As a birth worker, especially a Certified Breastfeeding Counselor (CBC), you will be asked a variety of questions. Many parents wonder if they can get pregnant while breastfeeding. In some cases, doctors advise patients that breastfeeding can work as birth control.
While breastfeeding can reduce fertility in many, it is very possible to get pregnant while breastfeeding. Breastfeeding can act as birth control in some circumstances, but it cannot be relied on for most people.
As a CBC, you can help educate clients about the reality of breastfeeding and fertility. You can assist in dispelling myths, which is important for clients not open to a new pregnancy.
What Is Lactation Amenorrhea?
Using breastfeeding as birth control is not completely a myth. When parents are exclusively breastfeeding at the breast, they are likely to experience lactation amenorrhea. This means they are not having a menstrual cycle. Without ovulating, one cannot conceive.
Many people do not experience a period during the early weeks and months of exclusively breastfeeding. However, the challenge is, one can have their first ovulation before the return of their period. This makes it quite difficult to know when their fertility returned.
However, if parents practice ecological breastfeeding, the rate of conception is extremely low. This makes it comparable to other forms of birth control early in the breastfeeding relationship.
What is Ecological Breastfeeding?
Ecological breastfeeding is a way of feeding which greatly reduces the risk of pregnancy. However, to practice ecological breastfeeding one must:
- Feed exclusively at the breast
- Not use bottles or pacifiers
- Feed on demand, including at night
- No more than one 4-6 hour stretch of sleep overnight
- Be feeding a baby under six months who has not yet started solids
Most parents do not fully practice ecological breastfeeding in our modern culture. Many parents return to work prior to six months postpartum.
However, for those who do practice it, it can be an extremely effective form of birth control. The chance of pregnancy is almost zero within the first three months. Between 3 and 6 months, the risk is less than 2%. After 6 months, the risk increases to about 6%.
Like other forms of birth control, if one deviates from “clinical use” the risk of pregnancy increases. With the use of pacifiers, bottles, long sleep stretches, etc., the risk of pregnancy increases.
For parents truly not desiring another pregnancy, and unable or not wanting to practice ecological breastfeeding, this is not an ideal form of birth control.
For those who are not planning a pregnancy but open to one, using breastfeeding to reduce the risk of pregnancy can be an option. However, they should be fully aware there is a decent risk of conception.
Can You Get Pregnant While Breastfeeding Without Your Period?
In general, if you do not have a menstrual cycle, you cannot get pregnant. For many, a period begins and then halfway through their cycle they would ovulate. Some call that first period a warning cycle.
However, it is completely possible to ovulate for the first time postpartum without a return of a period. A shift in hormones can trigger ovulation. If one conceives that cycle, they can miss having a period altogether.
Again, for those not open to another pregnancy, using no birth control until their period returns is a risk. As a CBC, it is helpful for you to remind clients of this if they inquire. You should also encourage them to speak with their midwife or doctor about options.
Can You Use Fertility Awareness Methods While Breastfeeding?
There are some clients who may be opposed to using hormonal birth control or barrier methods for a variety of reasons. Some will want to return to or begin using a fertility awareness method.
As a CBC, unless you have other qualifications, you should not specifically advise for or against any type of birth control. However, you can let your clients know that there are people who successfully use these types of methods to track their fertility to reduce the risk of conception.
Do You Have to Wean to Conceive?
In short, no. One does not need to stop weaning to conceive. However, in some cases, a delayed return of fertility could be a concern. Some parents hope to have children close in age or they may be parents of an older age worried about waiting.
As a CBC, you could help clients assess their options. If they are worried about advanced age, they can reach out to their provider for advice.
In general, though, many people can conceive while breastfeeding after the first 6-12 months. For others, they do not see a return of their fertility.
Many reproductive endocrinologists advise patients to wean before beginning fertility treatments. However, some patients can conceive with assistance while breastfeeding.
As a CBC, you can help clients be aware of their options, explore resources, and help dispel any myths about breastfeeding and conception. Most importantly, it is helpful to remind clients that if they do not want to conceive again, relying on breastfeeding as birth control is a risk.