Pregnancy while breastfeeding: Is this possible if one’s menses haven’t returned?

Approximately two years back, I gave birth to a bouncing baby boy. This happened at the same with my close friend who had also delivered. We were all full of excitement, till one day, I received a call from her at three months sounding low, weeping and so full of disappointment. I wondered what the problem was. She then informed me that a few days back, she was feeling uncomfortable with nausea, and general body weakness, and she then decided to visit the nearby hospital, only to be checked and told that she was pregnant. She then wondered if one can conceive in such a short period of time after delivery, yet her periods hadn’t returned.

Yes, it’s possible for one to get pregnant within a short period of time even when one’s menses haven’t returned. My friend isn’t the first and only woman to inform me about this. Through interaction with some women and in midwifery and women’s’ health practice, I have witnessed and encountered many women who have conceived unexpectedly and within a short period of time after delivery, even when their menses haven’t returned, regardless of whether one had a normal delivery or delivered by caesarean section. Such incidence has put a lot of women in a state of quagmire aka dilemma.

Breastfeeding has been called “nature’s contraceptive,” and like many other birth control methods, when used properly, it is highly effective in preventing pregnancy. Along with the numerous other health benefits of breastfeeding for both mother and infant, breastfeeding can provide safe and effective contraception for up to six months or more after a baby is born.

Normally for most mothers, as long as they are breastfeeding full time, most mothers will/may not ovulate and will/may not have regular menstrual periods and by default can’t get pregnant, at least for a while. The same hormone (prolactin) that makes milk suppresses the release of reproductive hormones.

On the other hand, it is still possible for a nursing mother to become pregnant during this time, but her chances are low if her physiological condition is consistent with the lactational amenorrhea method (LAM) guidelines. Though, it is very important for everyone to note that this natural form of contraception is still unreliable and a weak method of contraception.

How reliable is breastfeeding as a natural contraceptive? Well, this natural form of contraception requires a lot of discipline. You must follow the rules of the game to get the full benefits of the effectiveness of breastfeeding and fertility rates.

In the last ten years, lactation researchers have developed the lactational amenorrhea method (LAM) of family planning. Research shows that LAM’s effectiveness in preventing pregnancy is better than 98%, a figure that compares well with artificial methods of birth control.

According to LAM, a mother can rely on breastfeeding for protection from pregnancy if she can answer “NO” to the following questions:

1. Have your menstrual cycles returned?
2. Are you supplementing regularly or allowing long periods without breastfeeding, either during the day (more than three hours) or at night (more than six hours)?
3. Is your baby more than six months old?

Studies have shown that most mothers who are breastfeeding exclusively remain infertile for more than the six-month period covered by LAM. Ovulation and menstruation return mainly when the baby starts to nurse less often, and prolactin levels fall.

Conclusively, the World Health Organisation recommends child spacing of two years or more. Although breastfeeding alone can result in spacing of this duration, the individual woman is cautioned not to rely on breastfeeding alone if she wishes to achieve this goal. Therefore, the introduction and use of a family planning method during breastfeeding is an important health intervention.

The author is; Lilian Nuwabaine Luyima; BSc Nurse & MSN-Midwife & Women’s’ Health Specialist working with Aga Khan University & Heroes in Health Award winner-Midwife of the year 2021