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Breastfeeding, birth control. When to expect your period and fertility to return. Babble.com's Parental Advisory.

I am breastfeeding around the clock at six weeks. I plan to keep at it exclusively for as long as possible. Is it pretty safe to assume I will not get pregnant for the first few months? My doc says the mini pill is safe for breastfeeding, but he’s hardly a La Leche Leaguer, so I want to make sure. Is it safe? Do I need it? – Out of (Birth) Control

Dear Out of Control,

It is true that breastfeeding, when exclusive and frequent, will reduce your chances of getting pregnant. Some consider breastfeeding nature’s solution to optimal child spacing. This method is more officially known as the Lactational Amenorreah Method, or ecological breastfeeding.

But it is not foolproof. Repeat: It is NOT safe to assume that you will absolutely NOT get pregnant. Breastfeeding women – even around-the-clockers – can start ovulating at unpredictable times. Sometimes weeks, sometimes months, occasionally years after birth, the machinery creaks back into gear. This can happen without fanfare or obvious outward signs: you can be ovulating before you get your first period, so you may be fertile before you know it.

After the recovery period, any bleeding, however minor, could be a sign that your cycle is active. Many mothers find that their menstruation returns with a decrease in feedings. This can occur when you supplement or use a pacifier, when solids are introduced, or if you drop feedings (as in when your baby starts sleeping longer stretches at night). Other women find they need to wean entirely before their period comes back. You never know. Hormone levels vary from woman to woman, and over time as well.

So, if you really don’t want to get pregnant you’ll want to stay on top of your birth control situation. You can consider condoms, a diaphragm, a cervical cap or an IUD, all of which are safe for a breastfeeding mother. The lowest dose progestin-only birth control is the preferred choice for breastfeeding moms. Both progesterone and estrogen have been approved by the AAP for breastfeeding women, but estrogen-containing contraceptives should be avoided for the first six months or until solids are well-established. As far as we know, taking the pill does not hurt babies, though anecdotal evidence suggests that hormones can make a baby fussier. It’s also possible that very young babies (under six weeks) may not be able to process the hormones easily. Hormones, especially estrogen, can also affect supply. If your supply or the baby’s weight gain seems to suffer, discontinue the pill. Or discontinue breastfeeding – whatever makes sense for you. Also, keep in mind that hormones can have side effects, such as headaches and nausea.

No method of birth control is flawless. We just heard of someone who got pregnant on the regular ol’ pill. And another with an IUD. And there are slip ups with surgical birth control methods as well. Somebody’s gotta be that x%. Here’s hoping it’s none of us.

Have a question? Email parentaladvisory@babble.com

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