Breast or bottle–there’s so much to consider when you’re thinking about how to nourish your newborn. It’s a highly personal choice, and whichever way you go is valid. But if you’re on this page, you’ve likely decided to breastfeed.

In theory, when you are breastfeeding, you are not ovulating. This is why some tout the Lactational Amenorrhea Method, or LAM, as a form of birth control for the first six months after delivery.

Let’s assume mom is generally healthy. After giving birth, the body readies itself to generate breast milk. Levels of the reproductive hormone progesterone drop. Another essential hormone for the production of breastmilk, called prolactin, increases. 

As long as the baby is stimulating the nipples by suckling, prolactin levels will remain elevated. The combination of higher prolactin and lower progesterone inhibits ovulation. No ovulation means no egg. Which means no conception. 

If it sounds too good to be true, well, it is. We’ll explain the problems with relying on LAM as birth control, then offer other methods you can use right after having a baby.

Why We Don’t Support LAM as Birth Control
So here’s the deal: LAM is accepted as a form of birth control by the World Health Organization especially in areas of the world where women don’t have access to other birth control options.. But the American College of Gynecology (ACOG) does not recommend LAM because it is not an effective way to prevent pregnancy... 

Here is more detail on why LAM is not a good option for birth control. 

Women often assume they're in the clear from the baby-making brigade just because Aunt Flo hasn't made her appearance. Surprise, surprise! Turns out, Mother Nature likes to keep us on our toes. You might just find yourself in the ovulation game before your period even RSVPs post-baby. And guess what? There's no crystal ball to predict exactly when that first post-delivery ovulation will happen.

There’s no room for error. You must breastfeed exclusively—no formula and no bottle feeding (even bottle feeding with breast milk). And you must do so every four hours during the day and every six hours at night.

 

If you miss a single feeding at the breast, you’ll have to use another birth control method entirely. Yep, your biology is that sensitive. In just the downtime when your baby is (hopefully) sleeping, your prolactin levels fall, you produce less milk, and your chances for ovulation increase.

It can be exhausting. For some, breastfeeding requires a lot of physical energy. And adhering to the LAM schedule means you’ll never get more than five continuous hours of sleep at night. Snoozing for less than six and a half hours at night can trigger postpartum depression. 

It’s impractical. LAM is a major commitment, particularly compared to a barrier method of contraception like a condom. You may not be able to take the time off from work or other obligations to nurse your infant every four hours. Plus, not everyone can produce enough breast milk for every feeding.

Illness and medications can throw things off. If you get sick, you need to take care of yourself so you can recover quickly. Soldiering through will likely prolong your illness, making it harder to care for your baby. 

Say you have the flu. While you can’t pass it to your baby through breast milk, you can infect them through close proximity. Which would render LAM moot. 

With medications, most everyday meds likely will not pose a risk to a newborn, but some can. For instance, while using LAM, people can’t take migraine meds like ergot alkaloids and sleep aids.  

Postpartum Birth Control Options

There are many forms of birth control that are safe and will have no effect on your milk supply  for nursing women. You can use these options after delivery (once you’re cleared to have sex, that is).

 

Barrier Methods

Barrier methods include condoms, diaphragms with spermicide, cervical caps, and the sponge. Since they don’t involve ingesting chemicals, these are a safe bet for your little one. Of course, in order for them to work, they must be put in place every time you have sex. As a result, they have lower rates of pregnancy prevention, between 76% and 88%. 

If you used a diaphragm or cap before giving birth, be sure to have your ob/gyn check sizing again. You want to make sure they still fit properly.

 

Progestin-Only Contraceptives

Hormonal birth control works by releasing reproductive hormones into the body. They can contain estrogen and progestin (a synthetic version of progesterone), or just progestin. Generally, birth control with estrogen is not recommended for nursing moms since it may interfere with milk production. 

Postpartum or not, estrogen has also been shown to increase the chance of blood clots in people with risk factors. Pregnancy leads to elevated estrogen levels, which on their own might affect coagulation, or clotting. For this reason, docs typically suggest avoiding estrogen-related contraception for at least 30 days after giving birth.

That said, here are your progestin-only birth control options.

• Long-Acting Reversible Contraceptives (LARCs): These include intrauterine devices (IUDs) and contraceptive arm implants. LARCs are prescribed and administered by your clinician, can be removed anytime, and have not been shown to impact future fertility. They last for several years and are 99% effective. 
  
  Your doc can insert the contraceptive implant under the skin of your arm immediately after birth. Ditto for an IUD. Your clinician can put it into your uterus right after delivery or during a follow-up visit. 
  
   
• Contraceptive injection: Also known as depot-medroxyprogesterone, or by the brand name Depo-Provera, this injection goes into the upper arm or butt. It lasts up to 3 months and is 94% effective. 
  
   
• Mini pill: Also 94% effective, it’s called the “mini” because it contains just progestin (vs estrogen + progestin). Docs recommend a mini for women who want birth control pills and have a tendency toward blood clots.
  
   

Permanent Contraceptives

Some people decide they’re done having kids and don’t want to think about birth control anymore. That’s where tubal ligation or vasectomy may come in.

• Tubal Ligation: Also known as tubal sterilization, this involves cutting, tying, or blocking the fallopian tubes. It essentially stops an egg at security—preventing it from moving through the gates to get on the plane (or: through the tubes and into the uterus). This procedure can be done right after a vaginal or cesarean birth if a woman prefers doing it then.
  
   
• Vasectomy: Here, a man’s vas deferens—the tube that carries sperm—is cut. This means that semen no longer contains sperm. It takes six to 12 weeks for a vasectomy to be fully effective. Your doc will need to confirm that there’s no sperm left in the ejaculate.

Ideally, it’s always great to discuss postpartum contraception with your doctor pre-partum. Having a plan in place can take away extra decision-making in the “baby’s here!” fog. But no judgment if that convo didn’t happen early on. 

Just be sure that, once you’re having sex again, you understand that you can get pregnant. Your doc can provide advice that fits your unique circumstances, lifestyle, and move-forward plans.