Unfortunately, LAM is not well-known, nor much practiced, nor recommended by 
hcp's in my area.
However, I think it is a great method of contraception/child spacing.

Please remember that if something is 99% effective or 97% effective it means 
that some women will become pregnant  using the method even if they meet and 
follow the criteria. I believe 99% means 1 per 100 per year become 
pregnant?? Well other methods like birth control pills, IUD, even tubal 
ligations (surgical sterilizations) are also NOT 100% effective.

The criteria (as I learned it) needs to be met for LAM to be considered 
effective (albeit less than 100%) :
--less than 6 mos old **
--exclusive or very nearly excl bf
--no solids or pacifier use
--no return of menses

Therefore, if a particular woman happens to have an early return of menses 
(through no fault of her own, but just because there is a variability among 
humans in such things) then said woman should not consider the LAM method to 
be reliable at that time. She should assume that her fertility has returned 
at that time. She could add on other methods then.  My understanding is 
that, also, once solids are begun regularly and even if menses have not 
returned, the method should be considered unreliable and other methods added 
on. Same thing once baby reaches 6 mos.** More studies have been done and I 
believe showing that the method is still reliable (less than 100%, remember) 
if the other criteria are still intact.

Please do not think that I am against this method, I am just sharing my 
understanding and interpretation of the criteria. If a woman absolutely does 
not wish to become pregnant or for a medical reason should not become 
pregnant, this should be taken into consideration about using LAM, as well 
as using any other method of contraception.

Laurie Wheeler, IBCLC, MN, RN
New Orleans Louisiana, s.e. USA

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