Breastfeeding Habits that Improve LAM

Optimal breastfeeding is the key to successful LAM. The suggestions below maximize the health and nutrition benefits of breastfeeding and improve LAM.

• After delivery, baby should be placed skin to skin with mom and supported to begin breastfeeding within the first hour. Allow the infant to remain with the mother for at least several hours and to room-in with the mother.
• Breastfeed frequently whenever the baby is hungry, both day and night. During the first few weeks, this may be every two-three hours, sometimes even more. Signs of hunger include snuggling or rooting at the breast, making sucking sounds, or sucking on the hands. Crying is a late sign of hunger.
• Breastfeed exclusively for the first six months. Human milk is all a baby needs to eat or drink for about six months.
• Start giving the baby complementary foods at about six months. At each feeding, breastfeed first then give other foods and liquids.
• Continue breastfeeding for up to two years or more. Human milk continues to provide important immunities, is still good food, and keeps protecting your baby from diseases.
• Avoid using bottles or pacifiers. Artificial nipple use in the early days may reduce an infant's desire to suck at the breast, reducing frequency, and thus reducing both milk production and fertility suppression.
• Breastfeeding should continue even if the mother or baby becomes ill. The nutrients and immunological protection provided by breastfeeding are even more important when the mother or baby is ill. However, if the mother has a potentially terminal, transmittable disease--such as AIDS or active tuberculosis--she should consult her health care provider for advice.

Women who are breastfeeding need to satisfy their own hunger and thirst and get rest when possible. No special food is required to create good quality milk and no foods are forbidden.

Frequently Asked Questions about LAM

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 by breastfeeding. 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. However, current WHO guidance calls for treatment along with a call for exclusive breastfeeding, which both reduces the risk of HIV passage compared to mixed feeding, and provides protection against other health risks. As WHO guidance may change, please always check the latest guidance for up to date suggestions.

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

A. There is only one study of LAM use when mothers and child are separated. This study found an increase in unplanned pregnancy when women returned to work or school and began to express and store milk for daytime use, leaving the child with another caretaker. However, if a woman to be separated from her child still wishes to use LAM she may need special support. She should begin using LAM in the first weeks after childbirth while she is able to be with the child. When she returns to the work place, she can express her milk, preferably using manual stimulation of the breast and nipple in much the same way as the baby does. She needs to express her milk at least as often as her infant would be nursing and not have more than four hours between expressing. The working mother also should be advised to increase her frequency of breastfeeding when at home with the infant, especially during the night. 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 more responsive to each feeding at night than they are during the day, which means that each feeding at night has more of an impact than a daytime feeding towards 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.

Medical conditions that affect the use of LAM are few. Generally, the WHO provides recommendations on the few medical conditions that contraindicate optimal breastfeeding, which in turn makes LAM use impossible.