Another advantage of breast-feeding [letter]

In relation to the CMAs stand on breast feeding reported in "CMA supports breast feeding condemns contracts between formula makers hospitals" by Patrick Sullivan (Can Med Assoc J 1992; 146: 1610-1611 1613) there is another aspect to be stressed: the delay of the return of fertility. We all know that breast feeding per se does not prevent pregnancy and still less ovulation (although the first ovulations during breast feeding are often followed by such deficient corpus luteum function that pregnancy is not possible). Nevertheless the Bellagio expert meeting in 1988 gave the tentative figure of "below 2%" to the risk of pregnancy during the first 6 months if the mother breastfeeds fully and on demand and remains amenorrheic. Women who choose to put their confidence in the infertility provided by intensive breast feeding are said to choose LAM (lactational amenorrhea method) which in French in MAMA (method de lallaitement maternal et de lamenorrhee). Later clinical studies and a secondary analysis of data from earlier studies f breast feeding showed that the risk of pregnancy is somewhat below 1% for the first 6 months of amenorrhea during full breast feeding. In view of this shouldnt we offer in the postpartum period LAM as well as the other methods of contraception which often have a higher failure rate? When the choice is intensive and prolonged breast feeding attention during the first few months can be devoted entirely to building the relationship with the new baby with attempts at conception postponed until the 6th month the start of supplementation or the first menstrual period. whichever comes first. In the meantime followup should stress optimum breastfeeding. (full text)