Lactational amenorrhea method(LAM):

Lactational amenorrhea method is the use of breastfeeding as a temporary family planning method.

It provides natural protection against pregnancy and encourages starting other method at the proper time.

It works by stopping ovulation because breastfeeding changes the rate of release of natural hormones. When the prolactin, the hormone of lactation remains high it will lead to decreased production of estrogen and progesterone from the ovary leading to anovulation or short luteal phases or impaired luteal competence or it may interfere with implantation by itself or because of suckling induced oxytocin release.

Effectiveness:

When  commonly used: 2 pregnancies per 100 women in the first 6 months after childbirth

Very effective when used correctly and consistently: 0.5 pregnancies per 100 women in the first 6 months after childbirth.

Correct and consistent use means:

When the woman’s baby  is less than 6 months old.

Her menstrual period has not returned after last childbirth.

She is fully breastfeeding — day and night, and at least 85% of her baby’s feedings should be breast feeds.

Advantages of LAM:

Effectively prevents pregnancy for at least 6 months, maybe longer if a woman keeps breastfeeding often, day and night.

Encourages the best breastfeeding patterns.

Can be used immediately after childbirth.

No need to do anything at the time of sexual intercourse

No direct cost for family planning or for feeding the baby.

No supplies or procedure required to prevent pregnancy.

No hormonal side effects like other methods.

Counseling on LAM encourages starting a follow-on method at the proper time.

Breastfeeding practices required by LAM have other health benefits for mother and baby like,

It will provide the healthiest, readymade food for baby.

It will protect the baby from life-threatening diarrhea.

Help protect the baby from diseases like measles and pneumonia by passing mother’s immunities to baby.

Help develop close bonds between mother and baby.

Disadvantages of LAM:

Effectiveness after 6 months is not certain.

Frequent breastfeeding may be inconvenient or difficult for some women, especially for working mothers.

It will not give any protection against STIs, including HIV.

If the mother has HIV, there is a small chance that HIV will pass to the baby through breast milk.

Too prolonged lactation may lead to super involution of the uterus and persistent hyperprolactinaemia resulting in prolonged amenorrhea or oligomenorrhea.  These are difficult to cure.

Medical Eligibility:

A woman can use LAM after childbirth, if:

Her baby is less than 6 months old.

Her menstrual period has not returned after last childbirth

She is fully breastfeeding — day and night, and at least 85% of her baby’s feedings are breast feeds.

Most women can use LAM safely and effectively, like women who smoke cigarettes, are young or old are fat or thin.

The relative contraindications:

But women with these conditions can also use LAM in any circumstances, like

 Women with benign breast disease,

Women suffering from headaches,

 Having high blood pressure,

With varicose veins,

With history of valvular heart disease,

Known case of diabetes,

Suffering with iron deficiency anemia,

Women with malaria,

With history of sickle cell disease,

Having gall bladder disease,

With history of thyroid disease or taking medication for it,

Women  with uterine fibroids etc.

The absolute contraindications are:

Baby 6 months or more old, as the method may not give full protection.

Mother cannot fully or nearly fully breast fed the baby day and night.

When menstruation starts means bleeding at least for 2 days after 8 weeks of child birth.

Mother using medications like reserpine, antimetabolites, radioactive drugs, cortisone, cyclosporine, anticoagulants etc.

Mother having viral hepatitis cannot breast fed the baby until baby goy immunized as chances of spreading of virus through the milk are there.

Mothers with HIV/AIDS also should not give breast milk to the baby as transmission can occur.

When mothers apt breast feeding as contraceptive method they should,

Breastfeed often day and night and at least 85% of her baby’s feedings are to be breast feeds.

They should breastfeed properly:  they have to use correct breastfeeding technique and have to take adequate diet.

They can start other foods when baby is 6 months old. And may give breastfeed before giving other food, if possible.

They have to start another family planning method when:

Menstrual period returns that is bleeding at least for 2 days after 8 weeks of child birth (bleeding in the first 56 days or 8 weeks, after childbirth is not considered as menstrual bleeding), or

She stops fully or nearly fully breastfeeding, or

Her baby is 6 months old (about the time when baby starts sitting up), or

She no longer wants to rely on LAM for family planning.

Some problems can occur in breast feeding when using as family planning method like,

Deficient milk supply, it can be overcome by feeding the baby more often in every 1 to 3 hours. Taking good rest, plenty of fluids, healthy food with milk and sago preparations and decreasing stress.

The problem of sore nipples or cracked nipples can be overcome by giving milk from less sore nipple, drying the nipple in air, using emollient ointment for 1 to 3 days, expressing out the milk from affected breast by squeezing or with suction pump till baby can take milk from that breast.

In case of engorgement of breast, may be because of over filling, have to feed the baby more often, remaining milk to be expressed,  to reduce milk secretion temporarily estrogens can be given.

If infection is there, it should be treated with antibiotics, no need to stop breast milk, estrogens can be given. In case of breast abscess, feeding from that breast should be stopped until it is drained and cured.

Though lactational amenorrhea method is good for family planning better to combine with second method for further safety.