Hi lactnetters!  My name is Kristin, and I am a nursing student at the
University of North Dakota.  I have an interest in the Lactational
Amenorrhea Method.

Lactational Amenorrhea Method (LAM) is a type of contraception in which the
absence of menstruation during breastfeeding, with specific situations, is
considered to prevent pregnancy.  It is believed that breastfeeding
decreases the release of gonadotropin releasing hormone by the
hypothalamus.  This then disrupts the release of luteinizing hormone (LH)
from the pituitary.  When LH pulses are irregular and inadequate, the
secretion of estrogen by the ovaries is decreased.  Therefore, not enough
is secreted to stimulate LH surge and ovulation, which leads to infertility
(Kennedy & Kotelchuck, 1998).

One study pertained to the knowledge of certified nurse-midwives (CNM) and
support of natural family planning and LAM (Fehring, Hanson, & Stanford,
2001).  In this study, it was found that only 83% of CNM respondents found
LAM to be an efficient form of birth control, even though it is considered
to be 98% successful by experts.  In addition, only 34.5% of the CNMs
believed that LAM would be effective up to 6 months.  This study concluded
that CNMs do not suggest LAM as a method of avoiding pregnancy, mainly
because they do not feel that the technique is effective.  They also do not
necessarily believe that LAM behaviorally fits with their clients.  This
was the only study that I found that contradicted the use of LAM.

A study was done by Kennedy, et. al of 876 LAM users in Pakistan and the
Phillippines to determine women’s understanding of LAM.  The results of
this study showed that the majority of LAM clients in the study could
consistently list the LAM guidelines.  It also showed that LAM fits a
variety of users.  However, it concluded that in the future, more emphasis
should be placed on maintaining pregnancy protection after LAM ends
(Kennedy, Kotelchuck, Visness, Kazi, & Ramos, 1998).

In a commentary by Kennedy and Kotelchuck (1998), I came across
the “Bellagio Consensus.”  This statement was first made in 1988 to include
these three rationale: amenorrhea, first 6 months postpartum, and full or
nearly full breastfeeding.  However, it has now been updated to read the
following.  (1) “It is not possible to eliminate the amenorrhea criterion.
(2) “It may be possible to relax the requirement of full or nearly full
breastfeeding.”  Women need to slowly introduce the supplements, and
breastfeed before providing the infant with the supplement to reduce the
chance of a lessening breastfeeding stimulus.  (3) “It may be possible to
extend LAM beyond six months postpartum.”  The chance of pregnancy is still
low at 12 months, varying from 3% to 10%.  Even though full breastfeeding
should not be exclusive after 6 months of age, it is possible that a woman
may still be protected for pregnancy after 6 months, as long as she remains
amenorrheic and continues to have a high degree of breastfeeding
stimulation.

My question: Even though research states that it is an effective form of
pregnancy prevention, is the Lactational Amenorrhea Method frequently used
for birth control in your experience? If so, has it been reliable?

References

Fehring, R. J., Hanson, L., & Stanford, J. B. (2001).  Nurse-midwives’
knowledge and promotion of lactational amenorrhea and other natural family-
planning methods for child spacing.  Journal of Midwifery & Women’s Health,
46, 68-73.

Kennedy, K. I., & Kotelchuck, M. (1998).  Policy considerations for the
introduction and promotion of the lactational amenorrhea method: Advantages
and disadvantages of LAM.  Journal of Human Lactation, 14, 191-203.

Kennedy, K. I., Kotelchuck, M., Visness, C. M., Kazi, A., and Ramos, R.
(1998).  Users’ understanding of the lactational amenorrhea method and the
occurrence of pregnancy.  Journal of Human Lactation, 14, 209-218.

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