Melisa started this thread with frustration about a woman who said:

"Actually the first period is usually anovulatory. you are assuming all =
post-partum bleeding is menstruation.  My point was women have a right =
to know that any bleeding in the first two months pp can be disregarded =
if the baby is exclusively nursing.  There is no reason to=20
put chemicals in our bodies when it isn't necessary.  Incidentally, the =
odds of getting pregnant in the first three pp months is almost nil, in =
the next three months if the mom is amenorrheic it only goes up to 1%.  =
This is better than any artificial method.  "

I believe the idea that bleeding can be disregarded in the first two months
postpartum (56 days, actually) comes from the Bellagio Consensus and is based
on a study in which a doctor took endometrial biopsies from postpartum women
at varying intervals.  The chances that bleeding within that window was
associated with ovulation for fully breastfeeding women were minuscule.
(Sorry, I don't have a citation; I heard about this study in a tape of a talk
on LAM from the 1995 LLLI International Conference.)  The information I have
on LAM says that bleeding in those first eight weeks is called "hormonal
bleeding" and can be disregarded by fully breastfeeding women.  I am
unfamiliar with the information Rachel gave on bleeding which resumes more
than 14 days after cessation and would like to know more.

The woman whom Melisa quoted appears to be referring to Sheila Kippley's
research on what she calls "ecological breastfeeding":  no bottles, no
pacifiers, no schedules, minimal mother-baby separation, co-sleeping at night
and for naps, and exclusive breastfeeding for about the first six months.
These effectiveness statistics are the ones given by the Kippleys in both
"The Art of Natural Family Planning" and "Breastfeeding and Natural Child
Spacing."

These statistics differ from the LAM effectiveness statistics (pg rate of
less than 2% in the first six months postpartum) because a mother who chooses
ecological breastfeeding will almost certainly nurse more frequently than the
average mother who is fully breastfeeding by LAM standards (which allow for
pacifier use after the first six weeks as well as sleeping apart from baby).
Frequent nipple stimulation is key to maintaining breastfeeding infertility.
Ecologically breastfeeding mothers experienced an average of 14.5 months of
postpartum amenorrhea in the Kippleys' two studies, in contrast to the 50% of
LAM users whose periods return by 6 months postpartum.

While there is considerable variation among women, a useful rule of thumb is
that fertility returns about when a mother is down to 6 or 7 nursings a day.
So a mother of twins could probably expect a longer stretch of amenorrhea
than she experienced with a singleton.

One other comment:  I want to cast a vote for precision in talking about LAM
(the Lactational Amenorrhea Method) vs. lactational amenorrhea (LA?).
Lactational amenorrhea can last for years; LAM, at this time, can only be
used for six months.  I don't mean to quibble; it just sticks out for me when
someone says, "I had twenty months of LAM."

Enjoying the thread...

Jamie in Oak Park, IL
CCL NFP teacher and volunteer bfing counselor

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