Long class
... family planning methods when she no longer meets the LAM criteria and may choose to continue to rely on lactational amenorrhea for pregnancy delay. In this case the woman should be counseled to keep breastfeeding frequently and to breastfeed before giving the infant other foods. She should be informed that her risk of pregnancy increases. QWhat are the advantages and disadvantages of LAM? Very effective Provides up to 0.5 CYPs (Couple Years Protection) Has no side effects Does not require insertion of any device at the time of sexual intercourse May attract new family planning users Contributes to family planning prevalence directly and through increased acceptance rates Can be initiated immediately postpartum Is economical and requires no commodities or supplies Contributes to optimal breastfeeding practices and therefore enhances maternal and infant health and nutrition Acceptable to all religious groups Advantages Disadvantages Can only be used for a short period (up to six months postpartum) Requires breastfeeding frequently both day and night 2 Frequently Asked Questions on the Lactational Amenorrhea Method (LAM) QWhen can LAM be initiated? LAM can be initiated at any time during the first six months postpartum. The best time to begin counseling a woman about LAM and other family planning methods is during the antenatal period to allow her to make an informed choice about which method she wishes to use following the birth of her baby. LAM can be started immediately postpartum. The health care provider can help prepare the woman to begin breastfeeding immediately after birth and, if the woman has decided to use LAM, verify that she understands the three criteria for LAM use. If a woman wants to initiate LAM use within the first two months postpartum, she must verify that she has been fully or nearly fully breastfeeding her baby since delivery. A woman may still be having postpartum bleeding (lochial discharge) that may be similar to a monthly bleed. As long as she is fully or nearly fully breastfeeding, the bleeding in the first two months does not disqualify her Q from initiating LAM during this period. If a woman wants to start using LAM when she is more than two months postpartum, the health care provider must carefully verify that she has met the three criteria for LAM use since delivery. 1 Guidelines: Breastfeeding, Family Planning, and the Lactational Amenorrhea Method (LAM). Institute for Reproductive Health, Georgetown University, 1994 (available in Arabic, English, French, Russian and Spanish). What is the difference between LAM, breastfeeding, and amenorrhea? s LAM is a contraceptive method, based on the physiology of breastfeeding. LAM is a method of contraception that a woman consciously chooses to use to reduce her chance of becoming pregnant by adhering carefully to the three criteria. s Breastfeeding is a feeding practice. s Amenorrhea, or the absence of menstrual bleeding, reflects a reduced risk of ovulation, but neither breastfeeding nor amenorrhea is a family planning method. QWhat are the optimal breastfeeding practices1 that contribute to breastfeeding and LAM success? 1. Breastfeed as soon as possible after birth, and remain with the newborn for at least several hours following delivery. 2. Breastfeed frequently both day and night. 3. Breastfeed exclusively for the first six months: no water, other liquids, or solid foods. 4. After the first six months when complementary foods are introduced, breastfeed before giving complementary foods. 5. Continue to breastfeed for up to two years and beyond. 6. Continue breastfeeding even if mother or baby is ill. 7. Avoid using bottles, pacifiers (dummies), or other artificial nipples. 8. Mothers who are breastfeeding should eat and drink sufficient quantities to satisfy their hunger and thirst. 3 Frequently Asked Questions on the Lactational Amenorrhea Method (LAM) not expect a high level of contraceptive protection from LAM, even if she expresses milk during the separation. Expressing breastmilk may not be as effective as suckling at the breast in suppressing ovulation, and for this reason a woman who expresses her milk may not be able to rely on LAM. In a study on LAM in working women, the pregnancy rate increased to five percent. Some women can make arrangements to have their babies brought to them to nurse and/or are able to go to their baby at regular intervals. Women who are able to keep their babies with them at the work site, market, or in the fields and are able to breastfeed their children frequently can rely on LAM. Q Q How many return visits are needed by LAM users? When counseling a new LAM acceptor, the health care provider should discuss her follow-up needs and determine with the client how frequently she needs to be seen and what setting is most accessible for her. At the very least, a client needs to return for a visit if she perceives any breastfeeding difficulties or as soon as any one of the LAM criteria changes. An additional followup visit at five to six months postpartum is essential to determine the client’s plans for switching to another contraceptive method and for introducing complementary foods when her baby is six months old. Whenever possible, the health care provider should schedule the visit when the client brings her baby for assessment or immunization, in this way saving the mother time by reducing the total number of visits to the clinic. If the client is unable to schedule a visit or if she lives far away and will have difficulty returning, the provider should give her a supply of condoms, spermicides, and/or progestin-only pills. In this way she can maintain contraceptive protection if LAM is discontinued before she is able to return to the clinic. What contraceptive methods can be used after LAM? When any one of the three criteria for LAM use is no longer met or when a woman decides to stop using LAM, she needs to begin using another contraceptive method for as long as she wants to prevent another pregnancy. Women who are breastfeeding and who switch to another method should be advised on contraceptive options. Combined oral contraceptive pills (COC) and combined injectables are not recommended before six months postpartum because they contain estrogen, which may decrease the quantity of breastmilk. After six months postpartum, a woman who is breastfeeding can use any method of her choice as long as she is properly screened and meets the eligibility criteria. QCan a woman who is separated from her baby use LAM? The amount of time that a woman is separated from her baby is a key factor in establishing the LAM criterion of full or nearly full breastfeeding, day and night, with no long intervals between feedings. A woman who is separated from her baby regularly for more than four to six hours can- QHow flexible is the method? LAM is a flexible method. In some countries, programs may modify the criteria slightly to reflect cultural norms or national policies without decreasing the method’s efficacy. Many women have occasionally had longer intervals between feedings, their baby has slept through a night, or they have fed the baby regularly with small amounts of complementary foods, and still have had the same high level of effectiveness. 4 Continued on page 6 Frequently Asked Questions on the Lactational Amenorrhea Method (LAM) 5 There is only a one to two percent chance of pregnancy at this time.* When the answer to any one of these questions becomes YES... LAM Decision Making Path1 Ask the mother, or advise her to ask herself, these three questions: *However, the mother may choose to use a complementary family planning method at any time. 1. Have your menses returned? 2. Are you supplementing regularly or allowing long periods without br...