Jeanette Panchula raises good questions in her post about LAM & her Public
Health clients. I agree that women need to know what choices are available
to them (absolutely!), and that you can't withold information out of lack of
trust in women's decision-making. But...

There is so much cultural pressure (in the US, anyway) to breastfeed in
patterns that are likely to undermine the effectiveness of LAM. So much of
what we perceive babies are "supposed" to do is antithetical to the kind of
nsg. that makes LAM effective:
baby sleeps by him/herself - own bed at least, separate room even "better"
baby "should" sleep through the night - the sooner the better
unrestricted nsg. will "spoil" the baby - get on a schedule ASAP
nsg. in public not generally acceptable for many families - so must either
stay home all the time or use bottles when out
"baby needs to learn to settle himself" - nsg. to pacify unsettled baby not
good
"one little bottle won't hurt", "oh, you need a break - let me feed baby",
"father needs to bond w/baby (by giving bottle)"
NO intercourse for 6 wks., then SHOULD resume sexual activity so hubby not
ignored or neglected (love these sex rules!)
etc., etc., etc...

We could name dozens more "rules" here - we all know them! New moms hear
these bits of advice all the time, from everyone - family, friends, hcps,
strangers on the street. We often aren't even aware of them, they're just
the cultural subtext.  My worry is that, as part of a smorgasbord discussion
of contraception options, the key things that make LAM work are likely to be
forgotten in the face of our "standard" baby-care practices. People forget
that the nurse told them about the uninterrupted exclusive BFing, the
night-time fdgs, etc., and retain "oh, she said that if I was breastfeeding
I wouldn't get pregnant", and we know where that can lead.

But they DO need to know...difficult issues!

Cathy Bargar, RN, IBCLC Ithaca NY