Lactational Amenorrhea Method

The Bellagio Consensus provided the scientific basis for defining the conditions under which breastfeeding can be used safely and effectively for birth-spacing purposes; programmatic guidelines were developed at a meeting of family planning experts for its use as a method of family planning, and the method was then given the name the lactational amenorrhea method (1,2). These guidelines include the following three criteria, all of which must be met to ensure adequate protection from an unplanned pregnancy: 1) amenorrhea; 2) fully or nearly fully breastfeeding (no interval of >4–6 hours between breastfeeds); and 3) <6 months postpartum.

All major medical organizations recommend exclusive breastfeeding for the first 6 months of life, with continuing breastfeeding through the first year and beyond for as long as mutually desired (3). No medical conditions exist for which use of the lactational amenorrhea method for contraception is restricted. However, breastfeeding might not be recommended for women or infants with certain conditions.

Women with conditions that make pregnancy an unacceptable risk should be advised that the lactational amenorrhea method might not be appropriate for them because of its relatively higher typical-use failure rates. The lactational amenorrhea method does not protect against sexually transmitted diseases (STDs), including human immunodeficiency virus (HIV), and women using this method should be counseled that consistent and correct use of the male latex condom reduces the risk for transmission of HIV and other STDs. Use of female condoms can provide protection from transmission of STDs, although data are limited.

HIV Infection

HIV can be transmitted from mother to infant through breastfeeding. Therefore, in the United States, where replacement feeding is affordable, feasible, acceptable, sustainable, and safe, breastfeeding for women with HIV is not recommended (3,4).

Other Medical Conditions

The American Academy of Pediatrics (AAP) also recommends against breastfeeding for women with active untreated tuberculosis disease, untreated brucellosis, varicella, H1N1 influenza, or positivity for human T-cell lymphotropic virus types I or II or for those who have herpes simplex lesions on a breast. In addition, infants with classic galactosemia should not breastfeed (3).

Medication Used during Breastfeeding

AAP recommends that the benefits of breastfeeding outweigh the risk of exposure to most therapeutic agents via human milk. More information about specific drugs and radioactive compounds is provided by AAP (5) and LactMed (http://toxnet.nlm.nih.gov).

References

1. Kennedy KI, Rivera R, McNeilly AS. Consensus statement on the use of breastfeeding as a family planning method. Contraception 1989;39:477–96. http://dx.doi.org/10.1016/0010-7824(89)90103-0 PubMed
2. Labbok M, Cooney K, Coly S. Guidelines: breastfeeding, family planning, and the Lactational Amenorrhea Method-LAM. Washington, DC: Institute for Reproductive Health; 1994.
3. American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk [Policy statement]. Pediatrics 2012;129:e827–41. http://dx.doi.org/10.1542/peds.2011-3552 PubMed
4. Perinatal HIV Guidelines Working Group. Public Service Task Force recommendations for use of antiretroviral drugs in pregnant HIV-infected women for maternal health and interventions to reduce perinatal HIV transmission in the United States. Rockville, MD: Public Health Service Task Force; 2009.
5. Sachs HC; Committee On Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics 2013;132:e796–809. http://dx.doi.org/10.1542/peds.2013-1985 PubMed.