Contraception and Lactation

Joyce King, CNM, FNP, PhD

Disclosures

J Midwifery Womens Health. 2007;52(6):614-620. 

In This Article

Abstract and Introduction

Abstract

The benefits of breastfeeding for both the infant and the mother are undisputed. Longer intervals between births decrease fetal/infant and maternal complications. Lactation is an effective contraceptive for the first 6 months postpartum only if women breastfeed exclusively and at regular intervals, including nighttime. Because a high percentage of women in the United States supplement breastfeeding, it is important for these women to choose a method of contraception to prevent unintended pregnancies. Both the method of contraception and the timing of the initiation of contraceptives are important decisions that a clinician must help the breastfeeding woman make. Ideally, the chosen method of contraception should not interfere with lactation. This article reviews the research on the effect of contraceptives, including hormonal contraceptives, on lactation.

Introduction

Each year, more than 100 million women worldwide make decisions about the use of a method of contraception after childbirth.[1] These decisions include not only making a choice regarding a contraceptive method but also deciding the best time for initiation of the chosen method. These decisions may be more complex for breastfeeding women, because both the choice and timing of hormonal methods of contraception may effect both milk production and infant growth and development.[2]

It has been well documented that breastfeeding provides excellent nutrition for infants as well as protection against a variety of infectious diseases, including lower respiratory infections and otitis media. There is also strong evidence that mothers who breastfeed have reduced postpartum bleeding, more rapid uterine involution, and delayed resumption of ovulation with increased child spacing. Setty-Venugopal[3] observed that a 3-year interval between births decreases neonatal and postneonatal mortality as well as child mortality for the second child. Longer birth intervals also decrease maternal complications such as third-trimester bleeding, postpartum endometritis, and anemia.[4] Therefore, spacing of births by using contraception after childbirth provides important health benefits for mothers as well as their offspring. This article provides a brief review of the physiology of lactation and the contraceptive effect of lactation. The literature regarding the use of contraception in lactating women is reviewed. One important caveat is that most of the research on this topic was conducted during the 1970s and 1980s; little additional research has been conducted in the past 20 years.

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