Where Breastfeeding (BF) and Birth Control Come Together

FEBRUARY 2025
Michal Schonbrun, MPH

While most women today know that they have the option of planning a natural childbirth without medical intervention, fewer women seem to know that they can use breastfeeding as an effective method of contraception without medical intervention.  But… it is not breastfeeding alone that is the reliable method, rather it is breastfeeding together with monitoring a primary fertility sign, cervical secretions (CS)/vaginal discharge, that can communicate “infertility status” for months at a time, and even beyond. 

Every new mom deserves to know if and when her fertility is resuming and when pregnancy is possible, no guesswork or calculating necessary.  Every mom can learn this tool and benefit from it, each and every day.  It just needs to be learned, not from a book, but from a trained fertility awareness professional. How liberating it can be to have this knowledge as it gives a new mom a tremendous amount of peace of mind, sexual freedom and freedom from hormones, IUDs and the unpleasant side effects they commonly cause.

Because most physicians and breastfeeding counselors are uninformed about this, they tend to recommend only the “easier” methods such as progesterone-only pills or IUD’s. Some providers may recommend LAM (Lactational Amenorrhea Method) but this “method” is actually an algorithm and is very unreliable in western countries.  Most of the research supporting LAM was conducted in the developing world, where cultural values and breastfeeding practices are very different, and where women have less access to and willingness to use “modern” (medical) birth control methods.

Breastfeeding. by itself, is not a reliable form of birth control in western cultures, because it is not practiced in a way that can naturally suppress ovulation.  In traditional, tribal cultures, mothers typically nurse their young round the clock for a few years.  Since they are physically bonded, 24/7 with a sling, without pacifiers, formula, bottles, cribs or strollers- their babies are naturally sipping at the breast throughout the day and night.  They also sleep together. This is known as “ecological” breastfeeding, known to prolong lactational infertility for an average of two years.

Many western women use the term “fully breastfeeding” to refer to a belief that full BF suppresses fertility. But the term “full” is not the same as “frequent “stimulation of the breast.  Full BF means that the baby’s nutrition comes solely from the mother’s milk. Full BF is not the same as frequent BF.  When a baby sleeps for more than 4-5 hours at a time (during day or night)- the breast is not getting frequent-enough stimulation to suppress ovulation  (There is some controversy among lactation professionals whether pumping milk has the same fertility suppression effect as BF).

Western women who aspire to frequent BF have another choice. They can effectively combine BF and rely on one of two other natural methods during the postpartum time.  

The Billings Ovulation Method® (BOM) teaches women how to identify infertile  secretion patterns This is particularly useful during breastfeeding. The method works best in situations where a mom is physically close to her baby and a mom who has a high degree of trust in her instincts and self-confidence.

 While frequent BF can delay a first ovulation and return to fertility, it is learning to understand and interpret one’s infertile secretion pattern that gives someone the power of a highly effective and natural contraceptive method.  This cannot be learned from a book.  Many Fertility Awareness Educators have extensive experience teaching this method and providing long-term follow-up to BF moms.

The Billings Method is appropriate for any mother who is breastfeeding frequently, not menstruating and motivated to learn about her secretion patterns so she can know if and when her fertility is resuming and when pregnancy is possible.  The method is appropriate for someone who is open and curious about developing a new and intimate relationship with her body. Effectiveness can reach over 95%, with proper instruction. Without professional guidance, efficacy will be much lower. 

Once cycles resume, the Sympto-Thermal Method (STM) is appropriate for any mother whether she is breastfeeding (at any frequency) or not, and wants to control her fertility naturally. STM is one of many variations of the Fertility Awareness Method (FAM).

These methods can be learned in small group workshops or on an individual/couples basis.  They require approximately 7-10 hours of instruction with an experienced teacher. 

Personal motivation, a desire to take responsibility for one’s sexual health plus the ability to trust one’s observations are the critical factors in determining whether someone is a good candidate for these methods. 

For postpartum mothers without cycles, it is necessary to observe, track and correctly interpret your secretion pattern (known as BIP-basic infertile pattern). After just a few weeks one can learn to identify their BIP and use very simple and easy rules for a hassle-free sex life.  When cycles resume, it will be necessary to add basal body temperature (BBT) tracking, using a special basal thermometer. Since most women who begin to cycle are still breastfeeding, they are in hormonal transition, so it may take a few months of charting before the method rules can be implemented.  Contrary to popular belief, there is no point taking basal temperature during breastfeeding- until the menstrual cycle resumes.

Let us envision the day when all mothers are knowledgeable about their own bodies, cycles and hormones, so they can teach their young daughters how to recognize their natural secretions and times of fertility and infertility. This learning literally becomes a tool for life. Let us do for our daughters and granddaughters what probably wasn’t done for us- learn to normalize our bodies, their functions, intelligence and wisdom. May all females love themselves and embrace the way they are.  This basic awareness can empower all of us to navigate and manage our health, fertility and sexuality, for the rest of our lives. 

For more information:
1. Dispelling myths about fertility and breastfeeding  
2. The physiology of breastfeeding, hormones and natural contraception
3.Trying to conceive while breastfeeding