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  • Title: Breast-feeding and postpartum ovulation.
    Author: Howie PW, Mcneilly AS.
    Journal: IPPF Med Bull; 1982 Apr; 16(2):1-3. PubMed ID: 12311528.
    Abstract:
    This paper reviews the evidence for the contraceptive effects of breastfeeding on postpartum ovulation. In developing countries breastfeeding prevents more pregnancies than all the other methods of contraception. In a detailed Edinburgh longitudinal study of 27 breastfeeding and 10 bottlefeeding mothers, the return of ovarian follicular development and ovulation was determined by several estimations of total urinary estrogen and pregnanedial excretion, respectively. In the bottlefeeding mothers the patterns of events after delivery was consistent. Basal prolactin levels fell to non-pregnant levels within 2-3 weeks postpartum. By 15 weeks all bottlefeeding mothers had resumed ovulation and menstruation. By contrast, all breastfeeding mothers who breastfed for a mean of 40 weeks maintained elevated basal prolactin levels for longer than the bottlefeeders. The mean time to 1st ovulation was 36 weeks with a range between 15-66 weeks postpartum. The infant feeding patterns showed striking differences between these mothers (33% of the whole group) who suppressed ovulation for more than 40 weeks postpartum and the rest of the mothers (67%) who ovulated before that time. The mothers who suppressed ovulation for more than 40 weeks not only maintained breastfeeding for the greatest number of weeks, but also suckled more frequently, breastfed for a longer total time each day, and maintained 1 or more night feeds for a longer time. After supplementary food was given there was a rapid increase in the number of mothers with evidence of ovarian activity and within 16 weeks of starting, 71% had evidence of follicular activity and 52% had ovulated. Mothers who introduce weaning food abruptly and reduce sucking rapidly will be more likely to experience an early return of ovulation and potential fertility. The mechanism of lactational infertility is not clearly understood. 45% of the completed menstrual cycles during lactation were anovular and of the 55% which were ovular, many were associated with defective luteal phases. The birth spacing effect of lactation is of great importance in communities where alternative contraceptive devices are not available or not acceptable. Breastfeeding is a complementary form of contraception.
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