When I asked for ideas for this week, quite a few ladies wanted to know more about Lactational Amenorrhea and Postpartum Charting. So, here we go!

Postpartum Charting

I contacted a pair of NFP (Billings and STM) teachers I know and asked them for their thoughts on Postpartum Charting. Here are their main things to consider.

As with the rest of this series, please understand that this is in no way a substitute for an NFP/FAM class and for instruction with a certified instructor.

• It’s good to begin before your first menses. Some women don’t think they need to start charting until their menses returns, but it’s possible to ovulate prior to the first menses (although this is less likely if you are exclusively breastfeeding and <6 months post-partum, it is possible.) 
• Some women like to begin charting again after lochia has finished. Others prefer to wait until they observe some signs of rising fertility, such as fertile-type mucus, before beginning.
• When you’re making/charting mucus observations, be aware that if you observed soon after nursing the lubrication breastfeeding stimulates could be mistaken for fertile mucus.
• Chart all bleeding, but not all bleeding is menses. There’s no scientific standard for determining the first menstrual bleed post-partum. As a rule of thumb, a menses should have days of medium or heavy bleeding, not just light bleeding or spotting, and it should have a crescendo-decrescendo pattern. But trumping the rule of thumb is whether the woman feels like it is her period or not. So just to stop and question yourself when noting bleeding. Does this feel like a period to me? If it does, the woman should start another chart. But if she feels it was just spotting (breakthrough bleeding) she can continue the current chart.
• Post-partum charting requires patience and the charting equivalent of thick skin. Before the first ovulation, temps can be highly variable, but you should still see a clear sustained rise after the first ovulation. And about 1/3 of women may have mucus signs that don’t correlate so well with their hormonal fertility status, usually with lots of mucus caused by breastfeeding hormonal fluctuations. So it can help to work with an instructor to help distinguish details and interpretation if you’re unsure.
• The first cycle after the return of menses is typically longer than usual, so requires more patience with abstinence, but usually has a shorter luteal phase.
• As a STM instructor our clients don’t start a new chart postpartum until they confirm it’s true menses through a qualifying temp shift. They may start new charts for organization, labeling them Chart1, chart 1a, chart1b, etc but that’s all. 
• After the first 56 days, postpartum, all bleeding is considered fertile until a temp shift is confirmed and legitimate AF is known.
• A benefit of charting earlier vs waiting is that if you do have a basic infertile pattern (BIP) it’s easier to establish that early on vs once your hormones start fluctuating more. It can really save on unnecessary abstaining later on.
• The first temp shift can be rather weak so don’t hesitate to keep your instructor on speed dial for any questions you need clarity on.
• It’s normal for cycles to be prolonged pre-ovulation and shorter then normal post-ovulation for as many as 6 or so cycles once cycling does return.
• Working with your instructor is really important. For some methods the rules available to you can change depending on your fertility category. For instance with Northwest Family Services (NWFS,) there is a slightly different mucus patch type rule available for women who are in the first 12 weeks with “intensive breastfeeding” vs after that point and breastfeeding. Regardless it’s a good time to stay in close contact with someone trained if at all possible.

Lactational Amenorrhea Method (LAM)

The following information about LAM comes from Breastfeeding Answers Made Simple (Mohrbacher) pgs. 495-498

Lactational Amenorrhea Method (LAM) is a temporary NFP method that does not require abstinence and has been found to be at least 98% reliable during the first 6 months postpartum in studies around the world. LAM consists of breastfeeding rhythms that provide more that a prolonged period of natural infertility.

For LAM to be effective, the mother must answer “NO” to three specific questions:

1. Have your menses returned? (Menses defined as two consecutive days of bleeding after 8 weeks postpartum or a vaginal bleed the mother considers a menses.)

2. Are you supplementing (with formula or via bottle) regularly or allowing long periods without breastfeeding either day or night?

3. Is your baby more than 6 months old?

When a mother can answer NO to all three questions, she has less than a 2% chance of pregnancy. When a mother’s answer is YES to any of the three questions, she should begin using another method of family planning.

The key to suppression of fertility through breastfeeding is frequent breastfeeding, day and night. The mother can rely on LAM with confidence when she breastfeeds exclusively (Baby receives only mother’s milk and no other liquids or solids,) or almost exclusively (along with breastfeeding, baby receives no more than two mouthfuls daily of other foods, drinks, and/or vitamins/minerals,) at least until her menses return, her breastfeeding pattern changes, or her baby turns 6 months old.

LAM was originally limited to 6 months because this is when introduction of other foods is recommended. But if a mother’s menses has not returned, solids are given after the baby breastfeeds (or delayed past 6 months), and the mother does not go without breastfeeding for longer than 4 hours during the day and 6 hours at night, very few pregnancies occur.

Personally, my menses returned with DD1 at around 4 months postpartum, whereas with DD2, my menses was delayed until she was closer to 14 months. Both girls were exclusively breastfed, and solids were delayed until closer to 10 months with both girls. The big difference between the two girls was the frequency of night nursing. We didn’t start bedsharing until having DD2, and she literally nursed all night long. She would attach and stay attached.

Your turn! What has your experience been with LAM or postpartum charting? Do you switch from one method to another when breastfeeding or postpartum?

Thank You to Mikayla and Kristin for the postpartum charting info!!

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Tomorrow is our last day! We’ll talk about some non-religious reasons to switch to NFP/FAM!