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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See it on Amazon.
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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  1. Jackie,

    This is really interesting! I also had my period start really quickly (I think about 8 weeks) after birth for all of my children. However, I was nursing 2-3 hours night and day, without a break, with Elena, and it still started again. Perhaps I am just abnormal though. ;-)

    1. Hey Kimi! Thanks for sharing your experience! As a momma who started ovulating VERY soon after pregnancy, this topic fascinates me. I'm always interested in knowing what other mommas have experienced, too.

      It's not surprising to me that you started shortly after, even with nursing every 2-3 hours. If Small's study is right and as she says "within two hours after a feed, serum prolactin levels of nursing mothers are are back to baseline" that makes completely sense with what you experienced.

      When you look at cultures who this actually works for... such as the !Kung San... they nurse their babies about every 15 minutes!

    2. Thanks for your comment. It made me realize I needed to clarify a few things in the post. :) I added a few things, including the info about the !Kung San <3

    3. This is Ann, and this is an interesting-sounding book that I have not read. Nonetheless, my cycles stayed away for 12-14 months with my children. I later read about ''ecological breastfeeding'' in a similar-sounding book, "Breastfeeding and Natural Child Spacing," by Sheila Kippley. She has 40 years experience with nursing babies and child spacing. She recently wrote a new book, "The Seven Standards of Ecological Breastfeeding" which I read in 2 days. It is full of research also, and defines behaviors that help cycles stay away for a majority of women. Have you heard of them?
      I am a health care provider and it bothers me that so few women understand some of the concepts in your blog. By the way, a couple of studies show that bleeding in the first 56 days with some very specific forms of nursing can usually be attributed to infertility { one is1988 Bellagio } . Plus, different input than your beautiful photo above, is that pacifiers could interfere with child-spacing hopes. I am so happy that your experience with your little one has been so positive!

  2. My second child nursed about every 20 minutes as a newborn. When he was 22 months old he started going 2-3 hours between feedings and this is when my fertility returned. I sit holding my newborn baby as I type. She hasn't gone longer than a couple hours being detached from the breast (and these long stretches of 2 hours or so is at night). Babies are usually designed to nurse that frequently. However, mothers often use substitutes for the breast like pacifiers and restrict their babies to nurse on a schedule. It seems many moms are looking at nursing as a chore to do as little as possible and to get over with as quickly as possible. Because this is so common in our society---it seems crazy to nurse a baby every 2 hours or even every hour (or in my case even more frequently). When in actuality that is very normal behavior. Sure---not all babies will need to be nursed that often but it is completely normal. Kathy Dettwyler has done research to show human babies are designed to nurse up to several times per hour, and that has been my experience as well.

    I'm not sure what causes early return of fertility for some women (even those who practice ecological breastfeeding and/or nurse frequently). But one thing I've noticed is it usually happens QUICKLY (within the first 3 months pp) and whatever is causing is probably something that it wouldn't matter how often that particular woman nursed- it would still come back regardless. But it breastfeeding (in a natural/ecological way) can be effective for a large majority of women. If you research Sheila Kippley's work on ecological breastfeeding there are statistics on how reliable ecological breastfeeding is for child spacing when it's used correctly. The numbers are pretty high, but you will always hear more from women it DIDN'T work for (the small majority) instead of the many women it does work for.

    I didn't practice eco-bfing with my first (just regular breastfeeding that is common to our culture- scheduled feedings for example) and my fertility returned at 9 months pp. I used eco-bfing with my second child and my fertility returned at 22 months pp- a substantial difference.

  3. This was a very interesting post and I appreciate all the research you put into it. That said, I think you are a bit too "down" on using breastfeeding as "birth control" I have experienced 12-17 momths of LAM with all my kids and I wasn't nursing every 13 minutes. I did nurse A LOT (at least every 2 hours), but I also got plenty of sleep and was never sleep-deprived. I think co-sleeping is really key, the keeping the baby close at night and nursing all night while still letting mama rest is a huge factor.

    I think letting the baby nurse to sleep and sleep suckle is another big factor. I think those long stretches of nursing where the baby falls asleep on the breast and continues to sleep suckle do a lot to suppress fertiilty and the high levels of prolactin that result can carry you through 1 slightly longer (like 4 hour stretch at night). For example, if the baby nurses for 45 minutes straight before going to sleep, and then sleeps 4 hours, I think prolactin levels aren't going to drop as much as if the baby nurses for 10 minutes before sleeping for 4 hours.

    We also do baby-led weaning and I think that helps keeps fertility away as well, because they are "slower" to start eating lots of solids.

    And, in that picture above (which IS beautiful), the pacifier is definitely going to interfere with the fertility-suppressing effects of breastfeeding. Comfort nursing is a major factor (again that sleep suckling). While your baby is sleeping on you while sucking on a pacifier, my babies would sleep on me my while nursing. Thankfully I am able to sleep with them latched on. :) I think that is a major factor right there, there have been several times where I went to sleep with the baby nursing and woke up a few hours later and they were still latched on and flutter sucking. I think that makes a big difference.

    In my experience a few longer stretches of time without nursing didn't really affect fertility as long as there were other longer stretches of comfort nursing or sleep nursing

    Please don't misunderstand me, I'm not trying to say my way is "better". I just think that breastfeeding as birth control can work, even if you aren't Kung, and I was just trying to explain how I did it. Although my purpose in nursing this way isn't for birth control, the birth control aspect is just a side effect, it's just easier for me to co-sleep and nurse to sleep and not worry about pacifiers and all that. LOL

    1. I think we must all be different. But what you have just described matches my experience. I think you put it very nicely. I liked to lie down to feed. It was one way for me to rest & relax. Unfortunately it seems not all mothers are able to do this. My daughter couldn't. It can be due to the shape & size of the breast .So I lost very little sleep, having baby close by & not putting lights on etc. My periods didn't return at all while I was feeding, for aprox the first two years, until after I had completely finished. That was with my first two, which I thought was wonderful! I started to think maybe I only needed a small amount of stimulation to keep my periods away for longer! With my third child I fed for more than two years. This time my periods did return. It was while I was still feeding. I can't remember when? Maybe between two and a half and three years. I had also studied the Billings method so was aware when ovulation takes place. All three babies fed very differently. For instance the length of time between feeds and the amount of sucking at each feed. Even when my daughter was sleeping through the night my periods didn't return. It seems that there is no easy explanation.??

  4. All of my mother's friends told her she wouldn't get pregnant while breastfeeding my older sister. I'm living proof they were wrong.

  5. I followed Shiela Kipley's ecological breastfeeding advice. (ie cosleeping, babywearing, nursing on demand) My period returned at 14 and 17 months postpartum, which was nice, but I think the sleep deprivation from this method can be too much, and I am thinking I will do something else with a third. I want my kid to sleep 8 hours even if it means I get my period back. That is very healthy for mom and baby!! On the other hand, I am still able to nurse my almost 3 year old because of ecological breastfeeding. While it is a pain at times, it is very useful when he is sick, and also for his emotional development. He is great little guy.

  6. Thank you soo much for this article!! Since my first baby in 2004 I've nursed all four of them for what seems like every 15 minutes aka on demand!! I gave up looking at the time, because I felt that I would lose my mind. :) Not something you tell other mommas that you want to encourage to breastfeed. Anyways, my cycle returned at different times after giving birth. My first after a year and the others 6-9 months after birth. I've never gotten pregnant while nursing because I relied on the old rule of thumb that exclusive breastfeeding provides you 6 months of protection as long as you haven't start your cycle. I'll never tell a Momma that again, or at least not without telling them to nurse every 15 minutes. haha

  7. That's entirely right -- I think people underestimate just how much nursing it takes to suppress fertility!

    My first child, I started off with a nipple shield and had a period at eight weeks PP. Then I weaned him off the shield and my period actually *went away again*! I have never heard of this happening to anyone else, but I figured it's because you don't get the level of stimulation with a shield as you do without it. He wasn't a really frequent nurser - like every two hours, and longer at night -- but I didn't have a period again till nine months, and I think that was because we visited family at that time. For a week the baby was getting held a lot by other people and I must not have nursed him as much. Even so, I had really short cycles and didn't get pregnant till 16 months PP, by which time the toddler was sleeping through the night in his own room.

    Second baby nursed ALL. THE. TIME. Night and day. But again, we visited family around nine months, and I left the baby with them to go on a date with my husband for four hours or so, and I bet that was it .... I got my period a couple weeks later. Again I had short cycles, especially months when the toddler slept particularly badly. But he was only sleeping maybe four hours at a stretch when I did get pregnant again, 18 months PP.

    I've also read the Seven Standards book, and it does work well, except that you are supposed to take a nap with the baby every day. That's all very well with your first baby, but what about when you have older kids who don't nap?! The no-pacifiers rule is a good one, though -- it makes the baby naturally nurse more often. Basically every rule is about giving the baby more opportunities to nurse and encouraging them to nurse, without actually watching the clock. I also think proximity to the baby in itself -- even when you are not nursing -- makes a difference. Babywearing and cosleeping both increased my milk supply even when the baby wasn't nursing any more often.

    The author does say that if you want your cycle to come back sooner, you'll have more effect if you take one day away from the baby than if you gradually wean. A sudden shift makes more of a difference, whereas if you keep weaning a very gradual process, your cycle will stay away longer. And that certainly was the case with me.

    I think her average from people who follow her seven rules is 15 months of amennorrhea, which is pretty good. And I like how it gives a baby the chance to influence when he has another sibling -- the really needy babies get you all to themselves for longer than the ones who sleep through the night early. I'd also recommend all those same rules to anyone who was struggling with milk supply, because everything that increases prolactin will help. Cosleeping pumps up your supply like nothing else I know of.

  8. Yup. Check out the seven standards of ecological breastfeeding: the frequency factor by Sheila Kippley. It makes perfect sense to me!

    My fertility has never returned before 12 months, and usually coupled with some kind of lull in BF : sickness or sleeping through the night.

  9. I must be unlucky. :P

    First child was almost exclusively nursing until he was 16 months old (he'd try foods from time to time, but got about 97% of his nutrition from nursing). I got pregnant with #2 when #1 was 12 months old. Sure, I can buy that.

    So when #2 was 8 months old and still nursing exclusively AND I was still nursing #1 about 8 times a day and 2 times during the night... I got pregnant with #3. Haha. In fact, I know the babymaking happened about 15 minutes after I had nursed the baby. Color me exhausted because being pregnant AND night nursing was incredibly draining on my body. Baby #3 comes along and now I have THREE children nursing. Got #1 to wean at 3.5 years old and I simply assume that I'm a fertile Myrtle and take extreme care now. :)

    Wish I could have been like my mom, not getting pregnant until the previous baby is weaned.

  10. I do think there is truth in how frequent and how long you nurse for. That being said, I also think that each women's body is different and that is greatly dependent upon when you will start ovulating again. Just as with how often or long you ovulated and got a period before you were originally pregnant, varies greatly from woman to woman. I am the standard Nancy that gets a period every 28 days. I do however ovulate very late (around the 21st day) but conceive very easily. That's not the norm for most women. I have also exclusively nursed my babies for as often and long as they needed and have always bleed for one week after delivery and then started my period just one week later (so my babies are only two weeks old!) My first little one had tummy issues and was sensitive to most things that I ate. That being said it of course comforted him and then upset his tummy but being the uneducated Mommy that I was I continued to not watch my diet as closely but nursed him often, very often. I had a miscarriage when he was 5 months old and then was pregnant again when he was 14 months old but still nursing some. My second had acid reflux and could not keep very much down at one time so she feed for shorter periods (15 minutes or so) about every 45 minutes. I got pregnant when she was 4 months old and my next one had no problems except she was a little piglet and loved to eat a lot and often and that was fine by me. I did start ovulating again very early (2 weeks) but we did a little family planning as we were moving over seas and my husband was going to be away at lot's of training and got pregnant when she was 18 months old. I was still nursing her but not as often. I also have extremely short labors with my first and longest at five hours and my shortest at just two hours. I have had friends that supplemented some and still didn't start their period until their baby was 12 -18 months. All this to say that I am definitely not the norm for most women, but I am the norm for my body. I think the key is to not only studying how and why a woman's body works, because there is lot's of norms and the science behind it, but also know your body and how it works and go with that. We are expecting our fourth little one in just a few weeks and are extremely excited. My oldest is 5 so that means 4 babies in five years, Whew! We have loved every minute of it and are ready for more. Lot's of work but lot's of rewards and blessings!

  11. Great article! I would add that not using pacifiers would help with extending the birth control affect since pacifiers are basically artificial nipples when they should actually be on the breast instead.

  12. I really enjoyed this. My Little turned one last month and I just started my period/ovulating again this month. Makes sense since my her feeding have now started getting more spread out. I think it is good though, because we are ready for our next!

  13. Thanks for sharing on Mostly Homemade Mondays! Be sure to stop over today and link up a few of your most recent or most popular posts:

  14. Hi Jacquelyn - Thanks so much for sharing with the Let's Get Real party.

  15. I read this when you posted it. It completely makes sense. It is effective for me, but I always notice when I start to taper off of nursing, I get cramps (not always a period, but cramping). This would fall into line with what you discussed. Good to know! Thanks for sharing with Countdown in Style.

  16. The absolute key point to this is that it happens in the early days only. breastfeeding guide


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