nfp breastfeeding
So you’ve made it through the first few weeks with your new baby at home and now it’s time for your six-week follow-up appointment. You’ll finally be cleared to resume relations with your partner (or maybe the idea of anything going on down there is still terrifying). Regardless of how you’re feeling about resuming your sex life, one topic sure to come up is your family planning method. Unfortunately, most healthcare practitioners will make it seem as if your only options are progestin-only or barrier methods if you wish to continue breastfeeding. But practicing natural family planning is entirely possible while still reestablishing your natural cycle postpartum and even while breastfeeding!
There are two main schools of thought related to breastfeeding’s impact on your natural fertility: Lactational Amenorrhea Method (also known as exclusive breastfeeding) and Ecological Breastfeeding.
Lactational Amenorrhea Method
There are only three requirements for LAM:

  1. Your child receives breastmilk only from the breast
  2. Your child is less than six months old
  3. You’ve had no bleeding after 56 days postpartum

When all three of these requirements are met, a woman has a 98-99% infertility rate. After six months, a woman wanting to further space her children would want to resume carefully charting and observing her natural fertility signs. KellyMom cites typical use of LAM to be 4x more effective at preventing pregnancy than the pill and almost 9x more effective than condoms.  Only the Mirena® IUD has a higher efficacy rate.
Ecological Breastfeeding
This method is much more detailed and has seven standards:

  1. Breastfeed exclusively for the first six months
  2. Pacify and comfort your baby at your breasts
  3. Don’t use bottles or pacifiers
  4. Sleep with your baby for night feedings
  5. Sleep with your baby for a daily nap feeding
  6. Nurse frequently day and night, and avoid schedules
  7. Avoid any practice that restricts nursing or separates you from baby

Perfect use of this method basically guarantees 6-8 months of delayed fertility. After you introduce solids, you can still follow standards 2-7 and have an average return of fertility around 14-18 months.
On top of these two methods, you can also continue to chart your fertility signs like you did pre-conception. Because your fertility signs may be affected by breastfeeding, you may find it helpful to add an additional symptom (adding temps or cervical position when you usually just did mucus, etc.) or try a new method completely (Marquette is particularly well-loved in breastfeeding circles due to its ease of use and clarity, although it is more expensive). This is when having financial and physical access to medical practitioners trained in fertility-based family planning methods is vital. For many women, their postpartum fertility signs may be all over the place for several months. Having the option of sending or bringing your chart to someone who has read thousands of breastfeeding charts is invaluable and a key to offering holistic care for women before, during, and after pregnancy. Especially since many mothers return to work before their baby turns six months old, this separation can further increase their chances of fertility returning. If that help isn’t there, they may feel their only choice is to begin using a progestin-only or barrier method.
Breastfeeding was something I was extremely passionate about while pregnant, but also something of which I was a bit terrified. Once my first child was born and we addressed any underlying issues, we were able to have a beautiful, albeit frequent, breastfeeding relationship. When I returned to work at 10 weeks postpartum (after following ecological breastfeeding’s seven standards), I was sure my cycles would soon follow and we would begin the child spacing discernment process again, guided by the knowledge of my fertility symptoms. However, because I followed the seven standards as closely as possible with being away during the day (namely unrestricted nursing while I was home, including frequently at night when prolactin levels peak), I didn’t notice any fertility symptoms until 20 months postpartum, and even then I didn’t have an actual cycle until 23 months postpartum.
For more resources on breastfeeding and fertility, I highly recommend Sheila Kippley’s book, “Breastfeeding and Natural Child Spacing: The Ecology of Natural Mothering.”