Breastfeeding: An Optimal Way to Space Babies

The September/October edition of New Beginnings, La Leche League International’s magazine, contains an article by Sheila Kippley about her new book The Seven Standards of Ecological Breastfeeding: The Frequency Factor

I recognize this approach is not for everyone. However, many couples wish to minimize the use of artificial birth control for a variety of reasons, and it can be difficult to find information about the relationship between breastfeeding and fertility.

In the article Kippley distinguishes between exclusive breastfeeding and ecological breastfeeding. Exclusive breastfeeding means that the baby receives all nourishment from the breast. It’s common for mothers to conceive three or four months after birth, even if they are exclusively nursing. As she writes, “Research shows that almost half of the exclusively breastfeeding mothers using the above rule [of exclusive breastfeeding, see #1 below] will experience menstruation prior to six months.”

Both exclusive breastfeeding and ecological breastfeeding are different from LAM, the lactation amenorrhea method of birth control. LAM works when the mother is exclusively nursing, the baby nurses at least every four hours during the day and every six hours at night, and the mother has not had a return of menses before the age of six months. If the mother has any bleeding after 56 days, she must consider herself fertile. LAM is a simple way to determine whether a mother is fertile, but it only works until she gets a period or the baby turns six months old. It is based on the fact that ovulation is extremely rare before the first period if the minimum spacing of feedings is maintained. That first period then serves as a warning sign of fertility so a mother can take precautions. Until the return of menses or six months postpartum, whichever comes first, LAM provides a 98-99% rate of protection from pregnancy.

The seven standards of ecological breastfeeding are meant to push off the return of that first period to six months and even longer. The standards are:

  1. Breastfeed exclusively for the first six months.
  2. Pacify your baby at your breasts.
  3. Don’t use bottles or pacifiers.
  4. Sleep with your baby for night feedings.
  5. Sleep with your baby for a daily-nap feeding.
  6. Breastfeed frequently day and night and avoid schedules.
  7. Avoid any practice that restricts nursing or separates you from your baby.

I followed these standards for all but one of my children, with the exception of the daily nap, and experienced breastfeeding infertility for one to two years.

More details about each standard can be found in the full article and the book.

Many years ago I recommended one of Kippley’s earlier books, Breastfeeding and Natural Child Spacing, to a friend. My friend enjoyed the book despite its Christian outlook and was inspired by the loving attitude of the author toward babies. In the New Beginnings article, Kippley goes well beyond a dry description of biological mechanisms connected to fertility and hormonal shifts. She is unapologetic about babies needing their mothers and the fact that comforting is as important as feeding, if not more so. The developing relationship between mothers and babies is about much more than nutrition or delaying fertility. While some mothers will appreciate this approach, others might find it preachy.

One important issue that Kippley does not address, at least in the published article, are signs that breastfeeding fertility is nearing an end. With an older baby there is not necessarily a warning period before ovulation.

Related:
Babies, Breastfeeding and Hormonal Birth Control

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Comments

  1. ooh am I first? 🙂
    I agree babies need their mamas, but I think a lot of women would think that list is too much. On maternity leave I think I did some of it, but i knew I needed to introduce a bottle for my own sanity as the sleep deprivation was too much, and I was scared of having a baby in my bed for two years. First time mothers I think are always scared of babies getting into habits which later can’t be broken – I’m not sure how right we are about that.

    we recently went away for a weekend with some work acquaintances – one couple had a 4 month old baby which had been left with it’s grandparents for the weekend. I was shocked but I think this is a very Israeli phenomenon. The mother was even still on maternity leave but the baby had been on formula from 2 months.

    as always a lot more to say but will leave it at that for now…

  2. oh and I can’t not say – in Israel to not have a dummy/pacifier/motsets? you’d be had up for child abuse by every nosy granny 🙂

  3. I only did 1 and 2 on the list, but expressed milk while I was at work. ALso, we do not use pacifiers (the babies never wanted them). I only became fertile after I stopped expressing, but still was breastfeeding. For 1,2 and 3 it was around 10 months and for 4 and 5 it was around 14 months. I think not getting a period is one of the best fringe benefits of breastfeeding.

  4. mominisrael says:

    Katherine, I think readers were too overwhelmed by the switch to comment on any other post!
    I agree about the habits–the parents have to remember that they always are in control and that small children, esp. babies, can learn new habits fairly quickly.
    Ariela, thanks for providing an example of how working mothers can benefit from this as well.

  5. I can say that this worked for us. I didn’t use pacifiers, our babies slept with us or next to us until they were over 6 months and I demand fed my two babies until I introduced solids. I didn’t have a period until 9+ months with both of them. When my period did return we began the FAM method of birth control until we were ready to add another baby.

    I have found that many mothers are surprised when their period arrives, even though they use pacifiers, and schedule their baby’s feedings. There is a lot of confusion about this issue. Thanks for writing about it.

  6. sylvia_rachel says:

    Interesting.

    We did all that stuff — well, maybe I didn’t nap with the baby daily, but she certainly nursed to sleep for almost every nap as long as I was on maternity leave (i.e., the first 13 months of her life). It worked really well as a means of getting a good night’s sleep, keeping my milk supply plentiful, and turning a super-cranky high-needs baby into a reasonably cheerful toddler. But I can’t tell you how well it worked as a means of delaying fertility, because I don’t have any fertility to delay. 😛

  7. I’ll call this lifestyle “natural mothering” . This is how i took care of my kids when they were babies. Really I found being a ‘unit’ with my baby was so much easier….

  8. Oh, as far as fertility , I went one year with my first, 16 months with my 2nd, 18 months with the 3rd and like 2 years with my youngest before my cycles returned! An added benefit!

  9. I nursed all four of my kids at least six months full-time. Two of them I nursed till age two. Regular periods resumed one month after the after-birth bleeding stopped…no breastfeeding fertility control for me. I’m 100% in favor of breastfeeding, but wouldn’t recommend breastfeeding as a contraceptive method. It seems too risky, if a woman really wants to prevent a new pregnancy. For me – and I realize that for many women breastfeeding *does* prevent fertility – breastfeeding is about all the other wonderful benefits to baby and mother.

  10. Those are great guidelines and while I followed a lot of them, I didn’t follow all of them. I am a working mom and I returned to work part-time at 3 months with DS and then full time at 6 months. With DD, I stayed home for 6 months and then went back full-time. I did use pacifiers and bottles, but also did plenty of pacifying at the breast and I pumped whenever my babies got bottles (i.e. when I was at work).

    That said, I knew I couldn’t count on breastfeeding as birth control given the choices I’d made. However, I was lucky to have 15 months with DS and 14 months with DD before my cycles returned.

  11. mominisrael says:

    Sherah: Thanks for sharing your experience. You’re right that this topic is confusing to many.
    S-R: Like Miriam points out, breastfeeding is about so much more than fertility.
    Tikva: I’m glad you finally came out to comment and share.
    Miriam: Most women don’t breastfeed for that reason alone. But if you are already doing it, it’s important to know the factors that affect fertility. I don’t see it as a recommendation, it’s one option of many. After all, no form of birth control is 100%. And, with education, it can be quite effective. The trick is knowing when ovulation can happen, and a good book, like Toni Wechshler’s “Take Charge of Your Fertility,” explains it well.

  12. Katherine we must live in different Israels. I do know of people like that but it is very rare with the mothers I know.
    I nursed my children exclusively until the started eating Mutzakim food (don’t remember the term in English) and that was the same time I returned to work. My daughter never took a bottle and would eat before I left and would wait for me to come home. This made the metapelet crazy. And for a while I would meet them for a midday nursing.
    I nursed my daughter until she was 2.
    And I nursed my son until I wanted to get pregnant again when he was 21 months old.
    I did almost everything on the list, except for that I went back to work. And it worked for me.

  13. sylvia_rachel says:

    Oh, of course, I know that 🙂 I was just pointing out that I am able to report on some results of “ecological breastfeeding” but not that one.

  14. Yael in IN says:

    I had read all these requirements for Ecological Breastfeeding and still heard people telling me they got their periods back sooner than the average. I recently read some LLL literature that said the actual number of minutes breast feeding (along with night feedings/sleeping together) seems to be the key to delaying fertility. I remember the article saying a woman has to BF during the day for 100+ minutes(I could be wrong about the amount of time) to delay fertility.

  15. MII just wanted to say I don’t like the comment feedback format. Now it delivers the entire comment into my inbox, as opposed to just an announcement about new comments. It means people are less likely to come back to the site to rejoin the conversation, and also it is disjointed because you don’t see all the comments together. I prefer the old format. Just wanted to let you know…

  16. anonymous poster says:

    Like Miriam, I met all the qualifications for ecological breastfeeding when nursing my newborn, except I was also tandem-nursing his older sister. Before my period returned I also started using a diaphragm (and was careful to use it properly), because I wanted to wait a year before becoming pregnant again. I figured that even though the diaphragm is not as effective as other methods, in combination with tandem nursing it would be sufficicently effective. And I wanted to avoid using the pill, which I knew from prior experience would affect my milk supply. Nevertheless I became pregnant before my infant was 9 months old. Ecological breastfeeding does not work for everyone.

  17. mominisrael says:

    I was sure I had responded to the earlier comments but I guess I never did.
    Mia, thanks for sharing your story.
    Sylvia, understood!
    Yael, I haven’t heard that. I wonder if it appears in the new book.
    I’m sorry the commenting format doesn’t suit you, Katherine. I’ll keep it in mind as I learn how to develop the site more.
    Anonymous poster:
    I’m sorry you had to deal with an unexpected pregnancy. I think that ecological breastfeeding for child spacing works best for people who don’t want to use birth control at all (for example strict Catholics and some Orthodox Jews) and are happy with whatever spacing they get. And, of course, who enjoy the closeness with the baby. As I mentioned, with ecological bf the key is recognizing the signs of a return to fertility. After six months there may not be a warning period before the first ovulation. I also know many people who got pregnant while using a diaphragm.
    Thanks for sharing your experience.

  18. anonymous poster says:

    Mom in Israel,
    I wrote that my pregnancy was unexpected, because I would have preferred to have had more time with my infant before becoming pregnant again (especially because pregnancy decreases my milk supply by about 50%, which was how I realized I was pregnant). Nevertheless, I was happy to be having another baby, and she is much loved today. I posted my experience because so many people seem to think that breastfeeding, expecially tandem nursing, will prevent pregnancy. I just noticed Yael’s post & wanted to add that I was definitely nursing more than 100 minutes per day, especially because my infant & toddler didn’t always nurse together.

  19. Just because you are breastfeeding, that doesnt mean you wont get pregnant. It really depends HOW you breastfeed. You should have baby nurse whenever he wants, and not go more than 3 hours in between. And nurse at night as well. Introducing solids doesnt mean you need to exchange a nursing session for a solid meal.People make a big deal over offering solids. My first son, I nursed him a lot, whenver he wanted, day or night. Also, I only offered solids when he expressed interest, which was around 7 – 8 months, but just offered, until he didnt seem interested, and kept nursing fully. At 14 months, he fell, and split his lip, and didnt want to nurse for 8 hours, so I got my period two weeks later, and got pregnant when he was 15 months. My daughter is 7 1/2 months, and I still havent had a period.

    • mominisrael says:

      Oksana, I agree that breastfeeding as you describe will usually delay your period.

  20. I forgot to mention, to working moms: my sister is a working mom, and pumped at work every 3 -4 hours, and nursed on demand when at home, day and night, and she didnt get a period at all. When her baby was a year old, she decided to quit the daytime pumping during work, and she got pregnant without ever getting a period. So it does work for working moms too. You just have to be committed.

  21. interesting. My mother’s natural spacing was 2-3 years between each of us, and I’m sure she followed these guidelines (though not deliberately… it happened naturally). She didn’t necessarily get warning signs, though… when she went to the doctor upon getting pregnant with one of my brothers, he asked her about the date of her last period. Her honest answer: three years ago. 🙂

  22. Back in the olden days, there were no pacifiers and supplementary food for babies- i,e, formula, or even infant cereal. No bottles. A woman usually stayed home with her babies, but if she had to work in the field or somewhere, she took her baby wrapped against her in a sling, therefore, not interrupting the nursing, and not upsetting her hormone level. Mothers took their babies everywhere with them, and a baby grew against the mothers breast. Breastfeeding the the wrong term, its not just food for the baby, its complete mothering at the breast. What else does the baby need, but the mother? If baby is hungry, mothers milk is there; if baby is thirsty, mothers milk; if baby is hurt, mm soothes and comforts him; if baby is frightened, same story, if baby is sleepy, mm puts him to sleep.

  23. It seems a lot of work, but actually its the easiest method of mothering. You dont need to think- is the baby hungry, or just wants a drink- or does he want to sleep, should I rock him, or give him a pacifier- all the guesswork is gone, you completely mother him at the breast, and when you do so, you naturally give the breast to your baby every half an hour to 2-3 hours, depends on the baby, and it will delay fertility. When you sleep with your baby, you are tuned in to him, and therefore give him the breast more, because if he is sleeping in another room, he may turn and twist, and fall asleep again, and can sleep through the whole night. And if he does awaken, and cry, you get tired of always going to the nursery to nurse, and rock to sleep. If you cant sleep with your baby, put him in a cot right by your bed so you can hear and see him. Mothers and babies are supposed to be together.

    • Oksana, I found it easy as well. But it takes a certain mindset, a relinquishing of control, and that is hard for some. It was hard for me at first.

  24. Yes, I agree, it is hard at first, as you learn this art of complete mothering. I consider it a gift if a mother realizes this way of nursing her child.

  25. Oksana, I’ve long wanted to write a post about this. People like Marjorie Ingall who feel that breastfeeding advocates minimize the difficulties also minimize the pleasures of breastfeeding.

Trackbacks

  1. […] Breastfeeding:An Optimal Way to Space Babies […]

  2. […] believe that it is a reliable method for an individual mother, there is no question that it delays return of fertility within a large population. Closely spaced children put economic and physical stress on […]

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