I am always amazed that many women do not understand the impact of breastfeeding their child on their fertility and sexuality.  Here are some quick general notes I recently threw together.  Hope it is helpful!

Sexuality:

• Some women report less sexual desire after the birth of their baby – taking care of a baby is intense work, and many women feel so much love and connection to their infant that the baby can consume much of the mother’s emotional energy. The couple may also be adjusting to being new parents and having less time alone.
• Some women report they feel heightened sexual feelings while breastfeeding.
• Masters and Johnson’s 1966 study pointed out that many breastfeeding mothers are more comfortable with their sexuality and are more anxious to resume sexual relations with their mate when compared to women who formula-fed their infants.
• Low estrogen levels associated with breastfeeding can cause severe vaginal dryness and tenderness. Mothers can try water-based lubricants or also talk with their health-care professional  estrogen-based prescription creams or suppositories.
• Lovemaking may stimulate a let-down
• The father’s feelings are important. Unlike the mother, his hormone levels have not changed, and he may feel hurt and confused by lack of sexual interest from his partner. Mothers also may feel fatigued and “touched out’ by the end of the day. Open communication is important!
• You do not have to “get away” from your baby in order to have a fulfilling relationship as a couple.  🙂

Breastfeeding and Fertility

“If all breastfeeding were to stop, within a year there would be a 20 to 30 percent rise in the birthrate world-wide.”

The Lactational Amenorrhea Method (LAM):

A Mother has LESS than a 2 percent chance of getting pregnant if

• A mother’s menses has not returned (no vaginal bleeding after the 56^th day after birth)
• The mother is not supplementing regularly OR going longer than four hours between feedings during the day OR longer than six hours during the night

AND

• The baby is less than six months old.

THE KEY TO SUPPRESSION OF FERTILITY THROUGH BREASTFEEDING IS FREQUENT NURSING DAY AND NIGHT!!

Breastfeeding increases the likelihood that the mother’s first menstrual cycle will be anovulatory (Not preceded by ovulation), but the longer a mother’s menses are delayed by breastfeeding, the more likely she is to ovulate before her first menstruation. Even after menstruation returns, breastfeeding can reduce fertility. A woman’s own body chemistry also influences when menses return.

CONTRACEPTION Compatible with Breastfeeding:

• LAM
• Natural Family Planning  – classes available through Couple to Couple League
• Barrier Methods –  do be aware spermicides can enter into a mother’s milk though no problems in babies have been documented and barrier methods with spermicides are considered compatible with breastfeeding
• IUD (copper); for progestin IUD see below
• Sterilization – hysterectomy does NOT affect breastfeeding
• Progestin-Only Methods – seen as compatible with breastfeeding, although in my work over the years many mothers have reported they felt their milk supply dropped with progestin-only pills
• Norplant maintains a lower level of hormones circulating than with the mini-pill, whereas injected contraceptives such as Depo-Provera result in higher circulating levels of progestin. Other time released progestin only methods include the vaginal ring, progestin IUDs, injected and implant. Timing of introducing these methods is still controversial – six to eight weeks is suggested by the WHO task force. No negative effects to the baby from the hormones (mainly studies have been done on the mini-pill)  have been found so far, and research has followed these children for up to 17 years.
• Estrogen containing methods – decreases milk supply and duration of breastfeeding. It is recommended by the WHO Task Force that babies be at least six months of age before considering these methods. There are no case reports of long-term effects of estrogen on breastfed babies.