Frequently Asked Questions about LAM

Question 2. Should women who are HIV+ or who have AIDS use LAM?

Question 3. Can women who work outside of the home use LAM?

Question 4. Why is breastfeeding at night important?

Question 5. What do you mean by exclusive breastfeeding? 

Q. How does LAM work?

A. When a baby suckles frequently at the breast it stimulates the nipple, sending signals to the brain, which then releases hormones that interrupt a woman's normal ovulation cycle. This effect is particularly strong in the early months after delivery when the baby is breastfeeding often. As the baby grows and starts to eat other foods (around 6 months) the time suckling at the breast decreases. When this happens the woman's body begins to return to its regular cycling and ovulation and menstrual periods return. 

In more technical terms, LAM is based on the hypothalamic-pituitary-ovarian feedback system. As the baby suckles at the breast neural signals are sent to the hypothalamus which mediates the level and rhythm of secretion of the GnRH hormone. GnRH influences pituitary release of follicle stimulating hormone (FSH) and luteinizing hormone (LH), the hormones responsible for follicle development and ovulation. Regular and frequent breastfeeding results in disorganization of follicular development.

Q. Should women who are HIV+ or who have AIDS use LAM?

A. This is a decision each woman must make herself based on the information provided to her. There is a chance that a mother can pass the virus to her baby through breastmilk. If a safe alternative to breastfeeding is available and affordable, a woman who is HIV+ or has AIDS should be informed of the risks of breast and bottle feeding and advised that breastmilk substitutes may be safer for her baby.

Q. Can women who work outside of the home use LAM?

A. Yes. Working women who wish to use LAM may need special support. They can begin using LAM in the first weeks after childbirth while they are recovering at home. When the woman returns to the work place, she can express her milk, stimulating the nipple in much the same way as the baby's suckling does. She needs to express her milk at least as often as her infant would be nursing and never have more than four hours between expressing. The working mother also should be advised to breastfeed more often when at home with the infant, especially during the night. Different methods of breastmilk expression may vary in effectiveness; therefore, the woman should be advised that LAM may be less effective if expression takes the place of the baby at the breast. In one study, LAM was found to be about 95 percent effective for women who hand-expressed their milk at work. Employers can be supportive of working women by giving the mother time and a private area to express, or even better, allowing the baby to be with the mother at work in the early months.

Q. Why is breastfeeding at night important?

A. Prolactin levels are notably higher at night than during the day, which means breastfeeds at night have more of an impact than day time feeds on suppressing fertility even though women nurse a greater number of times during the day. A mother relying on LAM should breastfeed at least once during the night.

Q. What do you mean by exclusive breastfeeding?

A. Exclusive breastfeeding means that no other food or liquid is given to the infant. It is recommended for the first six months of the baby's life to increase the many health benefits of breastfeeding. However, LAM is still effective even if a woman is not exclusively breastfeeding. Guidelines suggest that a woman relying on LAM practice full or nearly full breastfeeding, which means she is breastfeeding when the baby wants, both day and night, and other foods or liquids do not replace a feeding at the breast and are given only in small amounts. She does not permit intervals between breastfeeds of longer than four hours during the day and six hours at night.

What is LAM?

Breastfeeding Habits that Improve LAM 

Family Planning for the Breastfeeding Woman 

This page was adapted from the original web site of the Institute for Reproductive Health, a project funded by the United States Agency for International Development (USAID) under the terms of Cooperative Agreement DPE-3061-A-00-1029-00. Information (photos excluded) and publications may be reproduced, adapted, and disseminated without permission, provided the Institute for Reproductive Health is acknowledged and the material is distributed free of charge, or not for profit.
The LAM section was originally developed by Shirley Coly

Photograph on this page by Prospero Madamba.