Breastfeeding and Fertility

My work as an IBCLC gives me the opportunity to hear directly from lactating moms, and a common topic that comes up is Breastfeeding & Fertility.  From questions about birth control while breastfeeding, to general fertility issues, here are some of the most frequently asked questions.

Q: Can I get pregnant while breastfeeding?

Yes it is possible, but it depends on many factors, including: How old is the baby? Are you breastfeeding on demand? Is the baby being supplemented or eating solids? Are you using any other forms of birth control? Any of these things affect your likelihood of getting pregnant while breastfeeding.

If the baby is less than six months old, exclusively breastfed, and being put to breast for 20+ minutes at least eight times every 24 hours, you are likely a good candidate to use a form of biologically regulated birth control called LAM or Lactation Amenorrhea Method. This method is based on the fact that if people breastfeeding are directly putting baby to breast more than eight times in a 24-hour period, that the menstrual cycle is naturally suppressed by the high levels of prolactin being synthesized that suckling stimulates.

Q: Can I get pregnant if I’m exclusively pumping?

Yes, and unfortunately, while exclusive pumping may still delay the return of fertility, we do not know how much or for how long because sufficient research has not been conducted. We do know that the absence of physical contact and anatomical physiological stimulation that direct oral-mammary suckling brings, means the oxytocin levels are lower than they would be if baby was feeding directly, so LAM would not be a good option for birth control in this situation.

Q: Are there ways to maximize my natural period of infertility (anovulation)?

There is not one safe or reliable way to ensure you wouldn’t get pregnant while breastfeeding, especially after six months. However, from a biological standpoint, the longer a baby has physical and feeding contact with their mother/parent throughout the day, the more likely that ovulation will be delayed or suppressed. Habits such as safe co-sleeping(within arms-reach as endorsed by the AAP), baby wearing, and any other bonding, tactile activities that keep oxytocin + prolactin levels high and therefore menstrual cycle reproductive hormones low, can possibly keep you from ovulating or at least delay cycle periods.

Make sure that if you are outside of any of the boundaries of LAM stipulations and not seeking a subsequent pregnancy, that you use a form of contraception or barrier that works for you and your partner just to be sure!

Q: Is it safe to use hormonal birth control while breastfeeding?

That is something that is best discussed with your midwife, obstetrician and/or IBCLC! Because birth control is used to treat so many other maternal child health reproductive conditions, it is best to discuss with them not only if or how, but what your best fit is in terms of hormonal contraception or barriers.

Generally speaking, if it is a hormonal contraception method that is systematically distributed (blood stream, digestive track, muscular tissue, etc) it definitely has a higher probability of affecting breastfeeding hormones, however your IBCLC and Maternal Child Health provider can help analyze your health background and needs to make the best decisions for you.

Q: What are the signs that full fertility is returning?

That varies for every person, but the most obvious is when your menstrual cycle returns. However, because your cycle changes throughout your life and certainly with each subsequent birth, you may have no warning signs at all or the stereotypical PMS with cramping, fatigue, increased sensitivity, etc.

If you suspect your let-down reflex has suddenly slowed, or that your baby is nursing more frequently or for longer because your supply seems mildly slumping, sometimes this is the first sign of fertility returning, especially if baby just started taking a bottle, eating solids, or sleeping more than 3-4 hours at night.

Taking a calcium and magnesium supplement (in addition to your prenatal vitamins) can ease these symptoms, however if it seems more severe than you can manage, reach out to a healthcare professional right away to help support you in the situation.

Q: Once we’re ready to have another baby, will I need to wean in order to increase my chances of getting pregnant?

This again depends on your health history but generally speaking, you will need to space your feedings further apart to increase your chances of getting pregnant.

For some people, very few changes will be needed and for others (depending on age, fertility range and health history), night weaning may give you much better chances of conceiving. A well educated IBCLC can actually work with you and create treatment plans to execute these changes comfortably.


About the Author

Leah DeShay
Leah graduated from La Sierra University and it was during her undergraduate studies that she found her passion for women’s health care. She completed her post-baccalaureate work in Lactation at the University of California, San Diego, holds a CLEC (Certified Lactation Educator Counselor certificate, and is an IBCLC (Internationally Board-Certified Lactation Consultant).