Is breastfeeding an effective means of birth control?
The nurses at the hospital and maybe even your OB/GYN will assure you that its not. I'm not sure this is a really fair answer for a new mother, because it does not provide accurate information that could help her make decisions for her family. What I'm learning is that Lactational Amennorrhea, or natural infertility following childbirth, is less about breastfeeding in general, and more about the specifics of how a new mother goes about this miraculous process.
In my own experience, 15 months after Aviel's birth, I'm still experiencing natural infertility. This means that through breastfeeding alone, I have achieved 100% infertility. That's better than most hormonal forms of birth control on the market today! Although I was aware, through my studying on Natural Family Planning, that breastfeeding had potential to delay the return of fertility, I did not intentionally seek to use this part of my care for Aviel for this purpose. It has been an incredibly spirit led process, which involved being sensitive to Aviel's unique feeding needs. It wasn't until Aviel was about 9 months old that I realized my own instinct had led me into a style of feeding that actually has a name, ecological breastfeeding.
A term coined by Sheila Kippley, founder of the Couple to Couple League, and author of Breastfeeding and Natural Child Spacing, ecological breastfeeding is a rigorous form of breastfeeding that involves seven practical measures (which I'll get to in a second) to help delay fertility and space children between 18 to 30 months apart. In her research, Kippley has found that this method has the highest percentage of effectiveness for the first six months following childbirth, and the average return of fertility for women who chose to breastfeed beyond 12 months is 14.6 months. Of course, every women's body is different, so results vary from person to person.
Lets start with the basic principle of how this works.
During my time as a nursing mother, I have been incredibly amazed by how symbiotic the breastfeeding relationship is between a mother and her baby. When it comes to fertility, this symbiosis is highly evident. As a mother nurses her baby, a hormone, prolactin, is released that sends her body the message that she has a little one still needy enough that she could not healthily sustain the life of another. The action of the baby causes a reaction in the mother's body. Beautiful.*
The less often this hormone is released, the more her body begins to prepare for the possibility of housing a new life. This means that frequency of nursing on the breast is key for remaining infertile. The problem with this is that the practicality of frequent feeding is oppositional to how new mothers are encouraged (or discouraged) and taught to breastfeed culturally and socially.
Kippley recommends some practical measures for helping to facilitate frequent feedings in a not-so-supportive western culture. As I mentioned before, by my own instinct I've hit each of the seven points, so I'll list her suggestion and explain my own experience.
1. Exclusively breastfeed for the first six months without introducing solids, formulas, or other liquids.
This is something I hoped to be able to do for Aviel before he was born. Blessedly, I didn't have any complications with our breastfeeding relationship and was able to feed him exclusively until we introduced solids (via Baby-led Weaning) at six months.
2. Comfort your baby at the breast.
Comfort nursing became what I might describe as a "mission" for me after reading this in Isaiah 66:10-13
“Be joyful with Jerusalem and rejoice for her, all you who love her;
Be exceedingly glad with her, all you who mourn over her, That you may nurse and be satisfied with her comforting breasts, That you may suck and be delighted with her bountiful bosom." For thus says the LORD, “Behold, I extend peace to her like a river, And the glory of the nations like an overflowing stream; And you will be nursed, you will be carried on the hip and fondled on the knees. As one whom his mother comforts, so I will comfort you; And you will be comforted in Jerusalem.”
Living in Jerusalem, I felt that breastfeeding Aviel was a living testimony of this verse. Rather than simply nursing for food, I would nurse him if he bumped his head, if he had seemed afraid of something. I nursed him to sleep, and I nursed him to wake up. This still remains our basic approach at 15 months old, although his needs have changed overtime. To be a place and person of comfort has become part of my understanding of my identity as a woman of God.
3. Refrain from using bottles or pacifiers.
Since frequency of feeding on the breast is key to how this works, it makes sense that the introduction of other feeding or sucking subsitutes would cut back on the amount of time the baby spends on the breast.
Early on, I was weary of introducing bottles for fear of nipple confusion, and I couldn't quite figure out pumping. How and when was I supposed to fit in time to pump and bottle feed with Aviel's need to eat so often during the day, and my need to sustain a milk supply? It just didn't make sense to me, and honestly, avoiding that entire process, opting to do all feedings at the breast, seemed much easier! When we finally decided to try a bottle one day, Aviel refused. He didn't want it, so Aviel never had a bottle.
As for pacifiers, we allowed him to use one at night, but around three months old he self-weaned upon discovering his hands. He preferred his fists to a pacy, and never went back after the phase ended. We actually tried several different styles, but he refused them all! The only real downside to this is that its often hard to soothe him in his car seat, but we're surviving well pacy free.
4. Sleep with your baby for night feedings
The reason this is encouraged is because proximity in the night encourages frequent feedings. At present, I am aware that bed sharing is a controversial practice, which involves the baby actually sleeping in the bed with his/her parents. The term co-sleeping implies sleeping in the same room within arms reach.
We're part-time co-sleepers/bed sharers, which we do safely. Both of our parents were co-sleepers, so this was not an unusual idea; however, it also wasn't something we set out militantly to do. Aviel sleeps in our room, but he begins the night in his own bed. Often times he will move in with us at some point in the night because it really is easier to nurse him in our bed. Sometimes we all sleep best like this, and sometimes we all sleep better when he's in his own bed.
During my time of doing sleep and breastfeeding research, I learned that night feedings, particularly between 12 and 2 am when strong hormones are released, are important for sustaining a healthy milk supply. Also, breastmilk contains a sleep inducing hormone, cholecystokinin, or CCK. Part of God's design for breastmilk is to help a baby sleep! Knowing this built my confidence that allowing Aviel to nurse to sleep was part of God's natural system, and not something that would teach him bad sleep habbits. Interestingly enough, this same hormone is also release in the mother while she nurses her baby. Most nursing mothers know the drowsiness that comes while your baby feed. CCK is the culpret, and part of God's natural system for keeping both mommy and baby on a similar sleep schedule. Amazing!
The more I learned about breastfeeding, the less interested I became with sleep training Aviel. Most of what I was reading about how to get a baby to sleep through the night worked against what was instinctual for how I wanted to care for Aviel, and it often contradicted what I was learning about how my body worked for producing good milk. I made a conscious personal choice, with the support of Devin, to prioritize our breastfeeding relationship over trying to teach him to sleep 8 hours. [I know many families who chose to sleep train, and they are great parents. This just wasn't the Lord's leading for our family!] Most other moms I speak with say that night weaning was the largest factor in seeing a return of their own fertility.
5. Sleep with your baby for daily nap-feedings.
This one has been a dream come true. Since I made a choice not to sleep train, this means I am not sleeping through the night! Taking one of Aviel's two daily naps with him has kept me feeling rested and refreshed. It is also a good way of helping stretch a nap longer. Often I will nurse him to sleep, he'll wake up about an hour later, at which point I'll nurse him back to sleep for another hour. I'm not sure exactly how nap-feedings will work for us when we have more babies, but it has been a blessing with one!
6. Nurse frequently, avoiding scheduled feedings.
Aviel was about 2 weeks old when I discovered that both of our bodies responded better to cue based feedings than trying to keep a schedule. Aviel was slow to gain weight in the beginning, but when I started feeding totally cue based (not exceeding 2 hours between feedings) his weight gain increased dramatically, and my milk supply became much fuller. His Tipot Halav pediatric nurse even took notice, exclaiming, "You did this through breastfeeding alone?!" Yep. I did not take her advice to introduce one formula bottle a day, instead deciding to feed at least every two hours, around the clock for several days to build up a good supply.
Feeding on cue, rather than a schedule also changed how I thought about our breastfeeding relationship. Rather than being just about eating, listening to Aviel's cues allowed nursing to also be about comforting and nurturing, and learning about my baby's personality.
I've kept with this style of feeding, realizing Aviel often nursed in clusters as a small baby, and currently still enjoys frequent short "snacks" as a toddler.
7. Avoid practices that restrict nursing or cause separation between a mother and her baby.
This one seems pretty obvious to me. The less a mother and baby are together, the more difficult the breastfeeding relationship can become. In my own experience, because Aviel wouldn't take a bottle and preferred a cluster style of feeding, I didn't feel comfortable leaving him with a baby sitter for long periods of time (or ever... if I was to be honest!). Devin and I got in the habit of taking him along with us when we would go out. I think this was very beneficial to our growth as a family, because it provided ample time for us to bond. This is also an area where Babywearing has been very helpful, since wearing him in a wrap made it easy to take him with us. I've enjoyed being able to invite him into our life in this way.
We made some changes when Aviel was 10 months old because we felt I needed to resume studies and finish the last few classes required for my Master of Architecture degree. This involved me being out of the house for several hours 3 days a week. Devin and Aviel would drop me off at school and we'd part ways with nursing. I'd sneak away from class twice during a five hour time frame to pump (I probably could have only pumped once, but I was trying to keep up the frequency), then greet Aviel with nursing when they would pick me up at the end of the day. While I was out, Devin would give Aviel breastmilk in a sippy cup. Even with this amount of separation, I have still been able to remain in Lactational Amennorrhea.
I think reading though the basic principles, its pretty clear why hospitals send mothers away with a lecture on why breastfeeding is not effective for birth control. This isn't the method of breastfeeding that is supported culturally, and without high frequency of nursing, women can expect their fertility to return sooner. How a mother chooses, or is able, to feed her baby will influence her fertility. This is a fact I wish those in health care would include when they give the "breastfeeding is not an effective means of birth control" speech.
For someone who hasn't considered feeding this way, it probably sounds daunting and like a ton of work. But to me, so does undertaking the entire process of pumping, freezing, and defrosting milk to make a bottle! Since this is exactly what I was doing before I knew of Kippley's suggestions, I can testify that its not as grueling as you'd think. Ecological breastfeeding wasn't something I was striving for, but rather something that fit organically into our lifestyle, and I've enjoyed putting this natural system to work!
*Being the architect that I am, the wisdom behind this natural design blows my mind! However, I do want to take a moment to mention that even though I believe this is a natural process that God created, I also believe each family is a unique formation, and each baby is a unique creation. According to my heart and convictions, this means 1) God has the ability to override all of our systems and bring forth life according to His perfect timing and purpose! and 2) Any woman (or family, really) who is not as amazed and inspired as me to live out this natural system is not a sinner! LOL!
Resources for Additional Reading that include way more facts, charts, and data than I wanted to include in this post:
Natural Child Spacing and Breast Feeding La Leche League
Breastfeeding and Fertility" from Kellymom.com
Ecological Breastfeeding" from Type A Parent
Ecological Breastfeeding from Physicians for Life
Breastfeeding and Natural Child Spacing from Dr. Sears
Babywearing around the House
I love Baby Wearing
Fill the Earth
At the Sound of His Voice
Titus 2 Revelation