Sunday, November 18, 2007

Let's get LAM right!

Sheila Kippley, a long time colleague from my days doing research on NFP, reviewed the breastfeeding information in the new CCL manual, The Art of Natural Family Planning: Student Guide. She points out that "There are two statements that are seriously incomplete and therefore possibly misleading. 1) “Some studies show that 97% of mothers who exclusively breastfeed can be assured of postpartum infertility for at least six months” (page 161). 2) “Exclusive breastfeeding: Generally, highly infertile during the first six months postpartum” (Reference guide, page 254; italics in the original)." (see for more detail)

While exclusive breastfeeding will reduce the risk of pregnancy, it is not a reliable method of family planning. Neither is amenorrhea (i.e., no menstrual periods) alone. Both are proxies for reduced fertility, but neither alone achieves an efficacy that would be acceptable to families not planning a pregnancy.

What is LAM? It is a method based on the physiology of lactational infertility. IF you are fully breastfeeding (exclusivity is not necessary) AND IF you have not had a menstrual-type bleed after 8 weeks postpartum, AND IF you have not started regular complementary feeding, your risk of pregnancy is less than 2% by lifetable analysis.

How does this risk compare to other family planning methods? This risk is comparable to data reported for some oral contraceptives, and better than most barrier methods.

How do we know this? LAM underwent clinical trials in at least 10 countries, including the United States, Germany and Italy. Additional sites were in Indonesia, Egypt, Nigeria, Mexico, Chile, Pakistan, Philippines, Rwanda, and Ecuador, among others. Trials had consistent findings of 0-2% pregnancy rates.

Which organizations note and support these findings? At least WHO and ACOG note these findings and present LAM as an acceptable introductory method postpartum. It is an accepted method in several countries around the world.

Why is it not more widely known and utilized? There is no one profiting from it, and hence no one investing in advertising it. Further, promoting its use means that you must trust a woman to follow the criteria. Unfortunately, this trust is not as yet the norm among clinicians, but hopefully it is increasing.

What can I do to support the use of LAM? Create a demand! Ask your providers about it. If they are uninformed, send them to the WHO Medical Eligibility Criteria for contraceptive use and/or to ACOG Clinical Review, 12(1), Jan/Feb 2007, or, it!!

Please contact me if you have further questions on LAM:


Pam said...

Thanks for this post. It's a really helpful explanation.

Liz said...

I have a couple of questions. First what is the distinction between fully breastfeeding and exclusively breastfeeding. Secondly how long a time can mothers go between nursings in the day time (I know it's not longer than 6 hours at night, but I've seen 3 hours, 4 hours and not more than 6 hours listed in the day time, I've also seen 6-10 feeds a day given as a standard).