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Fertility After Childbirth:
When You’re Ready but Your Body’s Not (and Vice Versa)
By Tricia Ballad

You’ve heard that breastfeeding postpones the return of fertility. You’re a few weeks postpartum, you’ve (finally!) stopped bleeding and now you’re wondering – how long before your regular periods start up again? When should you start charting your fertility signs again? Do those patches of mucus mean anything yet?

Lactational amenorrhea
The best answer to all these questions, of course, is that there’s no clear answer. The biggest factor in determining how long you’ll remain in a state of lactational amenorrhea (also referred to as breastfeeding infertility) is your style of breastfeeding.

Most breastfeeding experiences fall into two categories: cultural breastfeeding and ecological breastfeeding. In cultural breastfeeding, babies may be given a pacifier when they’re not hungry and may receive occasional bottles of either formula or expressed breast milk. With ecological breastfeeding, babies receives all of their nourishment directly from the breast. Their need to suck is also met exclusively at the breast.

With mothers who practice ecological breastfeeding, the average length of lactational amenorrhea is 14.5 months. The length of lactational amenorrhea with cultural breastfeeding is unknown, but is certainly affected by the amount of time babies spends at the breast. Without breastfeeding at all, normal fertility usually returns about six weeks postpartum.

The seven standards of ecological breastfeeding
If your goal is to stretch out their postpartum infertility as long as possible, follow the seven principles of ecological breastfeeding.

1. Breastfeed exclusively for the first six months of life; don't supplement with either liquids or solids.
2. Pacify your baby at your breasts.
3. Don't use bottles and pacifiers.
4. Sleep with your baby for night feedings.
5. Sleep with your baby for a daily nap and feeding.
6. Nurse frequently day and night. Avoid schedules.
7. Avoid any practice that restricts nursing or separates you from your baby.

When you nurse less frequently
If you are not following all the standards of ecological breastfeeding, predicting the return of your fertility can be more difficult. It all depends on your own body, how much or how little you breastfeed and how often you pump.

According to Helen Jost, a natural family planning teacher in Illinois, pumping and nursing is enough for some women. For others, fertility returns quickly after they begin pumping or supplementing. Some women need more stimulation to remain infertile than others.

Another factor in how soon fertility returns is how often you breastfeed and pump. If you pump according to your baby’s normal eating schedule, you’re emulating your infant’s eating and are more likely to remain infertile. If you pump less often, you’re emulating the eating pattern of an older child, and your body will naturally respond to that pattern by becoming fertile again.

Don’t forget about fertility signs
There is always a small chance of conception before the first period, so you should be aware of your fertility signs even while you’re in lactational amenorrhea. Experts agree that any bleeding during the first two months postpartum can be ignored for the purposes of determining fertility. In the first six months, the chance of ovulating prior to your first postpartum period is approximately 1%. Between six and 12 months, your chance of conceiving before your menses return is 6%.

Fortunately, couples who know what to look for can often predict their return to fertility and act accordingly to avoid pregnancy. Predicting the return of fertility relies heavily on mucus signs. Unfortunately, many women experience background mucus or on-and-off patches throughout lactational amenorrhea, so interpreting these signs can be tricky.

Since there are usually two to four days of more-fertile mucus before ovulation, you should consider yourself in Phase II on the evening of the first day of a more-fertile mucus patch, continuing through the second day of drying up. The temperature sign can be a helpful cross reference in determining whether or not ovulation has occurred.

During other times, couples should follow Phase I rules (not in the morning, or on consecutive days). Once regular cycles return, couples should chart normally regardless of breastfeeding.

Tricia Ballad is a web developer by profession and a writer and natural family planning advocate by passion. See more about Tricia Ballad.

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"The media have become the mainstream culture in children's lives. Parents have become the alternative. Americans once expected parents to raise their children in accordance with the dominant cultural messages. Today they are expected to raise their children in opposition to it." -- Ellen Goodman, Boston Globe columnist


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