Dear Sharon and others,

This is yet another example of why personal experiences should not be the
sole basis for teaching health-related behaviors. Too often we personally
experience an "exception" and then are tempted to ignore the "rule" of the
issue.

Teaching LAM is like teaching any other health-related behavior.  We should
teach the facts as we know them - if the baby is less than 6 months, mother
fully breastfeeding and amenorrheic, the odds of ovulating before
menstruation (and therefore becoming pregnant) are around 2%. If the baby is
older or less than fully breastfeeding but still no periods, the odds of
ovulating rise but are still somewhere under 4-6% (94-96% protection). Once
periods begin, the mother should be considered fertile.  Offer no guarantees,
no "advice." Just the facts.

Every method of family planning has odds calculations and "rules" that must
be followed in order for the odds to apply. Our job is to give full
information about risks, benefits, and thorough how-to instruction and gently
but firmly place the decision and responsibility in the hands of the woman.
 It's hers to decide, for example, whether the 2% odds of ovulation before
menstruation are acceptable or not.  She runs the risk of being in the 2% of
women who will ovulate prior to menstruation even while fully breastfeeding
twins!  Continuing this example, if the 2% odds of pregnancy are unacceptable
to her, she could add a barrier method, learn fertility awareness, abstain,
etc etc. I'm sure we all are very aware of the few mothers who fall into the
category of "exceptions."

My personal soapbox issue: Teaching the "why" isn't enough for LAM,
breastfeeding, unmedicated birth, etc.  HOW must be taught thoroughly for the
"why" to matter and be useful.  I've often said "Lack of information on
helpful techniques contributes to breastfeeding (or LAM) failure and results
in a grieving process. The guilt of failed breastfeeding is caused by an
insufficiency of information on techniques, not an abundance of information
on the benefits."

Even if you personally experienced a "method failure," please continue to
teach the rule, even while acknowleding that there are exceptions.  Teaching
the method even more carefully and thoroughly may help all concerned.

Linda Smith, FACCE, IBCLC - Dayton OH.