & Parenteau-Carreau, S. (2018). Dissociation between Cervical Mucus and Urinary Hormones during the Postpartum Return of Fertility in Breastfeeding Women. The Linacre Quarterly, 85(4), 399–411.