More realistically, your baby will probably need to suckle at least every 2–3 hours during the day and at least every 4 hours at night to prolong your infertility. Regardless, though, the key point is that the longer and more often your baby is away from your breast, the sooner you will start ovulating again.
The Intensity of Breastfeeding
There are essentially two different types of nursing: partial and exclusive. As with everything, there are pros and cons to both.
Partially breastfeeding is the most common form practiced by women in developed countries. With partial nursing, a woman may breastfeed her infant according to a schedule, and she is happy to see her baby sleep through the night as early as possible (can you blame her?!). In addition, she may begin supplementing her own milk with formulas, baby foods, cereals, and bottles within weeks or months of giving birth.
She may also provide her baby with a combination of nursing, pumped breast milk, and formula. This form of breastfeeding is very convenient, of course, but it seriously limits the frequency of suckling at the breast, which means it is not uncommon for a woman to experience her first ovulation and menstrual period close to three months post-partum.
Exclusively breastfeeding is defined as nursing day and night, whenever your baby desires, during his first 6 months. In other words, all of his nutrition comes from your breast, since you don’t give him bottles, solids, or even a pacifier. Your baby stays so close to you that you can nurse or pacify him whenever he wants.*
With this type of breastfeeding, a baby receives breast milk exclusively from the mother, without supplements. In fact, the mother could be working outside the home and expressing milk, while someone else is actually feeding him with a bottle. However, you need to be aware that if your baby is not suckling when he or she desires, your fertility may return faster than you prefer. You will need to follow the rules in the chart here carefully to avoid any unwanted surprises.
And even though many mothers nurse their babies a minimum of once every 4 to 5 hours at night, the baby might also be sleeping in another room and for long intervals. Indeed, even though this is technically considered “exclusively breastfeeding,” for some, it may include feeding schedules, and relatively longer periods of separation from the baby. A woman in this category can usually expect to see her first menstrual periods resume within about a year.
In any case, someone had quite the sense of humor to design exclusively nursing women with the gift of anovulation, but alas, the sleep-deprived exhaustion prevents them from taking advantage of its contraceptive benefits.
DECIDING WHAT TYPE OF BREASTFEEDING IS RIGHT FOR YOU
Choosing your own style of breastfeeding is a very personal decision. How you breastfeed and for how long after you give birth will be based on a number of factors, including your own goals and lifestyle. Your decision will also be influenced by the overall health and wellness of both you and your baby. Regardless, don’t let others judge you, whatever decision you make.
To be sure, a new mom needs to take into account not only her own needs and desires, but also those of her baby. If the goal is long-term breastfeeding, she will need to practice frequent breastfeeding, day and night, to guarantee continuous breast stimulation and an adequate milk supply. In this situation, at night she may want to consider having her baby in bed with her or in a crib immediately alongside the bed, and during the day in a body sling. Doing all this will make frequent suckling both easy and accessible.
If a mom knows she will be returning to work within 3 to 4 months and she wants to nurse her baby long-term, she will need to consider if and how often she will be able to express milk while away from home. A woman who desires to breastfeed for an extended period will also need to decide what happens when her baby begins sleeping for more than 4 or 5 hours straight at night. Will she wake the baby, let the baby sleep, or will she opt to pump milk? If a woman who starts out with full breastfeeding decides to introduce solids earlier than six months, she should prepare herself for an earlier first ovulation while enjoying the freedom of increased mobility and independence.
Regardless, if breastfeeding ever becomes a burden, it may be time to re-evaluate your goals and plans. There are no right answers. Every woman needs to find the balance that works for her. Defining this balance will involve considering her personal preferences and lifestyle as well as her true commitment to what is, in the end, a deeply gratifying but often time-consuming process.
CHARTING, FAM, AND THE TRANSITION TO RESUMED FERTILITY
Breastfeeding women will almost always have a warning of returning fertility through observation of their cervical fluid. In fact, they will probably have many patches of cervical fluid that tend to be somewhat longer than normal as the body attempts to finally ovulate after months of anovulation. More specifically, you will probably notice quite a few “false starts” in which you experience more and more patches of fertile-quality cervical fluid as your body tries to pass over the estrogen threshold necessary to release an egg.
In any case, in order to chart while nursing, you will first need to wait until your lochia stops. Lochia is the bleeding and spotting that emanates from the part of the endometrium where the placenta imbedded before being released after childbirth. As it heals, it usually becomes less red. The lochia may continue for about 5 weeks after childbirth.
You should probably not have sex for 6 weeks or so anyway in order to give your body and cervix a chance to recover from childbirth. But if you resume checking your cervix, you’ll notice that after giving birth vaginally, the cervical os tends to feel more like a slightly open horizontal slit rather than a small round dimple. So it may take time for you to learn how it now feels when open and closed.
Regardless, once you are ready to chart again, the next appendix details how to use FAM when experiencing anovulation (no matter what the cause, including breastfeeding). In addition, there is a summary table on the last page of this appendix that lists the various FAM rules to follow, depending on what type of breastfeeding you are using. You will probably want to review both at least a couple times if you plan to use breastfeeding for contraceptive purposes.
The Transition Back to Normal Cycles After Childbirth
Typical Cycles Before Childbirth
First Three Cycles After Childbirth
Your first cycle following childbirth may be months to even a year long before you finally ovulate. You will initially have about 5 weeks of blood-tinged secretions from your healing uterus (called lochia). Even during those months of infertility, you may go through numerous patches of wet cervical fluid that you need to treat as potentially fertile. Finally, you will ovulate, with your first Luteal Phase after childbirth often shorter than normal.
Your second cycle may be relatively normal, but don’t be surprised if you have a longer Fertile Phase and still shorter Luteal Phase than normal.
Your third cycle will often return to your normal cycles that you experienced before you had your baby.
CONCLUDING REMARKS ON NATURAL BIRTH CONTROL WHILE BREASTFEEDING
The most important thing to remember when experiencing the transition from childbirth to resumed cycling is to constantly be on the lookout for a change in cervical fluid that could indicate approaching ovulation. You may prefer to not take your temperature until you see that change, but once you do, you can also have the benefit of checking your cervical position during any times of uncertainty.
You should also not be surprised if you go through weeks or even months of wet cervical fluid before you return to normal cycles. Understandably, this can be very frustrating if you are trying to avoid pregnancy again. So you’ll need to decide whether you want to abstain during those long stretches or use a barrier method.
Remember that your body has not ovulated in a long time, and it may take a while for it to get back to its usual pattern of fertility. While this could test your patience, try to keep it all in perspective. Before long, your baby will be dating and you’ll be dealing
with bigger issues than your own contraceptive concerns!
APPENDIX J
Using FAM During Long Cycles and Phases of Anovulation
There is no need to read these pages if your charting reveals that you are ovulating normally. But if you aren’t, or your cycles are longer than 38 days, you should go back and internalize the basic principles of Chapters 6 and 11 before reading further. And breastfeeding women should additionally read Appendix I, specifically devoted to using FAM while nursing.
No matter why you aren’t ovulating, you should be aware that FAM is a more difficult method to initially learn while you are going through these menstrual transitions. I would encourage you to work with a FAM counselor during these times if you find it confusing.
The typical woman will experience about 400 periods in her lifetime. OK, kvetch and moan if you must! But remember, not every bleeding episode is preceded by ovulation, and therefore, technically, such bleeding is not necessarily menstruation. In fact, women may go months or longer without ovulating or bleeding altogether—or they may still experience anovulatory bleeding. Women who are most likely to experience anovulatory cycles are those who are:
•teenagers
•coming off the Pill
•dealing with PCOS or other hormonal conditions such as hyper- or hypo-thyroidism
•exercising strenuously or have exceedingly low body fat
•going through stress due to factors such as illness and travel
•following childbirth—whether or not breastfeeding
•premenopausal
As you can infer from its varied causes, anovulation can be a temporary phase lasting no more than a month or two, or it could last up to several years. Regardless, most women will have an anovulatory cycle every now and then. The key point to understand is that if you ovulate, you will have a period (unless, of course, you conceive), but if you bleed, it doesn’t necessarily mean that you ovulated!
Of course, when a woman isn’t ovulating, it would seem obvious that she isn’t fertile, right? Well, yes and no. When women don’t ovulate, they clearly aren’t fertile. Yet ironically, anovulatory cycles, or, more generally, abnormally long cycles, can be more challenging to interpret, because the conspicuous patterns of fertility don’t occur. You don’t see the predictable buildup of fertile cervical fluid followed by drying up and a thermal shift. In essence, then, you must treat each day as if you are preovulatory, since ovulation could still occur.*
YOUR BASIC INFERTILE PATTERN (BIP) WHEN NOT OVULATING
As mentioned in Chapter 6, all ovulating women have a Basic Infertile Pattern, which is the type of cervical fluid that they tend to produce in the few days after their period and before the Point of Change indicates rising levels of estrogen. For some, that may be dry for a few days. For others, it may be sticky or some other non-wet quality. The important point is that it is the same unchanging quality, day after day. And for women who have very short cycles, they probably won’t have a BIP at all, but instead may develop a wet-quality cervical fluid immediately after their period, signaling an early ovulation every cycle.
However, during anovulatory or abnormally long cycles, your BIP is likely to extend for weeks or even months. Again, many women who experience an extended phase of anovulation are continually dry day after day. Others may notice that instead of experiencing dry days when not ovulating, they have essentially the same type of unchanging nonwet cervical fluid day after day. Regardless, if you don’t have the usual patterns of post-menstrual cervical fluid in the week or so after your period ends, your body is clearly reflecting a lack of activity in your ovaries. So such days are treated as if they were dry days, but only after you have clearly established your anovulatory BIP, as discussed on the next page.
ESTABLISHING YOUR BASIC INFERTILE PATTERN (BIP)
In order to establish a BIP, you should abstain from intercourse for two weeks without the interference of semen and spermicides, or anything else that may mask the observation of cervical fluid. Once you have carefully observed it for two consecutive weeks and have charted what type of unchanging pattern you produce, you have established your Basic Infertile Pattern. Only then may you apply the two anovulatory rules listed in the pink boxes below.
UNCHANGING DRY DAY RULE
If your 2-week Basic Infertile Pattern (BIP) is dry or essentially the same-quality non-wet cervical fluid day after day, you are safe for unprotected intercourse the evening of every dry or unchanging sticky day.
However, if on the next day you have residual semen that masks your cervical fluid, you should note it with a question mark and not consider that day safe. In addition, women with a BIP of wet cervical fluid should not consider themselves infertile until the BIP changes.
As mentioned here, a trick to eliminate the semen from your vagina following intercourse is to do SETs, or Semen Emitting Techniques. Then, if the day after intercourse, you once again experience essentially the same unchanged dryness or non-wet cervical fluid, you are safe for unprotected sex that evening.
Corrie’s BIP chart. Corrie abstained for two weeks so that she could determine her BIP. Once she realized it was an unchanging sticky quality, she considered herself safe every evening of a sticky day.
TWO CHALLENGING BASIC INFERTILE PATTERNS
1) Both Dry and Sticky Cervical Fluid
Instead of your cervical fluid being dry day after day, there may be times in your life when you observe a pattern of dry and sticky over the 2-week observation time in which you determine your BIP.
If you are a new user of FAM, I would encourage you to consider only the evening of dry days as safe until you can absolutely confirm that your pattern toggles back and forth between dry and sticky for at least two weeks, preferably more. For experienced users of FAM, you may choose to use such a combination pattern as your BIP, but remember that the critical point is to pay special attention to any change whatsoever to a wet-type cervical fluid. Regardless, you should be aware that you may be taking a somewhat greater risk when you have a combination of dry and sticky.
For this reason, I suggest you verify that you have no wet cervical fluid at your cervix before having intercourse (see Appendix G regarding internal checking). Or you should at least verify that your cervical position is firm, low, and closed. Ultimately, though, you may decide that this dry and sticky pattern is more risk than you are willing to take, and thus choose to abstain or use barriers instead on the non-wet days.
To see how you would record a BIP of both dry and sticky days, see Sasha’s chart below.
Sasha’s chart. Because she is a professional figure skater who is in such good shape, Sasha has virtually no body fat. The combination of the stress of competition and her low body weight have led her to stop ovulating while she is competing. So she chose to abstain for the prior two weeks before the beginning of this chart, in order to establish her Basic Infertile Pattern (BIP), which was a combination of both dry and sticky days intermittently.
She could have considered herself safe any day in which she had either dry or sticky days, but she chose to still use just dry days for unprotected intercourse. But on Day 55, her partner used a condom when she had sticky. Throughout her anovulatory months, she kept her eye out for any patches of wet cervical fluid, and abstained during those days through to 4 days beyond the last day of the patch, or PA plus 4. This Patch Rule is discussed on the next page.
Note that on Day 64, she had eggwhite for the first time in a couple months. Had she been taking her temp, as well, a thermal shift would have helped her to know whether or not that patch ultimately led to ovulation. As it turned out, she hadn’t ovulated, and was able to tell that because she didn’t get a period within the next 12 to 16 days.
2) Wet Cervical Fluid
Women with a BIP of wet cervical fluid day after day should consider themselves potentially fertile. While this type of pattern can be frustrating, it’s too risky to try to differentiate between one type of wet versus another. You may also wa
nt to get checked to rule out an infection or cervical issue. But assuming all is healthy, during these phases, you should either abstain or use barriers until you resume normal ovulation again.
THE TRANSITION: SIGNS OF IMPENDING OVULATION
During the various phases of your life in which ovulation doesn’t occur or you have exceedingly long cycles, your body may go through numerous attempts to release an egg before it actually does. With these transitions, after weeks or months of the same BIP (for example, dry day after day, or sticky day after day), you might notice a change to patches of more fertile-quality cervical fluid or sensation, interspersed with dry or nonwet days. Their lengths may be anywhere from one to several days.
It’s critical to be attentive to such changes, because it’s your body’s way of reflecting hormonal activity that can ultimately lead to ovulation again. So if you start noticing patches of sticky amid the dry phases, or wet amid the sticky phases, you must follow the rule below in order to avoid a pregnancy.
PATCH RULE (PATCH + 4)
If your 2-week Basic Infertile Pattern (BIP) is dry or essentially the same-quality sticky cervical fluid day after day, you are safe for unprotected intercourse the evening of every dry or unchanging non-wet day. But as soon as you see a change in your BIP to wet cervical fluid, vaginal sensation, or bleeding, you must consider yourself fertile until the evening of the 4th consecutive non-wet day after the Patch Day.
The Patch Day is the last day of the more fertile-quality patch of cervical fluid in your BIP.
Taking Charge of Your Fertility Page 44