bearing blog: LAM update.

At the beginning of October I wrote a post about lactational amenorrhea that broke my previous record for number of comments (30 I think).

At this point I would not use the term "reliable" to describe ecological breastfeeding for spacing. Some women are fortunate (or blessed, or whatever term you want to use) to find that amenorrhea lasts a long time; some are not. Even if that were true for most women --- maybe it is --- the fact that you can't tell in advance whether you fall into the "most women" category would make it not "reliable" (it would if that "most" was "all but a tiny few" but it is not). There's a significant element of unpredictability there.

Rather contrary to the suggestion that women risk selfishly doing EBF for the fertility suppression at risk of harming their babies, I'd say that EBF is worth doing for the baby's sake, and if you get some spacing out of it, that's just a bonus.

Another thing I want to throw out there: A lot of people seem to be measuring the "reliability" of EBF as a baby-spacing means with "how many months of amenorrhea did I get." I'd say that unless you're happy with lactation being your only spacing mechanism -- which is fine for many families, I know -- the measure of reliability has a lot more to do with whether you can detect the return of fertility clearly enough that you know when to start abstaining in anticipation of switching to NFP.

If you look at my "how many months" data, it sounds pretty good. I wasn't following the 7 standards the first time (I was in grad school and did a lot of pumping) and I still got 6 months of amenorrhea. Here I am still not cycling at 8m postpartum.

But for us, it has been a significant sacrifice to continue with lactational amenorrhea. I haven't (yet) tried to kick-start the cycles by depriving my baby of time he needs with me, but we've certainly been tempted. And the reason for that is that my pattern of return to fertility has been an early onset of fertility signs which last many, many weeks. And no, before you tell me it is probably a "basic infertile pattern," I can assure you that it is not, not according to any sort of system (CCL, Creighton, or Billings). EWM for months straight. Oh, and, three out of three times, the first ovulation has occurred without a "warning period."

I wouldn't use the term "unreliable" either for EBF -- the connotations of the word are too negative. Truth is, it's useful for many couples. Many informed couples are, clearly, willing to rely upon it because of their own very subjective judgment; which is what matters for them. And again, the standards that increase the odds are good for babies and worthy for that reason. But I'm not willing to call it "reliable" under any objective standard. There's just not enough predictability.

Later, by email, Official Bearing Blog Epidemiologist ChristyP reminded me that (despite the NFP community doing a lot of cheerleading about breastfeeding being able to space babies 18 months or more apart), the lactational amenorrhea method is reliably reliable up to 6 months postpartum, and not at all reliably reliable after that.

I think maybe the best summary is this: Most people will be able to get away with LAM without a whole lot of abstinence up to 6 months postpartum. After that, as the months go by, fewer and fewer couples will be able to get away with a low-abstinence approach.

Anyway, I thought I'd post on it again just to note that we have now made it through the end of lactational amenorrhea; I am nearly done with the first full postpartum cycle. Yeah, it kind of sucks to be having periods again, but it's a relief to be, for now, coming out of the confusing season of my childbearing years.

Only now after four babies (three with adherence to LAM requirements as described in the link above) do I feel like I have gotten the hang of how to handle lactational amenorrhea. I recently described it to a questioner in an NFP mailing list I'm on, a first-time mother who was seeing so-called "fertile-quality" mucus early in the postpartum period:

I sympathize greatly as I always had a lot of mucus changes with all four of my postpartum periods. We prefer to operate quite conservatively so there was a lot of abstinence for us. With the first I was working, so couldn't trust LAM at all, and just abstained; with the other three, we began abstinence prior to 6 months pp because I started to have migraines which have always for me been a sign of ovulation.

For example, this most recent time, I had a string of migraines at 4 and 1/2 months postpartum -- we began abstinence then. I didn't have many dry days and they rarely strung together into several dry days in a row. It happened once about 6 and 1/2 months pp that we got 4 dry days...Then back to abstinence. I continued to have occasional migraine. At exactly 9 months pp I detected first ovulation with temperature rise. First menstruation followed 13 days later.

...It helps a lot that both of us agree on taking a fairly conservative approach.

Like I said, we're rule people. The hard part about LAM for us has always been the difficulty figuring out which rules apply. Ignoring CM until after the first migraine OR six months pp, whichever comes first, seems like a comfortable compromise for the length of LAM. Incidentally, the "uncertain time" (read: time of very high abstinence) has turned out to last about four and a half months every time. Believe me, that's not an insignificant length of time, and as it wears on it is increasingly annoying, since it's only in hindsight that you know how long it will be; but neither is it marriage-destroyingly horrible.

Too bad I can't go back in time to, say, mid-August and tell myself that it won't be all that bad... but then, if I could perfect the Time Travel Method of natural family planning, well, we'd all be having a lot more fun, wouldn't we?