Is Breastfeeding a Form of Birth Control?

Question: Is breastfeeding a form of birth control? Answer: No, kinda, sorta, well it’s complicated. Breastfeeding itself should not be considered a form of birth control. However, breastfeeding is a component of Lactational Amenorrhea, which is a form of birth control.

There are 3 components of Lactational Amenorrhea

  1. Infant is less than 6 months

  2. Infant is exclusively (or near exclusively breastfeeding) with no more than 4-6* hrs between feeds. This includes nights. The CDC does not state this, but I have also seen other definitions include breastfeeding from both breasts.

  3. Your period/menstrual cycle has not returned (this is the definition of amenorrhea)

When done correctly this form of birth control is 98% effective. For comparison, typical use of birth control pills leads to 91% efficacy, but perfect uses is over 99%. Condoms are about 82% effective with typical use, but 98% with typical use.

Some women do not have a return of their menses until well after six months postpartum while breastfeeding. However, I would caution against continuing to use this method past the first six months. Generally speaking a period follows ovulation. Breastfeeding may continue to decrease your fertility, but there really is no guarantee. If you have ever heard someone say, I don’t know how I got pregnant I didn’t even have my period back yet, you can hopefully better understand this now - ovulation generally precedes menstruation.

* This is the CDCs definition. An exclusively breastfed baby who only nurses every 4-6hrs in not getting enough milk. I think the intention is that the baby is not going longer than 4-6 hours during the night. Or, if you supplement once a day that leads to a long interval of not feeding directly at the breast, this method would not be for you. For instance, you nurse at 5pm, supplement at 7:30pm and the baby nurses again at 11:30pm, this stretch between feeding at the breast would be too long.

Favorite Parenting Books

Here is a simple list of my favorite parenting books

Happiest Baby on the Block - Harvey Karp

Baby Led Weaning - Gill Rapley

Simplicity Parenting - Kim John Payne

How To Talk So Little Kids Will Listen - Joanna Faber and Julie King

Siblings Without Rivalry - Adele Faber and Elaine Mazlish

Parenting: 14 Gospel Principles - Paul Tripp (Religious; Christian)

Grace Based Parenting - Tim Kimmel (Religious; Christian)

*Crib Sheet - Emily Oster is on my list; I have enjoyed her other works.

I read SO many parenting books when I was pregnant with my first and through her first year. Babywise, No Cry Sleep Solution, Bringing up Bebe, and many more that are blending in my brain. I think the greatest thing I learned from all these books is, rarely is one parenting style the “right” way. If you like to read a lot, do it! Just take it all with a grain a salt and glean from it what makes the most sense for you and your family.

~ Jessica

How Can I Increase My Chances of a VBAC?

You might be asking yourself, what can I do to increase my chances of a vaginal birth after cesarean (VBAC)? Here are a few newer studies I read and some thoughts about them.  (Please know, while I try to look at high quality studies, I am not a nurse researcher and this is in no way an extensive literature review.)

Two things to consider, birth location likely matters, and maternal/fetal weight gain impacts outcomes as well.  I think it is great the literature is reflecting birth location and outcome.  This is true for vaginal birth and cesarean in general, not just VBAC.  When possible, try to find information on birth settings in your area.  Pre-pregancy weight and pregnancy weight gain are not new.  This is something to pay attention to when planning for a VBAC.  I would say this is probably more important if you are planning a hospital birth rather than birth center/home birth.  Typical US hospital practices lead to immobility during labor. 

Hospital contribution to variation in rates of vaginal birth after cesarean  https://www.nature.com/articles/s41372-019-0373-2

In the most basic language – hospital matters.  Vaginal birth after cesarean section rates among Michigan hospitals varied greatly.  This is well known in New York as statistics are publicly reported.  In this link you can see which NYS hospitals have the highest VBAC rate by first selecting vaginal births and then vaginal birth after cesareans.  If you have a choice between hospitals you might want to make it based on this information like this.   

Practice variation of vaginal birth after cesarean and the influence of risk factors at patient level: a retrospective cohort study https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/aogs.13059

While not a USA based study, this one also points to hospital variation in rates. 

Factors associated with successful vaginal birth after a cesarean section: a systematic review and meta-analysis https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2517-y

This review included 94 studies, so there is a lot of information in it!  It is open access, so feel free to read through more thoroughly.  I will just highlight a few aspects that are potentially modifiable. 

Obesity & Fetal Macrosomia are more likely to result in an unsuccessful VBAC attempt.  If possible, maintain or obtain a healthy BMI prior to pregnancy.  During pregnancy pay attention to recommended weight gain. 

Gestational diabetes was also more likely to result in an unsuccessful VBAC. 

Avoid induction of labor if not medically necessary.  Gestational age did not impact outcome.  This is a good reminder to not fall into the belief that if labor doesn’t happen by XX (insert arbitrary number) gestational age, it isn’t going to happen.  Or that there needs to be a cut off of gestational age to be induced for a VBAC.  

 Vaginal birth after a cesarean delivery for arrest of descent https://www.tandfonline.com/doi/abs/10.1080/14767058.2018.1443069

Note - this study is small.  100 women attempted VBAC after a cesarean for arrest of descent (pushed, but baby wouldn’t descend), 84 delivered subsequently delivered vaginally!  In general 84% is considered a high success rate, but particularly after an arrest disorder, this is pretty incredible.  The authors conclusion was: This suggests that arrest of descent is mostly dependent on factors unique to each pregnancy and not due to an inadequate pelvis or recurring conditions. Women with a prior CD for arrest of descent should not be discouraged from attempting TOLAC in a subsequent pregnancy due to concerns about the likelihood of success.

I hope you are continually encouraged that the majority of women are candidates for VBAC! Access and support for VBAC are critical and in my opinion the biggest predictor of success.

We Are Here For You!

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Picky Eater

With both of my children, I introduced solids using the method, Baby Led Weaning.  Essentially if you wait until your baby shows signs of readiness to eat (usually around 6 months), your baby can self feed.  It concentrates on using whole foods, rather than purees or pre-packaged foods.  For clarification in England the word weaning refers to the introduction of solid food, not the act of reducing or stopping breastfeeding. 

At the age of two, my son would be considered a good eater.  He eats when he is hungry, and doesn’t eat when he isn’t.  It is not so much about the food that is in front of him, rather his hunger level.  Often, he likes things that could be considered unusual for a toddler; feta cheese, seeds, almost every vegetable or legume and even iced coffee.  His newest trick is to ask for something, take 2 bites and request something else.  Now if he asks for a third food item, he has to finish most of the other two.  Additionally, if he asks for a snack an hour after dinner and barely touched his dinner, the plate comes back out. 

My daughter was also a good eater, eating most everything you offered her.  Especially if it came from my plate! At some point she started to become a little more picky, I think around two.  I could only see where this was going, as she started to refuse certain foods.  In starting with Baby Led Weaning, I had originally committed to not making a separate meal for my children.  Yet, I didn’t want a nightly stand-off of forced bites of food.  I felt stopping this pattern before it started was of utmost importance. 

I am not sure where I heard this tip from, but it definitely became useful.  Include at least one item in your meal that you know your child will eat.  The purpose being your child will not get used to refusing meals.  This one worked well for us.  Once my daughter would start eating the foods she liked, we could often convince her to try a bite of something else on her plate.  The words “you don’t have to like it, but you should at least try it” became a dinner routine.  Somehow removing the pressure to like the food gave her more freedom to try it. 

Where are we now?  While my daughter has a few foods she is unwilling to eat (e.g. tomatoes, beans) she will try most foods. 

I think the one other tactic that really works is to limit snacks before meal time.  Somewhere along the way, being hungry before a meal became wrong.  I try to keep the last snack before a meal at least an hour before or if a snack closer to dinner can't be helped, I tend to choose vegetables or fruit and then don't care as much if dinner is picked at. 

You may also find that your child eats best earlier in the day.  Perhaps by the time dinner comes around, they have actually consumed a large number of calories throughout the day.  While veggies or meat might seem like a breakfast oddity, a late morning snack packed with healthy nutrients would certainly be an option. 

Do you have any suggestions for picky eaters?  Things you have heard?  Tactics you have tried?

If I Was a Betting Woman...

Twelve days late, for the third time.  Same weight gain for momma; for the third time.  Birth weight identical to one sibling and 2 ounces less than the other.  If I was a betting woman, I would start placing bets on my pregnancies.  That is if there were going to be a fourth one.  I am (almost) positive this is the last baby for us.  I think. 

Little Miss has arrived.

2nd VBAC

Going Past Your Due Date

In addition to a little fun, I thought this post might answer some of the sporadic posting I have been doing lately. 

This pregnancy I have been a little vague when answering about my due date.  I usually start with early June and then only reveal the actual date if pressed.  My hope is to avoid the many questions that come when people realize you have reached the 40 week mark.  With the first two both delivered at 41 weeks and 5 days, I have become subject to these well-meaning questions twice over.

So here are my top “favorite” questions and the answers that only live in my brain.

1.     Feeling any contractions? – Yes, all the time.  Thanks for reminding me.  If I labeled my uterus with a personality it would be irritable. 

2.     You’re still pregnant?!?- Well, unless unbeknownst to me the baby slipped out, yes I am very much indeed STILL pregnant.  Or - Does one typically hide a basketball under their shirt after they give birth?

3.     What does your doctor think? – I dunno.  They accidently dropped their crystal ball a few weeks ago and decided not to replace it.

4.     When do you think the baby is coming?  I dunno, my crystal ball is out of order as well. 

5.     How are you feeling? – Like I wanted to give birth 6 weeks ago.

6.     Are you sleeping at night? Yes, in between the trips to the bathroom, the baby’s nightly dance party, the ache of my hips, and my pillows falling to the floor. 

7.     Happy due date! – I am sorry, what are we celebrating? 

8.     Well they are easier to care for on the inside than the outside! – Says who?  You try carrying around a bowling ball 24/7 and let me know how that works for you. 

Any others I missed?

Perhaps post-delivery I will reveal the gestational age of this pic!

Perhaps post-delivery I will reveal the gestational age of this pic!