Background and guidance

The lactational amenorrhoea method of contraception (LAM) was formalised over 20 years ago1 and the Faculty of Sexual & Reproductive Healthcare (FSRH) guidance on postnatal sexual and reproductive health2 is clear: “Women may be advised that if they are <6 months postpartum, amenorrhoeic and fully breastfeeding, the lactational amenorrhoea method (LAM) is over 98% effective in preventing pregnancy. Women using LAM should be advised that the risk of pregnancy is increased if the frequency of breastfeeding decreases (stopping night feeds, supplementary feeding, use of pacifiers), when menstruation returns or when >6 months postpartum.”

Yet a recent survey3 found “particular inconsistencies” in the advice given to breastfeeding women in the UK that raises the risk of unplanned pregnancies. Practitioners seem to either dismiss LAM or give the impression that breastfeeding alone can work as contraception: “I received contradictory advice from the midwife and GP [general practitioner] – the GP believed that breastfeeding was a safe form of contraception, whereas the midwife warned me that it wasn't (but didn't offer any alternatives).”

There was also evidence that many practitioners fail to give advice to breastfeeding women about what action to take when the LAM criteria no longer apply.

LAM, breastfeeding rates and getting guidance into practice

LAM is more than a highly effective, temporary and economical form of postpartum contraception. It can also help to improve breastfeeding rates,4 and hence maternal and child health. For this reason, attempts were made to increase health professional knowledge of LAM in North London, UK through the provision of brief training and the production of a local patient leaflet.5 Unfortunately it seems that most health professionals are still reluctant to tell women about this method of postpartum contraception. As is …