Tuesday, December 18, 2007

Natural Child Spacing Through Lactational Amenorrhea

Below is an article I have written on the subject of naturally spacing pregnancies through lactational amenorrhea. You will not enjoy this article if you find the thought of a nursing child inappropriate in spite of the Bible's many mentions of this subject.


Natural Child Spacing Through Lactational Amenorrhea

Written by Zsuzsanna Anderson

December 2007

Breastfeeding provides a natural delay in women's return to fertility. It can also lower cancer rates and space babies more optimally. Mothers who breastfeed usually skip their menstrual period for some time after birth. Skipping periods during breastfeeding is called “lactational amenorrhea.”

By feeding a new baby only with breast milk, a new mother can prevent pregnancy if her period has not returned.

Baby's sucking controls the mother's ovulation. The more the baby has a need to suck, the less ready he is to be displaced by another. The less baby has a need to suck, the more ready and able he is to cope with a new brother or sister.

Research shows that even in the United States, breastfeeding delays the return of most women's periods.

Fully breastfeeding means the baby relies completely on mother for nourishment and for all of his sucking needs. Your baby's frequent nursing inhibits the release of hormones that cause your body to begin the monthly preparation for a new pregnancy. Ovulation does not take place and you do not have menstrual periods.

The exact duration of amenorrhea depends on each woman's nursing pattern and on her own physiology.

As explained by Sheila Kippley in Breastfeeding and Natural Child Spacing, the seven conditions to delay the return of menstruation are:

  1. Exclusive breastfeeding (no other liquid or solid from any other source enters the infant's mouth) for the first six months of life.
  2. Comfort your baby at the breast.
  3. Don't use bottles and pacifiers AT ALL.
  4. Sleep with your baby for night feedings.
  5. Sleep with your baby for daily nap feedings.
  6. Nurse frequently day and night and avoid schedules. (For young babies, this means at least every 2 hours during the day, and at least every 4 hours at night. For older babies, this means at least every 3 hours during the day, and every 6 hours at night.)
  7. Avoid any practice that restricts nursing or separates you from your baby (i.e. leaving the baby in the care of someone else with a bottle – even if it is pumped milk – while you get some “time off” from the baby).

Mothers who follow ALL SEVEN of these tenets will experience an average of 14 months without menstruating. Mothers who breastfeed but don't do so exclusively (or don't follow all the recommendations exactly) may have delay in the return of their cycles, but usually not for as long of a period of time as mothers who do.

Mothers who follow the above guidelines still have about a 1%-2% chance of becoming pregnant in the first 6 months after birth. Between 6 months to 1 year after giving birth, mothers have a 3%-6% chance of pregnancy. Night time feedings are especially important in preventing the return of fertility.

In Breastfeeding: A Guide for the Medical Profession, Dr. Ruth Lawrence explains that it is important that mothers don't expect casual breastfeeding to limit their fertility. She writes:

“A significant distinction should be made between token breastfeeding with early solids and more rigid feeding schedules and the ad lib breastfeeding around the clock with no solids until the infant is six months old. The amount and frequency of sucking are closely related to the continued amenorrhea in most women. When a totally breastfed infant sleeps through the night at an early age, requiring no suckling for six hours or more at night, the suppressive effect on menses diminishes. It has also been shown that if the infant uses a pacifier rather than receiving nonnutritive sucking at the breast, the suppression of ovulation is diminished.”

Menstruation generally occurs after the baby starts to suck less frequently. Babies need to suck at least 65 minutes a day to prevent pregnancy in their mothers. (McNeilly) Once menstruation occurs, increasing the number of daytime breastfeedings does not usually affect continuing menstruation. (Diaz) In mothers who wean before menstruation returns, most find that it returns by 2-8 weeks after weaning.

Breastfeeding can and should continue when menstruation resumes. Mothers sometimes notice that their babies become fussy at the start of menstruation, perhaps because many mothers have a slight, temporary drop in milk supply at the start of their period. After a few days of increased nursing, the supply will return. Some women experience moodiness and irritability. It is common for cycles to be irregular for the first few months. Even after the return of menstruation, the cycles may be anovulatory for several more months, meaning that the release of eggs from the ovaries is still suppressed and that pregnancy cannot occur.

Breastfeeding has a powerful effect on the body. Lactational amenorrhea is a normal, healthy part of the reproductive cycle that provides mothers with a natural break from fertility. Many scientists believe that extended periods of lactational amenorrhea may help to explain the lower rates of ovarian, endometrial, and breast cancer found in women who breastfeed.

Common objections to the effectiveness of lactational amenorrhea debunked

I have tried this before, and it didn’t work.

As stated above, the guidelines for holding off the return of menstruation must be followed 100% by some women in order to be effective. Other mothers are naturally less fertile and may not experience any menstruation as long as they are breastfeeding at all. Until you learn about your own personal fertility over time, you will need follow the guidelines exactly to make sure they work.

Many women who “try” this will find that they are following the guidelines only casually.

How can a baby go without bottles and pacifiers?

Simply don’t buy any. While there are mothers who cannot produce an adequate amount of breastmilk, this condition is extremely rare. Some people do not produce enough insulin and they suffer from type I diabetes, but this is likewise very rare. That is not to say that some women will not have to work harder than others to have an adequate milk supply, although personally I believe that this has more to do with the mother’s general life style, particularly how much rest she gets. A daily nap is vital to a new mother, as is healthy, balanced nutrition and loving support from her family.

If you are having a baby shower, request that you do not receive any bottles, pacifiers, formula, breast pump, etc. Do not buy any formula “just in case”. If you receive formula samples, give or throw them away. When your newborn baby is hungry and crying because your milk supply is not catching up with his growing demand fast enough, the best thing to do is to take it easy for a couple of days and lounge around feeding the baby around the clock. There are excellent herbal teas that you can drink during this time (or every day), as well as certain foods that increase milk production. If you have formula and bottles in the house, however, you will be tempted to feed your crying baby “just one bottle” until your supply increases. Although this may seem harmless, this usually leads to a downward spiral of more bottles and less nursing.

Anyone tempted to feed their baby formula should take a sip of it themselves. It must be the most disgusting tasting thing ever invented.

As far as pacifiers go, again – just don’t use one. Most babies have to be taught to take a pacifier and at first reject it vehemently. The babies suckling is not just to get milk. It stimulates the production of hormones in the mother’s body that hold off ovulation, even if the baby is not actually drinking. This is why extended nighttime feedings and a daily nap are so vital. While Mom and baby are snuggled up side by side sleeping, the baby will suckle without actually getting much milk, causing the mother’s hormone levels to be boosted.

How will we ever get a break from the baby if we can’t leave him at a sitter with a bottle?

Once breastfeeding is well established and you know your child’s personal feeding patterns, you will be able to take breaks by leaving right after a feeding and returning before the next. This window of 2-3 hours is enough to go shopping, go out to eat, or do whatever else it is you want to do.

That being said, I do not want to encourage mothers to view their children as a nuisance and a burden, but rather as an extension of their mother that automatically goes with them wherever they go. Nor do I ever leave our children in anyone’s care except their Dad’s. If we both want to go out on a date, we bring along all our children. Sad to say, children today watch dating couples on TV all day long and all too often see glimpses into their bedroom scenes, but rarely see their parents interact normally as a married couple. If you don not find going out with your children enjoyable, you may need to reevaluate their discipline (or lack thereof).

I have several kids – how can I take a nap?

Older kids can be taught to play silently if you give them puzzles, books, school work, etc. Younger kids (mostly the 4 and under crowd) who will not play quietly can be made to lie down with you. If you really can’t take a nap one day because of certain circumstances, you can retreat to a quiet spot with the baby and nurse him/her while relaxing yourself. If you cannot take a nap regularly because of your schedule, you should reevaluate your schedule. Your own baby should have priority over just about any other obligations. Many mothers are so busy “serving others” that they neglect their own child. I believe that the root cause of this is the fact that when you serve others, you receive praise and appreciation, something a baby cannot express very much. Mothers should remember that their own child also falls into the “others” category, and should be at the top of that list along with your husband and other children. Besides, taking a nap and being well rested will give you the energy to get more done in less time after your nap.

If you do not like naps because they make you groggy, plan for an extra 15 minutes after your wake up to get a small snack, a drink, and splash some fresh water on your face. You will be glad you napped later.

Not following a nursing schedule will mess up my day and take up all my time.

Babies will fall into their own predictable pattern themselves. By about 3 months of age, even if the mother has been feeding on demand exclusively, she will know her baby’s own unique pattern and be able to plan around that. Most babies born into the same family will follow the exact same pattern, making it even easier for the Mom to predict.

Personally, I think that a rigid feeding/sleeping/playing schedule designed by a “Nursery Nazi” does more to mess up a mother’s day than feeding on demand. Babies that are overscheduled tend to be thrown off by any slight change in schedule brought on by a vacation, an emergency, sickness, etc. These schedules were designed for bottle-fed babies and later somewhat “adjusted” to fit breastfed infants.

Where most people miss the boat is when the child becomes older (around 6-8 months or so) and is purposefully manipulating the parents to get his way, rather than just following the natural instinct to eat frequently. This can be corrected through discipline. Give the child what he wants, or give him what he needs – but leaving him to “cry it out” is a lazy approach.

I can’t imagine having our baby sleep in bed with us!

The practice of babies sleeping with their mothers still is practiced almost everywhere in the world, and has been throughout history. It is every mother’s natural desire to want to have her child close by and to make sure that s/he is safe. Not only is it vital to the success of breastfeeding and natural child spacing, but having your baby sleep by your side provides many health benefits to the baby, such as reduced rate of SIDS, better weight gain and growth, less colic, etc. It will also help the baby feel close to Dad, who may be gone at work much of the baby’s awake time. Mothers lose virtually no sleep at night once they learn how to nurse while lying down because the baby can eat while both s/he and Mom are sleeping side by side. These mothers will also rarely ever, or only very briefly, experience postpartum depression. This condition is brought on by poor hormonal balance after childbirth and will continue and worsen if the mother is disjointed from her child, while sleeping with the baby on the other hand will help the mother’s hormone levels to adjust.

Obviously, precautions must be taken in order to ensure the safety of the baby in the parents’ bed. Although even parents who move around much in their sleep will naturally be aware of the baby and stay away from him/her, this is not true if you are under the influence of medications, drugs, or alcohol. A crib is the safest place for children of such parents. Once the child is old enough to roll, a bedrail will keep him from rolling out of bed if s/he is not sleeping between both parents. Or you could simply push the bed against the wall, as long as there are no gaps at all.

If your husband has objections, try to explain to him how lactational amenorrhea works. For personal time without the baby, you could either lay the sleeping child in a bassinette/crib temporarily, or simply retreat to another part of the house yourself. Once you realize that most of your time in bed is spent sleeping soundly, you will not view the baby as an intruder.

Our church has mandatory nursery, and does not accommodate nursing mothers.

First, check if use of the nursery is really mandatory, or just preferred. If the latter is the case, just get used to the dirty looks you will get from others who bowed down to the “Nursery Nazis” while you keep your baby with you in the service. Even babies can be taught to sit somewhat quietly through church. The most difficult time of this training process is probably between 6-18 months of age, and you may have to step out if the child is disruptive. An excellent way to train your child, or even baby, is to read the Bible to him at home as a family and to encourage him to sit quietly during that time. You could also encourage your young child to adjust his sleeping pattern to sleep during church, since most babies will be sleepy from the car ride anyway. Or you could (GASP!) discreetly feed your baby in a sling during the service without anyone knowing about it, which will keep a young baby asleep and an older baby quiet. This is a great tool to bridge the gap between 6 and 18 months because babies can go from sleeping through the service to sitting through the service smoothly. When using a sling, other people may not notice the baby at all, or will think you are simply holding your sleeping child, as long as you use the right kind of sling that pretty much covers your entire front and back. Just don’t tell anyone what you are doing, or they may fall over dead.

Going to a church like that is a difficult situation, and you may need to be creative until you can find a good church that is also family-friendly and accommodating to mothers of large families.


If mothers follow their natural, God-given mothering instincts to feed and care for their babies rather than adopting man-made, modern methods and equipment, they will be able to have healthy, safe pregnancies at naturally spaced intervals. These mothers will also be more in tune with their children through naturally nurturing them, and will have children so pleasant and loving that they would love to have as many children as God will bless them with.


Bumgarner, N.J. Mothering Your Nursing Toddler. Schaumburg, IL: LLLI, 2000.

Diaz S, Miranda P, Brandeis A, Cardenas H, Croxatto HB. A study on the feasibility of suppressing ovarian activity following the end of postpartum amenorrhoea by increasing the frequency of suckling. Clin Endocrinol (Oxf). 1988 May;28(5):525-35.

Gray RH, Campbell OM, Apelo R, Eslami SS, Zacur H, Ramos RM, Gehret JC, Labbok MH. Risk of ovulation during lactation. Lancet. 1990 Jan 6;335(8680):25-9.

Heinig MJ, Nommsen-Rivers LA, Peerson JM, Dewey KG. Factors related to duration of postpartum amenorrhoea among USA women with prolonged lactation. J Biosoc Sci. 1994 Oct;26(4):517-27.

Jones RE. Breast-feeding and post-partum amenorrhoea in Indonesia. J Biosoc Sci. 1989 Jan;21(1):83-100.

Jones RE. The effect of initiation of child supplementation on resumption of post-partum menstruation. J Biosoc Sci. 1990 Apr;22(2):173-89.

Kippley, S.M. Breastfeeding and Natural Child Spacing. Cincinnati, OH: CCL, 1999.

La Leche League International: The Womanly Art of Breastfeeding. Schaumburg, IL: LLLI, 2003

Lawrence, R. and Lawrence, R. Breastfeeding: A Guide for the Medical Profession. New Jersey: Elsevier, 2005.

McNeilly AS, Glasier AF, Howie PW, Houston MJ, Cook A, Boyle H. Fertility after childbirth: pregnancy associated with breast feeding. Clin Endocrinol (Oxf). 1983 Aug;19(2):167-73.

Mohrbacher, N. and Stock, J. The Breastfeeding Answer Book. Schaumburg, IL: LLLI, 2002.

Perez A, Labbok M, Barker D, Gray R. Use-effectiveness of the ovulation method initiated during postpartum breastfeeding. Contraception. 1988 Nov;38(5):499-508.

Weinstein, M. Your Fertility Signals. St. Louis, MO: Smoothstone Press, 1989.

WHO The World Health Organization multinational study of breast-feeding and lactational amenorrhea. IV. Postpartum bleeding and lochia in breast-feeding women. World Health Organization Task Force on Methods for the Natural Regulation of Fertility. Fertil Steril. 1999 Sep;72(3):441-7.


  1. Christine said...

    Thanks for this it was very informative. This is a touchy subject for me and my girlfriends. For my first son he did not accept breast feeding from the 1st time and we got scared he would go without so we did bottle feed him. My second one did catch on quickly with no problems. I did breast feed him for a little over 2 months after that I just wasn't producing milk for him. And he was a very hungry baby LOL!

    I have a girlfriend who breast fed both her children to 1 years old some even till 2 years old. I'm sure with my next one it will hopefully be longer.

    It does make sense regarding the fertility timing.
    December 18, 2007 6:01 PM

  2. Some moms do not have to be as strict about breastfeeding to delay ovulation. I am currently breastfeeding a 15 month old and my periods still have not returned. My other kids were breastfed for 6, 9 1/2, and 8 months, and I never ovulated while nursing them. They used bottles and pacifiers at times. I am 35 years old which may or may not be a factor with my lactational amenorrhoea.

    We did use bottles when our toddler was younger--usually not more than once per day. There were times we gave him two or three bottles while traveling, and once he even went 9 hours during the day without nursing. To give you an idea how much he nurses now, he only drinks about 8 ounces of water or juice per day from a sippy cup.

    Like my first three kids who weren't breastfed as long, he started co-sleeping with us at about 5 months of age--when I felt safe enough to have him in our bed.

    I plan to stop breastfeeding when I get my period or when he turns two, whichever comes first...


  3. What a great artical! THe Lord truly has blessed you with the ability to write well.
    As for my situation, I got my cycle back after my babe was about six months old. With my second babe ten months, and now with the five month old....well lets say I am waiting for the second cycle to start. I applied all of the stratigies mentioned above, in earnest. I think everyone is diffrent. I just pray to the Lord that He wont give me more than I can handle, or my body for that much.
    With out faith it is immpossable to please God. Right!?
    Many blessings to you and yours,

  4. Hi : )

    I am one of those people that just really beat the odds- 3 times! I had 4 babies in 4 years & 2 months. I made it 4-5 months of no period after my 1st. baby, 5 or 6 after my 2nd., only a 4 week break after my 3rd., and a real stretcher with my 4th.- 6 months of no cycle!

    And that's with exclusive breastfeeding (with the exception of tube feeding a couple times during the first week with my 1st. and 4th. because they were all c-sections, therefore the milk delayed).

    My last 2 babies actually slept with me in bed (which is SO convenient for nightime nursings!). I delayed solids until 5 months, almost 6 with my 4th. baby, and she used no pacifier.

    I nursed on demand and was basically a human pacifier, expecially with my 4th.

    Even so, I'm now a mother of a 5 year old, 4 year old, 2 year old, and 1 year old. A good friend of mine also had hers spaced out almost identically, despite her being a 100% breastfeeding mom. It's in those cases that I believe that it was by God's hand and not my own- those babies were meant to be born when they were.

    So even with the best of efforts to space things out, sometimes God has other plans.

    1. Ha! Yes, indeed! My oldest nursed every 90 minutes around the clock, day and night. We slept together because I'd never get sleep otherwise. He never had a bottle or paci. And, well, I was pregnant just five months post partum. Ok, I figured I could handle that. I breastfed my oldest throughout that pregnancy because he obviously was too young to wean, and I tandem nursed when my second was born. My period still arrived shortly afterward, and yep, sure enough, one year later, WHILE tandem nursing no less, I was pregnant yet again. I had three kids in less than three years.

      That said, they are each of them miracles and blessings, and I cannot imagine life without them.

  5. I wish this information were more widespread among the Christians who promote schedule feeding, ala Babywise and Gary Ezzo.

    It is asinine to mix Ezzo scheduling with avoiding birth control. . . It's not God's design, and doesn't give moms and babies enough time with each little one being nurtured.

  6. Yes this is how my parent had their second child.

  7. I did all of this. I must be in the 1% of mothers that get pregnant, because even nursing the way you listed, I got pregnant four months after my first. I was 21 and very fertile. = ) I started my cycle three months after having my second boy. Now, with my girls, I didn't start my cycle until I weaned them. So who knows? Maybe they weren't ready for any more siblings. = )(and I had nursed all of them exactly the same) So, I am living proof that this does not work for every single woman.

  8. I know this is an old post so you might not ever see this comment but I felt I should add it anyway.

    We should all be aware that not all bodies work the same way and, even following all seven steps perfectly, some women will still become fertile again very quickly. My eldest fed ever 1.5-2 hours both day & night (and we know he was receiving plenty of milk because he grew exceptionally fast), we co-slept at night (mainly because I would have been exhausted getting up to him), no pacifier, no bottle and even so, my cycle began exactly four weeks after his birth. My later children have not always fed so frequently but in every case, I was cycling again by the time I attended my 6-week post natal checkup. I know this is rare but I do feel people should be warned that it will not work for everyone.

  9. After having my fourth child, I had no return of cycles, I stopped breastfeeding him at 9 1/2 months due to him biting me constantly no matter what I did (I persisted for about a month before giving up). Two weeks later still no return of cycles, thought I'd do a pregnancy test - I was definitely pregnant. I thought I could be 8-10 weeks along, the blood test result indicated 6 weeks. Went in for a 'dating scan' to find out I was 17-18 weeks pregnant, I was somewhat shocked - no pregnancy symptoms, weight gain or anything (although I'm still heavy from previous pregnancies). I do wonder how long I would have gone without noticing if I were still breastfeeding.

    I didn't adhere or know about all the conditions mentioned above, will try that next time and see. We are happy to add to our family, even if it was a surprise to find out the way we did.

  10. I was 28 months anemorrhea. It was nice..... My baby-led feeder baby did not eat solids until almost 12 months, he was probably nursing around 15 times in 24 hours, with many sessions lasting 20 minutes or more, some sessions lasting about 10 minutes.
    The longest I have heard of is 34 months. I always ask if anyone has gone longer?

  11. I was in amenorrhea for 30 month with this way of breastfeeding. It is definitly possible, and I loved doing it the whole time. It felt natural to me.

  12. Hi
    I think i just now got my period. I have one period after birth of my first son and got pregnant straight away i often dont count that one as it only lasted 2 days. Since then no period until today my oldest son turns 3 in nov. So to me its almost 36 months

    Now it all makes sense why i was so irritated with them feeding as i tandem nurse i couldnt stand it for more than a few minutes.

    Well lets see if it sets through
    Ps im 34

  13. This way of doing things simply doesn't work for all women or all families. I successfully nursed my first two children for a year, without being a human pacifier and on a reasonable routine (not schedule) by three months postpartum. Babywise is not bad, people! It does not endorse rigid scheduling. Read the book before you come to that conclusion! It does encourage the baby to take FULL meals and not become a snacker, which in turn gets them on a "schedule" if they're feeding well. Not rocket science, and certainly not a bad idea for busy families. Nursing this way, I was amenorrheic for 10 months with my first and 8 months with my second. My third child I didn't nurse beyond 7 weeks because she was not gaining weight, but it had nothing to do with Gary Ezzo. I worked with an LC and she was not transferring milk well. Due to being stretched in too many directions with little help, I could not work through these problems, and I put her on a bottle and pumped for six months and transitioned to formula afterwards. The sky didn't fall. AND....FORMULA IS NOT POISON. She thrived and was nourished. I researched ingredients thoroughly and found an organic, non-GMO one that she tolerated very well. I read stuff like this and cringe. Babies DO bond over a bottle, and countless ones do very well on formula. Thank God for the stuff, otherwise many babies wouldn't have a chance at life. Just be careful with regard to this "all or nothing" view of infant feeding. We don't know how tainted breast milk is by pollutants in our world today, no matter how clean you think you live. It may not be all it's cracked up to be. Just sayin.

  14. Zsuzsanna, a fellow church member sent this beautiful post to me and I'm so thankful to you for sharing this information. I really need to just take a couple of hours each day to binge read your older posts which will help me to deal with current challenges as a new mommy. You have covered so much over the years; what a wealth of information, a treasure really. Endless blessings to the *growing* Anderson Family!


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