Slide 1

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 2

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 3

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 4

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 5

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 6

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 7

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 8

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 9

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 10

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 11

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 12

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 13

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 14

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 15

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 16

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 17

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 18

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 19

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 20

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 21

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 22

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 23

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 24

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 25

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 26

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.


Slide 27

LACTATIONAL
AMENORRHEA
METHOD (LAM)
NATURAL BIRTH CONTROL WHILE
BREASTFEEDING
Presented by: Heather Eckstein, LLLL

Fertility Cycle Basics






A woman's fertility cycle (menstrual cycle) includes
both fertile and non-fertile days.
There are typically 5-7 fertile days each month.
During these fertile days, a woman can become
pregnant.
There are signs of fertility that signal ovulation, the
release of an egg.

Fertility Cycle Basics






Once ovulation has occurred, the egg only lives for
12-24 hours.
After 24 hours, an unfertilized egg will be
absorbed in the fallopian tube.
Sperm can live for up to 5 days in fertile cervical
fluid.
(Kass-Annese, Danzer 2003; Weschler 2006)

Tracking Changes in Fertility
NFP, FAM, and LAM

What is NFP?
Natural Family Planning (NFP) is a method of nonhormonal birth control based on the natural changes
in fertility that take place in a woman every month.
By tracking certain fertility signs, a woman is able
to determine which days during her cycle are most
fertile and least fertile so that intercourse may be
timed accordingly.

What is FAM?
Fertility Awareness Method (FAM) is a method of
natural birth control that also uses a woman's
natural changes in fertility to track fertile and nonfertile days during her cycle. This method involves
observing signs of fertility and using a
contraceptive method during the fertile cycle days
instead of abstinence.

What are fertile signs?
During a woman's monthly cycle, there are obvious
changes in cervical fluid and resting (basal) body
temperature. These changes signal ovulation and
allow fertile and non-fertile days to be charted and
recorded. Learning to observe signs of fertility
involves taking your temperature each morning
before rising and noting changes in the type of
cervical fluid present throughout your cycle. An NFP
or FAM instructor can teach you more about using
these signs as a method of natural birth control.

Cervical Fluid Changes
Fertile Fluid

Wet
 Stretchy
 Slippery
 Egg white
consistency


Non-Fertile Fluid

Sticky
 Pasty
 Crumbly






Fertile cervical fluid is usually described as wet,
stretchy, slippery fluid, often compared to the
consistency of egg white. Non-fertile fluid can be
sticky, pasty, or crumbly.
Some women experience creamy cervical fluid (like
lotion) as they near ovulation, just before the wet,
slippery, stretchy fluid appears.

What is LAM?
LAM is the Lactational Amenorrhea Method, a
natural method of birth control that can be used
when a mother is breastfeeding. Lactational
amenorrhea means no menstruation (amenorrhea)
because of breastfeeding (lactation). Exclusively
breastfeeding women usually do not begin to
ovulate right away after giving birth. This is
sometimes referred to as "natural child spacing"
and there are many misconceptions surrounding
pregnancy when breastfeeding.

Many women mistakenly believe that they cannot
become pregnant when they are breastfeeding or that
they will not ovulate when breastfeeding. Although
ovulation usually occurs before menstruation during a
typical fertility cycle, most women experience an
anovulatory cycle (no ovulation occurs) before their
fertility returns after giving birth.

(Eslami 1990)

This means that women usually have some warning
before ovulation resumes in the postpartum period.
The longer a woman experiences lactational
amenorrhea, the greater the chances of ovulating
prior to her first period.

The timing of this return to fertility can vary from
woman to woman. The earliest return of ovulation
using LAM is about 10 weeks after birth and the
average return of ovulation is about 14.5 months
after birth.

(Kass-Annese, Danzer 2003)

LAM is a scientific method of birth control that
involves exclusive breastfeeding (sometimes called
"ecological breastfeeding") during the first 6 months
after giving birth. When LAM is used correctly,
pregnancy can be avoided. There are benefits to
using LAM and there are strict criteria that must be
kept in mind.

Benefits of LAM
Free
 Convenient
 Non-hormonal
 Safe
 Effective
 Breastfeeding is the best nutrition for baby


Efficacy




Chances of pregnancy 1% when used
perfectly
Chances of pregnancy 2% with
typical use

(Institute for Reproductive Health 1994; Kennedy 2010; Labbok 2007)

Failure (pregnancy) rates are higher when women
are not counseled on the criteria for LAM
and

when women are not meeting the following
criteria…

(Türk 2010) (ACNM 2012)

LAM Criteria








Breastfeeding must occur at least once every 4
hours during the day
Breastfeeding must occur at least once every 6
hours at night
Woman must not have begun menstruating
Baby must be 6 months of age or younger
No supplements should be given to the baby, no
artificial nipples
(Institute for Reproductive Health 1994)

Cervical Fluid Patterns during LAM
Some of the cervical mucus patterns that may be
observed when a woman is breastfeeding:








Dry days throughout duration of breastfeeding.
Days of crumbly, pasty, sticky mucus between dry days.
Occasionally some women may experience wet mucus (usually
creamy) between dry days or days of crumbly, pasty, sticky mucus.
Changes in breastfeeding routine may result in changes in mucus
pattern. This means that fertility can return at any time.
Days of bleeding are possible and any bleeding should be treated
as a return of fertility.
(Singh 1993; Bellagio 1995) (Kass-Annese, Danzer 2003)

Will LAM work for you?
1. Have your menses returned? (Defined as 2 consecutive
days of bleeding after 8 weeks postpartum or a vaginal
bleed that you would consider your period.)
2. Are you supplementing regularly or allowing long
periods without breastfeeding either day or night?
3. Is your baby more than 6 months old?
If you can answer "no" to all three questions, you have less
than a 2% chance of pregnancy. You should ask yourself
these questions regularly and if any question is answered
"yes", you should begin using another method of
contraception.
(Mohrbacher 2010)

LAM in Special Situations

Pumping Moms






Pumping moms might have a higher risk of
pregnancy when using LAM.
Women using LAM while separated from their baby
might increase their risk of pregnancy, even when
they are pumping milk and their baby is receiving
breastmilk exclusively.
One study showed a 5.2% pregnancy rate in
working mothers using LAM.
(Valdes 2000)

Change in breastfeeding frequency




A change in breastfeeding frequency can result in a
change in fertility.
A sudden decrease in breastfeeding frequency may
cause a sudden return of fertility.

Appearance of fertile signs without
menstruation



If a breastfeeding mother experiences fertile
cervical fluid (wet, stretchy, slippery), she should
consider it a return of fertility.

Additional Resources
http://kellymom.com/bf/normal/fertility/
http://www.waba.org.my/resources/lam/

References
American College of Nurse-Midwives (2012). Breastfeeding and Birth Control. Journal of Midwifery & Women’s
Health, 57: 209–210.
Bellagio, Italy. Press Release, December 14, 1995. Family planning method endorsed. Family Health
International; World Health Organization; Georgetown University. Institute for Reproductive Health.
Eslami SS, Gray RH, Apelo R., Ramos R. The reliability of menses to indicate the return of ovulation in
breastfeeding women in Manila, The Philippines. Stud Fam Plann. 1990 Sep-Oct;21(5):243-50.
Institute for Reproductive Health. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea
Method-LAM. Washington, DC: Georgetown University, 1994.
Kass-Annese, B., & Danzer, H. (2003). Natural birth control made simple (7th ed). Alameda, CA: Hunter House
Publishers.
Kennedy, K.I. (2010). Fertility, sexuality, and contraception during lactation. In J. Riordan & K. Wambach (Eds.),
Breastfeeding and human lactation (4th ed., pp. 705-736). Boston, MA: Jones and Bartlett.
King, J. (2007). Contraception and Lactation. Journal of Midwifery & Women's Health, 52:614–620.

References (cont’d)
Labbok, M. H. (2007). Breastfeeding, birth spacing, and family planning. In T. W. Hale & P. F. Hartmann (Eds.),
Hale & Hartmann's textbook of human lactation (pp. 305-318). Amarillo, TX: Hale Publishing.
Mohrbacher, N. (2010). Breastfeeding answers made simple: A guide for helping mothers. Amarillo, TX: Hale
Publishing, L.P.
Mohrbacher, N. and Stock, J. (2003). BREASTFEEDING ANSWER BOOK, third revised edition. Schaumburg,
Illinois: LLLI, 2003;420-430.
Singh, K. et al. Effects of breastfeeding after resumption of menstruation on waiting time to next conception.
Human Bio 1993; 65(1):71-86.
Türk R, Terzioğlu F, Eroğlu K. (2010). The use of lactational amenorrhea as a method of family planning in
eastern Turkey and influential factors. Journal of Midwifery & Women's Health. 2010 JanFeb;55(1):e1-7.
Valdés V., Labbok MH, Pugin E., and Perez A. The efficacy of the lactational amenorrhea method (LAM) among
working women. Contraception, 01 Nov 2000; 62(5): 217-9.
Weschler, T. (2006). Taking charge of your fertility: The definitive guide to natural birth control, pregnancy
achievement, and reproductive health (Rev. ed.). New York, NY: Collins.