Can You Get Pregnant While Breastfeeding?

Welcoming a new baby is no doubt one of the most beautiful and memorable moments of our lives. As you know, as much as we plan and prepare, there is always an element of chaos involved. We have so many decisions to make and details to consider. Lack of sleep can make even the most simple decisions feel so daunting.

One thing that we rarely think about in the early days is if and when we are planning for another baby. This can be one of the farthest things from our minds when we are changing diapers, learning to breastfeed, cluster feeding and all of the other things needed to keep a tiny human alive.

More: Where to Get a Free (Or Almost Free) Pregnancy Test

Nonetheless, it’s an important thing to consider. There is a common question circulating the internet and one that I’ve heard new moms ask time and time, “Can you get pregnant while breastfeeding?”

You may have heard varying opinions or stories from family and friends but as a new mom and Doctor of Pharmacy, I will guide you through the details you need to help answer this question and discuss the use of the lactational amenorrhea method as a form of birth control while breastfeeding.

What You Need to Know About Your Hormones and Breastfeeding

In the early postpartum days, our hormones shift from those needed to support pregnancy to those needed to support lactation for breastfeeding. During pregnancy, estrogen and progesterone levels soar as they are produced by the placenta. These two key hormones allow our bodies to accommodate our growing babe.

Prolactin, which is the hormone that prepares breasts for lactation and drives breastmilk production, gradually ramps up as pregnancy progresses. Progesterone blocks prolactin from causing lactation until shortly after delivery, when progesterone levels plummet. At this time prolactin is able to finish its job and stimulate mammary glands in the breasts to produce milk.

Early on in breastfeeding, when your babe latches and suckles, it stimulates more production of prolactin to keep up your milk supply. Oxytocin, the same hormone that helps to stimulate labor, is also produced when your little one latches. Oxytocin allows the milk already present in the breasts to flow causing what we know of as a “let down.” Oxytocin also causes us to feel relaxed and bond with our little one.

So why do all of these hormones matter? Suckling leads to prolactin production which inhibits the hormones that cause ovulation, which is the maturation and release of a follicle or egg and menstruation. Ovulation is needed for pregnancy. Using this natural infertility as a form of birth control is known as the Lactational Amenorrhea Method, or LAM, according to the American College of Obstetricians and Gynecologists.

Can I Get Pregnant While Breastfeeding?

The short answer is YES; you can get pregnant while breastfeeding. This is why it is important to discuss family planning with your midwife, OB GYN or primary care provider, and select a contraceptive method that works for you and your specific situation. It’s important that you are empowered to make the best decision for you and your family when thinking about adding new little additions. We also know that spacing out pregnancies by at least 12 - 18 months can help ensure a healthy pregnancy.

How the Lactational Amenorrhea Method (LAM) Works

Knowing what we do about hormones and chances of pregnancy while breastfeeding, we can discuss a little more about how LAM works and what needs to happen to reduce, not eliminate, your chances of becoming pregnant.

1. Amenorrhea while Breastfeeding

This means that your first period must not have returned yet. This excludes bleeding that continues after giving birth for the first several weeks postpartum as we heal. Once your first period returns, this is an indicator that your chances of becoming pregnant are higher, despite breastfeeding. Getting your period is not a definitive marker that fertility has returned at that moment. In fact, ovulation occurs approximately 14 days before menstruation. This means that your fertility could return even before actually getting your period.

2. Exclusive Breastfeeding

LAM requires that you are breastfeeding exclusively or at least every four hours during the day and every six hours overnight. This can be a challenge for working mamas and babes that require supplementation with some formula. Once your little one finally starts sleeping through the night, your chances of pregnancy increase. It is unknown how pumping affects the efficacy of LAM so it is not recommended to rely on LAM if pumping.

3. Your little one must be less than six months old

There is limited data for LAM as effective contraception beyond six months postpartum. Usually six months is when we start to introduce solid foods. Though breastmilk or formula should be the primary source of nutrition for a baby's first year of life, once we introduce solid foods, our little ones do nurse less. Weaning will increase chances of fertility returning.

What’s the verdict on the LAM method?

Breastfeeding specifically with the Lactational Amenorrhea Method can reduce the risk of pregnancy, but certain criteria must be followed according to the CDC. LAM may be difficult to follow in real-life practice making it a less than ideal method.

Many new moms need to be away from their little ones for more than 4 hours at a time during the day while working outside of the home. Other mamas need to supplement breastfeeding with formula to bridge the gap between milk supply and baby’s nutritional needs. Some babies are great little sleepers from the get go and may sleep more than six hours at a time after the first few weeks. These variables can make it challenging to follow LAM to a T making it less effective.

Some mamas may not have access to other contraception, in which case it’s important to get support from your provider or IBCLC while using LAM. No method of contraception is 100% effective so it’s important to make this decision with your own team of healthcare providers.