Greetings!  I'm Sarah, a University of North Dakota nursing student.  I was interested in the Lactational Amenorrhea Method (LAM) of birth spacing, and noted the previous discussions in your archives.  Among you there seems to be minimal debate as to whether LAM is a successful method when meeting the Bellagio Consensus criteria.

In the USA, 63.4% of certified nurse-midwives thought natural methods of birth spacing would be appropriate for only certain couples (Fehring, Hanson, and Stanford, 2001, p. 70).  Valdes, Labbok, Pugin, and Perez (2000, p. 219) and Fehring, Hanson, and Stanford (2001, p. 71) postulate working or single mothers, low-income women, and sexually active teens may not be suited for LAM.

Conversely, the Bellagio Consensus is based on only three criteria, none of which refer to the above reservations (American College of Nurse-Midwives, 1996, p. 405).  In a multicenter study, researchers concluded LAM was appropriate for and viewed positively by many sociocultural groups in various developing and industrialized countries (Hight-Laukaran, Labbok, Peterson, Fletcher, von Hertzen, and Van Look, 1997, p. 345).  Similar studies included women who, in the USA, LAM would not be considered effective for based on the above objections (Fehring, Hanson, and Stanford, 2001, p. 71).

In your practices, have you noted LAM to be more effectively practiced by certain groups of women?  What are the prevailing practices on teaching any woman LAM, regardless of sociocultural factors?  If women are hypothetically not suited for LAM, do they also experience problems with other birth spacing methods (e.g. OCPs, barriers, etc.)?  Thank you very much for your insights and responses!

References:

American College of Nurse-Midwives.  (1996).  Clinical update: Consensus statement.  Lactational amenorrhea for family planning.  Journal of nurse-midwifery, 41(5), 405-406.

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(2), 68-73.

Hight-Laukaran, V., Labbok, M. H., Peterson, A. E., Fletcher, V., von Hertzen, H., & Van Look, P. F. A.  (1997).  Multicenter study of the lactational amenorrhea method (LAM):II.  Acceptability, utility, and policy implications.  Contraception, 55, 337-346.

Valdes, V., Labbok, M. H., Pugin, E., & Perez, A.  (2000).  The efficacy of the lactational amenorrhea method (LAM) among working women.  Contraception, 62, 217-219.

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