Is it possible to get pregnant while breastfeeding?

If you've just had a baby (congratulations!), you might be cautious about getting pregnant again any time soon.

And, from a health perspective, it's recommended to leave some time between pregnancies as this is linked to better outcomes for both mum and baby.

Exclusive breastfeeding is used by some as a way of preventing pregnancy but, although it sounds simple, there are a few things you should know if you're relying on breastfeeding as a birth control method.

When does your period return after having a baby?

After all of the changes that come with pregnancy and childbirth, it can take time for your body to adjust and resume pre-pregnancy processes and that includes your menstrual cycle.

The return of your period after having a baby is something that is highly individual and based on your body's unique physiology.

Plus, it also depends on whether or not you are breastfeeding, and how much you breastfeed.

For mums who bottle-feed their baby, or combine bottle-feeding and breastfeeding, your first postpartum period can return around 5-6 weeks after birth [1].

Those who are exclusively breastfeeding might not start having their period until they stop breastfeeding at night and their baby starts solids.

Most breastfeeding mothers regain their period around 9-18 months after birth [2].

How can breastfeeding affect getting your period?

As previously mentioned, it can take quite a few more months for your period to return if you are breastfeeding exclusively and using only breast milk to feed your baby.

This is because the hormone that creates your breast milk supply stops other reproductive hormones from preparing your body for a new pregnancy each month [2].

The act of your baby suckling triggers this process and so frequent nursing sessions restrict your body's ability to have a period [3].

Once you start weaning and your baby starts consuming solid foods, your period is very likely to return, although most people find that their period gradually returns even before weaning.

Do you ovulate while breastfeeding?

All people go through a few weeks without ovulation after giving birth, which is due to endocrine changes [4].

For those who aren't breastfeeding, the first postpartum ovulation typically happens anywhere between 45 to 94 days after birth.

However, you might start ovulating as early as 25 days postpartum.

Breastfeeding parents, on the other hand, don't tend to ovulate.

When the lactation hormone stops the body from menstruating, it also suppresses two other hormones that are essential for ovulation.

On top of that, if you do have a period while breastfeeding, it doesn't necessarily mean your menstrual cycle has returned or does it mean that you've ovulated.

This can be checked with a clinical test, however, you are more likely to be ovulating and regularly menstruating if your child is going for longer periods without breastfeeding (e.g. at night) or if they are older than 6 months.

Can you use breastfeeding to prevent pregnancy?

Since breastfeeding restricts your body's ability to ovulate and menstruate, exclusive breastfeeding can be temporarily used as a form of birth control.

The lactational amenorrhea method (LAM) is the technical term for this and in order for it to be effective, the following 3 criteria need to be met [3]:

• Your baby must be under 6 months old
• You haven't had a period
• Your baby breastfeeds exclusively.

Research also suggests that for optimum contraceptive protection using a natural family planning method like LAM, you and your child would have one nursing session at least every 4 hours during the day and at least every 6 hours at night.

If you're concerned about sore nipples or leaking breasts while breastfeeding, Kin's Breastfeeding Essentials kit contains a soothing nipple balm and lightweight breast pads to support you through breastfeeding challenges.

Can you get pregnant while breastfeeding?

If you carefully follow LAM, the chances of getting pregnant while breastfeeding are pretty slim.

Studies have found that strictly following the LAM criteria is 98-99.5% effective at preventing pregnancy [5].

Outside of the official LAM criteria, it has been found that lactation amenorrhea in women who continue to breastfeed exclusively while not experiencing their period at 12 months postpartum is 94% effective as a contraceptive [3].

It's also worth noting that not everyone will be completely successful at following LAM [3].

One study found that the rate of people who try to attempt LAM but don't keep up with the criteria typically ranges 0.45-7.5%.

How soon can you get pregnant after giving birth while breastfeeding?

Leading experts, such as the World Health Organisation and the American College of Obstetricians and Gynaecologists, recommend parents wait around 12-24 months after giving birth before getting pregnant again [6].

Having this gap makes the next pregnancy safer and has better health outcomes for the baby.

However, the reality is that it is possible to fall pregnant again quite soon after giving birth.

Unless you are exclusively breastfeeding, in line with LAM, some women can be fertile and start ovulating again 3 weeks after birth.

Can you get pregnant if you're breastfeeding and haven't had your period yet?

Although lactation can restrict your body from menstruating, it is still possible to become pregnant while breastfeeding, even if you haven't had your period yet.

If you are breastfeeding but combine that with bottle feeding, your lactation hormone is unlikely to prevent ovulation and you would not be protected from getting pregnant.

Even if you are breastfeeding only and don't have your period yet, LAM is only considered effective as contraception for the first 6 months postpartum — but even then, it's not 100% effective.

If you haven't had your period yet, but continue breastfeeding exclusively after 6 months, you could become pregnant as you're more likely to be ovulating by this time [2].

When should you start using contraception again after giving birth?

Understandably, not everyone is able to solely rely on breastfeeding and use LAM as a form of birth control.

Frequent nursing can be impractical for women returning to work, while others simply might not be able to produce much breast milk.

For those who need another form of birth control, it's recommended to start using one from 3 weeks after birth as this is when you may begin ovulating again.

However, each type of contraception has its own recommendation for when you should start using it after birth [5].

Barrier methods (such as condoms) and the contraceptive injection can technically be used right away, even if you're not ovulating yet.

Other methods of birth control require waiting a few weeks before you can start using them.

The implant, which is inserted into your upper arm, is recommended after 3 weeks.

The IUD, which is inserted into your womb, is recommended after 4 weeks.

Depending on whether or not you are breastfeeding, you may have to wait a bit longer before starting to use a contraception method containing oestrogen.

What style of contraception is best while breastfeeding?

One type of birth control you may prefer to delay taking, while breastfeeding, is any contraception containing oestrogen, such as the vaginal ring or contraceptive patch.

While various studies have had inconsistent results, some people have found taking oestrogen contraceptives reduces their breast milk supply [6][7].

It may also be possible for the hormone to be passed on to the baby through their mother's milk.

The World Health Organisation recommends not using these types of contraception until your baby is at least 6 months [6].

Aside from the risks associated with oestrogen-based contraceptives, each form of birth control has its own set of benefits and drawbacks, so chat with your doctor about which method would be best suited to your body and your lifestyle.

While breastfeeding your baby exclusively can help you prevent pregnancy, each body is unique and other aspects of life can complicate the lactational amenorrhea method.

Being aware of what happens with your menstrual cycle after your baby's birth, how it is affected by breastfeeding, and what other forms of contraception are available can help you manage this new part of your life.

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