Cincinnati OH USA
From New Beginnings, Vol. 25 No. 5, 2008, pp. 4-7
Editor's note: Many mothers have heard that breastfeeding affects their fertility. What is less likely to be discussed is the precise hows and whys. La Leche League Leader Sheila Kippley explains more about the relationship between breastfeeding and fertility in her newest book, The Seven Standards of Ecological Breastfeeding. Not everyone will want to practice what Kippley calls "ecological breastfeeding" or to use breastfeeding to space their children, but her book explains what that means for mothers. The book is excerpted in this article.
Ecological breastfeeding is the form of nursing in which the mother fulfills her baby's needs for frequent suckling and her full-time presence and in which the child's frequent suckling postpones the return of the mother's fertility.
Frequent nursing is the basic requirement for maintaining both an ample supply of milk and the normal suppression of fertility. While that is the reality, most mothers seem to be unaware of it unless they are properly instructed. The Seven Standards provide the rules or the proper instruction for the frequent and unrestricted nursing associated with ecological breastfeeding.
Further, there should be no debate that ecological breastfeeding is a form of natural child spacing. To be sure, it seems that almost everyone has heard of breastfeeding mothers who became pregnant only three or four months postpartum, but that simply highlights the difference between cultural breastfeeding and ecological breastfeeding. Cultural breastfeeding, which is the term I use when women breastfeed but on a schedule or while using pacifiers or while having separation from their babies, has almost no effect on postpartum fertility. I acknowledge that even with ecological breastfeeding, there can be an occasional very early return of fertility, but the demonstrated reality is that the early return is very far from the average and it cannot be regarded as the norm.
First Standard: Breastfeed exclusively for the first six months.
Exclusive breastfeeding takes place when you give your baby nothing but your milk; that is, the baby's only nutrition and hydration is milk suckled directly from your breasts. A normal healthy baby does not need water, other liquids, or solids during the first six months of life. The healthiest gift you can give your baby is to exclusively breastfeed him for the first six months of life. Breast milk is sufficient for nutrition and hydration.
What's the first step for breastfeeding infertility?
Exclusive breastfeeding is an important first step to take if you want the side benefit of breastfeeding infertility. The truth is when you provide 1) all of your baby's nourishment at your breasts and 2) the greater part of his other sucking needs at your breasts, you will almost invariably experience the side effect of natural infertility. To have that side effect for more than a few weeks or months, however, requires something more. Exclusive breastfeeding is an important part of ecological breastfeeding, but it is not the whole picture.
Exclusive breastfeeding without the rest of the Seven Standards of eco-breastfeeding may mean an early return of menstruation.
With exclusive breastfeeding the baby is receiving all of his nourishment from his mother's breasts, but the nursing may not be frequent enough to hold back menstruation. Research shows that almost half of the exclusively breastfeeding mothers using the above rule alone will experience menstruation prior to six months.1 This is why mothers who are interested in natural child spacing are often taught to nurse more frequently, to nurse during the night, to avoid letting too many hours lapse between feedings, and to avoid pacifiers. When mothers nurse more frequently day and night, exclusive breastfeeding is more likely to suppress menstruation and ovulation during the first six months postpartum.
Why isn't exclusive breastfeeding sufficient for natural infertility?
The exclusive breastfeeding rule says nothing about frequency. Some mothers have been very disappointed to experience menstruation or conception while following the "exclusive breastfeeding" rule for postpartum infertility. Quite often these mothers are not nursing frequently enough to maintain natural infertility. We have learned that exclusive breastfeeding by itself is no guarantee that menstruation or ovulation will not occur. A mother who exclusively breastfeeds primarily for nutrition may not be satisfying her child's other needs for comfort and bonding at the breast.
Babies need frequent suckling.
Taking nature as the norm, frequent nursing is normal for a baby. There is no reason to discourage the needs of the baby, which are met easily and naturally at the breast. It is usually easier for the mother to nurse her baby for a few minutes than to spend time trying to satisfy her baby by other means. It is easier on the ears as well. Who wants to listen to a crying baby? One of your baby's strongest instinctive behaviors is sucking. Sucking is his primary means to obtain nourishment and comfort from you, his mother. Just as you provided your baby's total nourishment in the womb, with exclusive breastfeeding you are now providing his total nourishment at your breasts. His frequent suckling at your breasts day and night is important because it stimulates a steady production of milk. The more he nurses, the more milk you will produce for him. The less he nurses, the less milk you will produce. It's a classic case of demand and supply. If you do not feel you have enough milk, you can nurse him more frequently during the day. You can also try to get more rest, especially by taking a long nap if possible during the day and letting your baby nurse during the nap. The extra nursings plus the added rest or nap normally increase the production of milk.
Exclusive breastfeeding for six full months is important for natural infertility.
Research since the mid-1950s has consistently shown that the introduction of solids and other liquids during the early months after childbirth is associated with an early return of fertility.
Giving early foods or liquids to a baby under six months of age usually lessens the amount of nursing that takes place at the breast. Such supplements interfere with the frequent, unrestricted, and exclusive nursing needed to maintain natural infertility.
Exclusive breastfeeding is 98 to 99 percent effective in postponing pregnancy when three conditions are present:
- The baby is not yet six months old
- The mother has had no menstrual bleeding after the 56th day postpartum.
- The breastfeeding is truly "exclusive" breastfeeding.2
Once your baby is six months old, or once you experience any menstrual bleeding after the first eight weeks postpartum (56 days), or once you are no longer exclusively breastfeeding, the effectiveness of this rule no longer applies. This rule is called the Lactational Amenorrhea Method and has been heavily researched. La Leche League International (LLLI) began teaching a similar "exclusive breastfeeding" rule as far back as the 60s.
In addition, research supports the conclusion that any vaginal bleeding in the first 56 days after childbirth can be ignored if the mother is exclusively breastfeeding.3 Thus a mother who is doing exclusive breastfeeding during the first 56 days after childbirth will know that she is naturally infertile even if she experiences vaginal bleeding during that time. If she continues to exclusively breastfeed and has no bleeding after the 56th day, she is 98 to 99 percent infertile until her baby turns six months of age or until she has menstrual bleeding or until she stops exclusive breastfeeding -- whichever comes first.
The exclusive breastfeeding rule is effective, is easy to teach, and is helpful to many nursing mothers, even for working mothers who want to nurse during their maternity leave.
Exclusive breastfeeding offers emotional nurturing for both mother and baby.
The emotional benefits of breastfeeding should be valued as much as the physical benefits of breastfeeding. More and more emphasis today is being placed on the importance of skin-to-skin contact between parent and child. Physical contact generates warm feelings of being loved and appreciated. Exclusive breastfeeding guarantees that the child will receive frequent physical contact from his mother during those first six months of life.
What happens to a mother during those first six months? First, she is discovering that breastfeeding is generally a very satisfying and enjoyable experience for her. She is also learning how to be a good mother in an easy environment. Through breastfeeding she learns to sacrifice her desires and time for the benefit of her baby. There may be some difficult times when she has to nurse and comfort her baby for long periods of time and the nursing is inconvenient. Yet she accepts this inconvenience because in her heart she knows that it is the right thing to do.
The importance of exclusive breastfeeding is that this emotional nurturing and intimate physical contact between mother and baby gets both off to an excellent start.
How long should a mother exclusively breastfeed?
Today almost every medical and breastfeeding organization at the national and world levels is asking mothers to nurse exclusively for the first six months of life. Breastfeeding research shows overwhelmingly the health advantages for both mother and baby. The more the mother breastfeeds and the longer she breastfeeds, the better the infant and maternal health outcomes. UNICEF states, "If all babies were fed only breastmilk for the first six months of life, the lives of an estimated 1.5 million babies would be saved every year and the health and development of millions of others would be greatly improved."4 If a mother can exclusively breastfeed for one month, that is better than not doing it at all. If a mother can do it for two months, that is even better. Will a baby benefit from four months of exclusive breastfeeding? Most likely. Babies exclusively breastfed for four months have 56 percent fewer hospital admissions during the first year of life.5
Would it be better for a baby if a mother exclusively breastfeeds for six months instead of four months? Do two months make that much of a difference? Yes, they do. Babies breastfed exclusively for four months, but less than six months, had double the risk of recurrent middle ear infections and four times the risk of pneumonia between the ages of six and 24 months compared to those babies breastfed exclusively for six months.6
More studies are showing the benefits of exclusive breastfeeding. Canadian researchers who studied almost 14,000 children up to the age of six and a half years of age found strong evidence that prolonged and exclusive breastfeeding improves children's cognitive development.7
The World Cancer Research Fund stressed the importance of education to the general public about the importance of preventing cancer through breastfeeding. Why? Because "there is convincing scientific evidence that it protects against breast cancer" and that breastfeeding "probably protects the child against being overweight and obese, which is important for cancer prevention because being overweight increases cancer risk." What is the World Cancer Research Fund's recommendation to prevent cancer? "We recommend that if they are able to, mothers aim to breastfeed exclusively for the first six months and then continue with complementary feeding after that."8
For a healthier baby and a healthier mother, this simple guideline of exclusive breastfeeding is one most mothers can follow. All mothers should be encouraged to exclusively breastfeed their baby for the first six months of life if at all possible.
Too many mothers quit nursing soon after childbirth or soon are no longer exclusively breastfeeding. Mother-to-mother support through La Leche League meetings can help dramatically. Both mother and baby will be healthier as a result. In addition, these mothers will probably have a successful breastfeeding experience. They will also be following one of the Seven Standards for extended breastfeeding infertility. This natural plan benefits everyone in so many ways.
- Pérez, A., Labbok, M., and Queenan, J. Clinical study of the lactational amenorrhoea method for family planning. The Lancet 1992 Apr; 339(8799):968-70.
- Consensus statement: Breastfeeding as a family planning method. The Lancet 1988 Nov; 2(8621):1204-5.
- UNICEF. Facts for Life. New York, New York: UNICEF, 2002.
- Murata, P. and Barclay, L. Full breast-feeding may lower hospitalizations for infections during first year of life. Pediatrics 2006 Jul; 118(1):e92-e99.
- Chantry, C. et al. Full breastfeeding duration and associated decrease in respiratory tract infection in US children. Pediatrics 2006; 117(2):425-32.
- Kramer, M. et al. Breastfeeding and child cognitive development. Archives of General Psychiatry 2008; 65(5)578-84.
- World Cancer Research Fund press release. Most women unaware breastfeeding can prevent cancer. April 28, 2008. Available at www.wcrf-uk.org.
Sheila Kippley has taught ecological breastfeeding and natural family planning (NFP) since 1969. She and her husband, John, are the Founders of NFP International. They have five adult children.
The Standards of Ecological Breastfeeding
This article discusses the first standard of ecological breastfeeding: Breastfeeding exclusively for the first six months. The other standards, which can be read about in more detail in The Seven Standards of Ecological Breastfeeding, are as follows:
Pacify Your Baby at Your Breasts
Pacification at the breast is important for breastfeeding infertility. The extra non-nutritive or comfort suckling at the breast is nature's way of providing those extra hormonal surges in the woman's body that help to maintain natural infertility. Pacification at the breast is nature's way of comforting the baby and is an essential practice for natural child spacing. Regular use of the pacifier interferes with this natural plan.
Don't Use Bottles and Pacifiers
Avoid the use of bottles and pacifiers. This rule is implied with the First Standard of exclusive breastfeeding and the Second Standard of pacification at the breast and this happens naturally with breastfeeding.
Sleep with Your Baby for Night Feedings
Nighttime nursings are important for maintaining a steady milk supply and for natural child spacing, and co-sleeping greatly assists both effects. Night feedings are normal for a breastfed baby. Many infants need one or several feedings nightly during the first few years of life. These form a normal part of the baby's nutrition
Sleep with Your Baby for a Daily-Nap Feeding
Sleep with your baby for a daily-nap feeding. A daily nap refreshes a mother. She avoids fatigue which may affect or reduce her milk supply. The lack of a nap may also negatively affect the natural child spacing mechanism. The hormonal suppression of fertility is dependent upon lactation, especially good lactation involving frequent and unrestricted nursing. For those reasons I believe that a daily nap with the nursing baby is extremely important for most mothers in maintaining amenorrhea.
Breastfeed Frequently Day and Night and Avoid Schedules
Frequent nursing is common among eco-breastfeeding mothers. Doctor William Sears, author of many breastfeeding-related books, was once asked, "How can a mother breastfeed successfully?" His answer was, "Frequently, frequently, and frequently." This same answer holds true for those mothers interested in the natural-child-spacing effect of breastfeeding: "Frequently, frequently, and frequently." It is the frequency of suckling that prolongs natural infertility after childbirth as well as helping a mother to nurse successfully.
Avoid Any Practice that Restricts Nursing or Separates You from Your Baby
Nature intends for mother and baby to be one, a biological unit. Mothers who remain with their babies will find it easy to follow the eco-breastfeeding program.
The World Health Organization described this oneness well: "Mothers and babies form an inseparable biological and social unit; the health and nutrition of one group cannot be divorced from the health and nutrition of the other." Other researchers have described mother and infant as one biological system. Mother-baby togetherness is the key to natural child spacing.