LAM is called 'lactational AMENORRHEA method' for a reason.
It isn't the lactation, but the amenorrhea caused by lactation, which is
responsible for decreased rates of pregnancy in populations using it.  That
is why we don't tell women that BF will keep them from getting pregnant, as
it is the amenorrhea which is the sign of ovaries being on postpartum
holiday.  Women having vaginal bleeding more than 14 days after cessation of
bleeding postpartum, are by definition not amenorrheic.  Recent posts
confirm the variation in return of menses postpartum even while fully BF.
The great thing is that each woman using LAM gets her own personal warning
as she needs it!

Two weeks ago I met a woman who became pregnant 5 months post partum, while
fully BF, including night feedings, and having not resumed menses.  This is
the first time in ten years I have seen a true 'failure' of the LAM.  It is
noteworthy that her pregnancy began toward the end of what is considered the
most effective period for LAM.  All the previous cases of conception
occurring less than 3 months post partum which I have encountered in my
practice, were in women who were either not fully BF or who had resumed
menstruation in the first 7-8 weeks, or both.  Most of them report having
had ONE menses, and they didn't know that meant they were more likely to
conceive in the next cycle.

Your acquaintance from the other list is right in saying that when menses
resume in fully BF mothers whose babies are under 6 months old, the FIRST
period is usually not preceded by an ovulation.  But the next cycle may well
be ovulatory!  The first period is the red flag signaling the end of the
time of highest contraceptive effect, and gives the woman a few days' grace
to think about whether she wants to take steps to avoid a new pregnancy by
using an additional form of contraception.

Likelihood of getting pregnant is lower while BF than while not BF.  The
likelihood, however small, is always present as long as anatomy is intact
and sperm cells are in the vicinity.  For some people the LAM rates are
acceptable, and for others they are not.  What you recount this other person
saying is oversimplified, and doesn't meet my criteria to give women an
informed choice, as the information is inaccurate and biased to give an
inflated impression of the effectiveness of the method.  LAM is very
effective, but some people still get pregnant while using it correctly.

Rachel Myr
Kristiansand, Norway

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