Dear Folks:
        When I first started teaching LAM in 1989, the director of childbirth
education of the place where I was teaching told me not to teach about it,
because the doctors were calling her saying that they had never heard of it,
so to please stop!
        When the breastfeeding promotion policy for the Philadelphia Health
Department was being written, I had to fight tooth and nail to get any mention
of LAM inserted, and even then, the MDs higher up had a disclaimer put in.
        LAM is 98% protective for 6 months, as long as she doesn't have her period
and is exclusively breastfeeding. It is always a challenge to get the concept
of exclusive bf across. Start out by asking people what happens if they don't
follow all the rules for the birth control method they are using. The class
thinks a minute, then someone says "You get pregnant" and they all laugh. And
that can segue into a discussion of  LAM with a reminder to follow the rules.
Sometimes I have done something outrageous when teaching this to underscore
that it must be exclusive breastfeeding: suddenly, I jump up on a chair and
talk about no pacifiers and no bottles and no pumping if they want to use this
method. People are startled at this change of venue. And that gets their
attention when the topic is the exclusive bf piece of the LAM.
        I don't want folks to leave class thinking only that breastfeeding is
protective without some memory that there is a bit more to LAM. So hopefully
they will remember me standing on a chair waving my arms!
        One can also teach that two methods of birth control are more effective than
one. There is always someone thinking, "I know me, I'm going to be one of
those 2 out of 100." So suggest using LAM plus a drugstore method. Two methods
together give over 100% protection and can delay the choice about the pill or
the shot or whatever for 6 months.
        Warmly, Nikki Lee RN, MSN, Mother of 2, IBCLC, ICCE, CST