Does BREASTFEEDING work as BIRTH CONTROL? (Yes? No? Maybe...?)

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We've all met women who SWEAR breastfeeding is adequate birth control. But most of us have heard other women say, breastfeeding does not work as a contraceptive at all.... and maybe even some who have kids to prove it. ;)

And then there are women (like me) who start ovulating at four weeks post-partum (despite the fact that I was co-sleeping and solely breastfeeding my Little Owl...)

Related Reading: Why You Shouldn't Be Using Hormonal Birth Control (Learn More)

So what's up? Why does breast-feeding seem to work as birth control for some mommas but not for others? What is going on?

Breastfeeding as Birth Control. (Yes? No? Maybe...?)

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Is it a difference in diet? A difference in milk-supply? Is it co-sleeping versus crib sleeping? Or is it simply an old wives tale that breastfeeding works as birth control? Or is there actually some validity to it?

I used to think that the answer must have to be complicated. And in some sense, it is. Yet, after reading a short section in Meredith F. Small's book, Our Babies,Ourselves: How Biology and Culture Shape the Way We Parent, I realized that her research and analysis of the situation makes a LOT of sense.

Contraceptives Need to be Used Correctly to Work...

Let's say, for the sake of argument, that breastfeeding does work as a contraceptive. As in, it changes the hormones in a woman's body enough so that she doesn't ovulate. Even still, all forms of birth control whether hormonal (pill, patch, breastfeeding, etc.) or other (condom, femidom, etc.) need to be used correctly in order to give any sort of guarantee that they will prevent pregnancy. Companies who manufacture birth controls know this, this is why they put detailed instructions for how to use their product all over their packaging. 

Breasts don't come with this sort of packaging or instructions.

Meet Prolactin: your contraceptive friend

So we cannot automatically know how breasts are supposed to be "used correctly" as birth control. So how DOES breastfeeding work as a contraceptive? Meredith F. Small points out in Our Babies, Ourselves: (emphasis added)

Prolactin, the hormone that maintains lactogenesis [the production of milk], is a highly labile [easily changed] hormone and it appears that suckling, not the passage of milk, is responsible for fluctuation levels of prolactin. Pulling on the nipple inhibits the dopamine release from the hypothalamus, which in turn allows the release of prolactin from the anterior pituitary.

In other words, the actual amount of milk produced doesn't matter so much for contraception purposes, as the regularity of nursing. So, it's not what you've got, it's how often you give it. Small goes on to state: (emphasis added)

... once the baby stops nursing, the prolactin level immediately begins to drop; within two hours after a feed, serum prolactin levels of nursing mothers are are back to baseline and within four to six hours the levels match those of non-nursing mothers.

In other words, it doesn't even take a few days for your hormones to register the fact that your not nursing as often. All it takes is over two hours! Less than even a single afternoon to yourself, of not nursing every few hours, for your hormones to register that something different is going on. It takes less than two hours of not nursing for your prolactin levels to change dramatically. 

The Key to Breastfeeding as Birth Control...

So why is prolactin so important for contraception? How does it affect ovulation? High prolactin levels are what triggers the body to suppress the other hormones that would otherwise set in motion the process of the regular menstrual cycle. Suppressed prolactin levels just might be the key to using breast-feeding as a reliable form or birth control. As Small words it: (emphasis added)

The key to reliable contraceptive effect [with breastfeeding] is that the levels of prolactin and other hormonal inhibitors have to be consistently high for ovulation to be repressed. So when women breastfeed only intermittently, or have long spaces between feeding bouts, or do not feed at night, their serum prolactin levels rise, other hormones kick in, and the risk of pregnancy rises; this period of “lactation amenorrhea” [i.e. infertility cause by breastfeeding] is highly sensitive to the maternal breastfeeding style. It's not the volume of milk that passes through the breast that makes the difference, but the frequency of infant sucking on the mother's nipple. For lactation to have an inhibitory effect on the ovaries it has to be relatively continuous and occur at night as well as during the day.

In other words, a woman cannot definitely not expect breastfeeding to work as birth control for her is she is not nursing at night AND nursing regularly (at LEAST every few hours) during the day. 

So who does this work for? Apparently, the !Kung San of Botswana are a good example of a culture that successfully uses breastfeeding as birth control. They have three to four year birth intervals between kids. What does using breast-feeding as birth control to accomplish this look like? In Our Babies, Ourselves, Small explains: (emphasis added)

San women breast-feed on average every thirteen minutes for the first few years, and sleep with their babies and allow them to feed at will during the night. Blood work showed that prolactin levels of the mothers remained high as long as they kept up this schedule...  

So I guess I should rephrase what I said earlier, if you want to use breastfeeding as a guaranteed form of birth control you should be expecting to nurse about every fifteen minutes... for, you know, a few years.

Now that, being said... you ask, "But, breastfeeding seems to work as birth control even for women who don't just nurse every two hours?" And my answer is... well, maybe. It could be that their hormones are slower to change, that their prolactin levels don't go down as fast as other mommas, or it could be that they simply haven't gotten pregnant.... There are lots of options. But, just because it "worked" for someone else, doesn't mean it's 100% proof that it will work for everyone... 

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For me, reading this section from Meredith F. Small's, Our Babies,Ourselves, made 100% sense of what happened to me at three weeks postpartum. Little Owl slept for eight hours straight. One night. That was it. My "lactation amenorrhea” was over. 

All it took was one night for my hormones to get back on track with ovulation. Not everyones hormones will work this fast, but the point is that the studies show they very well could. 

So, in other words, if you are planning on using breastfeeding as birth-control, you should also be planning on not getting much sleep and nursing a LOT. 

(Which really, who feels super sexy when they are covered in milk and super sleep-deprived, anyways? So I guess that's a whole other form of birth control, too....) ;)

Beautiful? In the true sense of the word, Yes. Sexy? No. (And yes, even crunchy mommas use pacifiers...)

Curious to learn more? Here are a few books I love and recommend that will help you better understand your womanly hormones and what exactly they do and when... 

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Honoring Our Cycles: A Natural Family Planning Workbook

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by Katie Singer is a short and concise book that explains how a baby is conceived, explains how to chart your body's fertility to either plan for pregnancy or to avoid it. Includes excellent dietary advice for optimal health and fertility. 

Taking Charge of Your Fertility: The Definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health by Toni Weschler. A very large, information-full book. For more than ten years women have used this as a go-to reference for achieving pregnancy, natural ways to avoid pregnancy and generally gain control of their bodies and health.

What about you? Did you use breastfeeding as birth control? Why or why not?

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