Hello my name is Jocelyn. As a second semester junior in the nursing program at the University of North Dakota in Grand Forks, I am interested in the Lactational Amenorrhea Method (LAM) as a means of contraception. In the LAM method, the act of breastfeeding is believed to reduce the hormones responsible for triggering the ovaries to secrete estrogen, resulting in infertility. (Olds, London, & Ladewig, 2000, p. 788) Lactational amenorrhea was formerly recognized in 1988 when a panel of experts gathered in Bellagio, Italy after receiving significant data from 13 studies done in 8 countries about lactational infertility. (Kennedy & Kotelchuck, 1998, p. 191) A statement called the Bellagio Consensus was created outlining the three criteria for achieving lactational infertility: (1) amenorrhea, (2) full or nearly full breastfeeding, and (3) within the sixth months postpartum. (Family Health International, 1988; Kennedy, Rivera, & McNeilly, 1989; as cited in Kennedy & Kotelchuck,
 1998)  A woman is amenorrheic if she is free of periods; spotting or bleeding within the first 56 days postpartum is not considered a return of menstruation. (Kennedy et al.) Full or nearly full breastfeeding means offering the breast regularly, not going long periods (four hours during the day and six hours during the night) without feeding, and not supplementing feedings more than 1 ounce per week during month 1, 2 ounces per week during month 2, and so on. (Labbok et al., 1997, p. 329) After the sixth month postpartum, the rate of pregnancy increases because time at the breast is less due to changes in the infant diet that require the introduction of other foods or liquids. (Kennedy & Kotelchuck, 1998, p. 192)  When all three conditions are met there is a 98% protection from pregnancy, but a change in one of the conditions means acquiring another form of protection. (Kennedy et al) 
Breastfeeding is encouraged because of the valuable nutrients the baby receives and the special bonding that takes place.  With the lactational amenorrhea method, breastfeeding is seen as a form of contraception, a natural birth spacing effect. It is as natural as it is easy. A multicenter study found that 78% of LAM users recited the guidelines from memory. (Kenny, Kotelchuck, Visness, Kazi, & Ramos, 1998, p. 213) A woman’s comprehension of LAM is the same as her understanding of other contraceptive methods. Why do many family planning providers remain unconvinced of LAM despite the evidence?  Are mothers being informed of LAM as a contraceptive method? In your clinical practice, have you educated women on LAM? If so, are women receptive of the idea or do they find more comfort in using other contraceptive methods and why? Please share your thoughts and feelings with me as I feel strongly about this topic. 

Jocelyn Kuhn, Student Nurse
College of Nursing at UND-Grand Forks

References

Family Health International. (1988). Consensus statement: breastfeeding as a family planning method. Lancet, 8621, 1204-1205.

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., & Ramos, R. (1998). Users’ understanding of the lactational amenorrhea method and the occurrence of pregnancy. Journal of Human Lactation, 14, 209-217.

Kennedy, K.I., Rivera, R., & McNeilly, A. (1989). Consensus statement on the use of breastfeeding as a family planning method. Contraception, 39, 477-496.

Labbok, M.H., Hight-Laukaran, V., Peterson, A.E., Fletcher, V., von Hertzen, H., Van Look, P. (1997). Multicenter study on the lactational amenorrhea method (LAM): I. Efficacy, duration, and implications for clinical application. Contraception, 55,  327-336.

Olds, S.B., London, M.L., & Ladewig, P.A. (2000). The newborn. In P. Blackburn (Ed.), Maternal-newborn nursing; A family and community-based approach (pp. 778-803). New Jersey: Prentice Hall Health.

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