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1

THE LACTATIONAL AMENORRHEA METHOD (LAM)AS A METHOD OF FAMILY PLANNING

If you are expecting a newborn, plan to breastfeed your baby and to use a family planningmethod. The lactational amenorrhea method (LAM) is one of the family planning optionsavailable to you.

1

1-Benefits of Breastfeeding for the Baby

Mother’s milk:

• Is considered the perfect food for the baby• Has sufficient water to satisfy the baby’s thirst• Is easily digested• Is always available and does not require any preparation• Protects the baby from infectious diseases. Colostrum is considered

the first vaccine for the baby• Is sterile when it comes directly from the mother• Reduces the possibility of the baby developing allergies, upper

respiratory tract infections, diarrhea, and malnutrition

Breastfeeding helps:

• The intellectual development of the baby• The development of the jaws and teeth• Strengthen the bonding between the mother and the baby

2

2 – Benefits of breastfeeding for the mother

Breastfeeding:

• Helps the mother’s uterus to contract, thus decreasingpostpartum bleeding (and the earlier the initiation ofbreastfeeding, the greater the impact)

• Strengthens the bond between the mother and the baby, andreduces the incidence of postpartum depression

• Allows the mother time to rest and take care of her familyand her home, and makes night feeding simpler

• Delays pregnancy, in the first six months after delivery whenbreastfeeding is full and the mother does not have hermenses back yet

• Reduces the possibility of the mother developing ovarianand breast cancer in the future

• Helps the mother regain her pre-pregnancy figure, since theuterus returns more quickly to pre-pregnant size, andbreastfeeding helps use the additional fat that the motheraccumulates during pregnancy

3

3 – Early initiation of breastfeeding

• Encourage the mother to start breastfeeding her baby during the firsthalf- one hour after birth

• Put the baby to the mother’s breast to nurse so that his stomachtouches his mother’s stomach (skin-to-skin contact)

Benefits of early initiation:

• The earlier the baby starts breastfeeding, the better his ability to sucklewill be; this helps the mother to produce more milk

• The baby gets the colostrum, which is all he needs nutritionally in thefirst days of life

• Colostrum also protects the baby from infections and helps him to passmeconium

• Reduces the possibility of the baby developing neonatal jaundice

• Helps reduce postpartum bleeding and helps the uterus to return to itsoriginal size more quickly

• Reduces problems of breastfeeding, such as breast engorgement andcracked nipples, etc.

Note: Every mother, regardless of the shape and size of her nipples or breasts,can successfully breastfeed her baby.

4

4 – Proper Positioning

• The mother must be in a comfortable position to nurse her baby, whether sheis sitting or lying down

• The mother brings the baby to her breast so that his stomach will be touchingher stomach. The baby’s ear, shoulder, and hips should be aligned and hischin touching mother’s breast.

• The mother supports with her arm the baby’s bottom, body & head.

Proper attachment• The mother positions the baby to the breast - so that his chin touches the

lower edge of the areola and his upper lip is opposite the nipple• Mother waits until the baby opens his mouth widely, or tickles his mouth with

her nipple so that he opens it widely, then she brings his head towards thenipple ,this allows the baby to take the nipple correctly

• The nipple and part of the areola will fill the baby’s mouth• The baby starts taking slow, deep sucks , and the mother can notice this from

the movement of the lower jaw of the baby.• It is important to ensure that the baby attaches well to the breast to prevent

the occurrence of breast problems, such as sore or cracked nipples andengorgement

5

5 – Exclusive Breastfeeding

• In the first six months of life, the baby should be exclusively breastfed. Themother’s milk is sufficient to fulfill the baby’s nutritional needs for both foodand water

• No water or any kind of food needs to be added to the baby’s diet until he hascompleted his sixth month of age

• Newborns often feed every 2 hours or at least 10-12 times per 24 hours.Frequent feeds help establish a good breast milk supply.

• The baby should be fed on demand, day and night. Ensure that he gets atleast eight feeds per 24 hours with one of them during the night, so that thereis no more than a four-hour period between one feed and the next during thedaytime, and no more than six hours between feeds during the night

• The baby should be allowed to feed on one breast until he leaves it beforethe mother offers the second breast. This allows the baby to get the hindmilk, which is higher in fat content and helps the baby to grow

• It is advisable that the mother continues to breastfeed if the baby becomessick, because breast milk will help the baby recover his health more quickly.If the mother gets sick she is advised to continue breastfeeding, because sheusually will not transmit the illness to the baby; and medications chosen forbreastfeeding mothers are safe for babies

• The properly breastfed baby is expected to wet at least six diapers per 24hours and his growth plotted on the growth chart should be satisfactory-these are sufficient signs that milk production is adequate for the baby’sneeds

• The more the baby nurses, the more milk the mother produces.

How to increase mother’s milk supply:

• Increase the number and length of feeds, even if the mother doesnot feel that her breasts are full

• Let the baby nurse until he leaves the first offered breast, beforeoffering him the other breast

• Allow enough time for nursing in comfortable surrounding• Ensure that the baby is positioned and attached correctly• Avoid the use of pacifiers and bottles

6

6 – Manual Milk Expression

Preparation: To prepare for milk expression ,the mother has to :• Wash her hands with soap and water, and prepare a clean cup that has a

tight cover

• Think about her baby. Massaging and stimulating her nipples will help herhave the let-down reflex

• Massage her breasts gently and apply warm compresses to her breasts for 3-5minutes.

Milk expression:To express her milk , the mother has to take following these steps:

• Place her thumb opposite her first finger on the outer edges of the areola withthe rest of her fingers supporting the breast

• While pressing backwards towards the chest wall, she should bring the thumband first (index) finger closer to each other and then push forward to start themilk flowing into the cup that she holds in her other hand

• Repeat the same procedure by placing her thumb and first finger in anotherplace around the areola and so on, until the first breast is emptied; then shemoves to the other breast and repeats the procedure until she feels that bothbreasts are soft

• At the end of the procedure, she can apply some of her milk around thenipples and let it air dry

• Cover the cup where she collected the milk and label it with the date and time

Storage:• The expressed collected milk can be stored at room temperature for up to 8

hours or in the refrigerator for up to 5 days at 4 degrees

7

7 – LAM as a Method of Family Planning

Definition of LAM:

LAM is a natural, modern, and temporary method of family planning forbreastfeeding mothers who are fully breastfeeding their babies.

LAM can be used for up to six months after delivery, if certain criteria are met.

There are three criteria for LAM:

1. Amenorrhea (no period has resumed after birth)2. Full breastfeeding day and night, and on demand3. Baby’s age is less than 6 months

If all these three criteria are met, then the effectiveness of LAM as a familyplanning method is more than 98%.

Now we will discuss each LAM criterion separately, but REMEMBER, a motherwho is using LAM must fulfill ALL THREE criteria to use the method.

8

8 – First LAM Criterion – Amenorrhea

1. For a mother to use LAM as a family planning method, her menses shouldnot have returned after her delivery.

2. Any spotting during the first 8 weeks after delivery is not considered thereturn of menses.

3. When the baby nurses from the mother, the breast sends messages to thebrain and the brain then sends messages to the ovaries not to produceeggs; therefore, ovulation is suppressed and there are no menses. Themore the baby nurses, the more impact it will have on fertility in the earlypostpartum months. With no ovulation, there will be no pregnancy.

4. After 8 weeks postpartum, the mother is considered to have return ofmenses if she experiences:

a. Any spotting or bleeding for two successive days ORb. Mother’s feeling or perception that her period has returned

5. When the mother experiences menses return, LAM is no longer aneffective method of contraception. The mother needs to go back to theMCH center to obtain another suitable method of contraception if shewishes to delay her next pregnancy.

9

9 – Second LAM Criterion: Full Breastfeeding,day and night, and on demand

For a mother to use LAM successfully as a family planning method, the secondcriterion must also be fulfilled. She has to:

a. Breastfeed her baby fully for the first six months of life. Encourage her topractice exclusive breastfeeding& not to give the baby any water, liquids,or food, because this is healthiest for her baby.

b. Breastfeed her baby day and night, on demand, and whenever she feelsher breasts are full

c. Do not allow more than four hours between one feed and the next duringthe daytime and six hours during the night (so the mother has to nurse thebaby at least once during the night)

d. The more the baby nurses, the greater the fertility suppression will be inthe early months postpartum, and the lesser the possibility of gettingpregnant again too soon

10

10 – Third LAM Criterion : Baby is less than 6 months old

For a mother to use LAM successfully as a family planning method, the thirdcriterion of LAM must be fulfilled:

• The baby’s age must be less than six months• When the baby finishes his sixth month of age, the mother needs to shift to

another method of family planning (other than LAM) if she wishes to continuewith birth spacing

Note: when the baby’s age is greater than 6 months, he needs to be started onsolid foods, e.g., soft mashed foods to start with; but mother is advised tocontinue breastfeeding until the baby is two years of age or more.

11

11 – Fourth Element of LAM: Transitioning to another family planning method

Q: What happens if one of the 3 LAM criteria is no longer met?

If a LAM user:

a. Starts to have her period again, ORb. Starts to regularly give her baby liquids or solids, OR there are

regularly long intervals between one breastfeed and the next (e.g.,baby sleeps through the night in one stretch for 6 hours withoutnursing), OR

c. Her baby reaches 6 months of age

A: Then LAM is no longer effective for the mother as a method ofcontraception and she must shift to another acceptable method of familyplanning.

Q: If a mother is using LAM, what should she do if

a. Her period comes back (restarts, resumes)?b. She starts her baby on solids?c. Her baby is over six months of age?

A: She should start another family planning method that is compatible withcontinuing breastfeeding.

12

12 – Complementary Feeding.

• A baby shows signs of being ready to be started on solids when he is able tosupport his head well, when he begins to reach out for what is around himand put it to his mouth

• After the baby finishes his sixth month of age, his mother can gradually beginto give him solids with a spoon, while continuing with breastfeeding

• The mother starts complementary feeding by giving the baby one kind ofmashed food— e.g. baby rice, vegetables, or fruits, and gradually increasesthe quantity and the variety of food by adding a new kind every 2 to 3 days

• The food offered to the baby should be prepared from fresh ingredients; it isadvised to avoid preserved foods

• The mother needs to remember to wash the vegetables and fruits that sheuse to prepare her baby’s food, and also to wash her hands and the baby’shands before offering him the complementary feed. .

• Between 7-12 months, the mother should breastfeed the baby first, then givethe baby the solid food

• When the baby reaches 10-12 months of age, he can be offered family foodwhile still continuing with breastfeeding until he is two years old or more

• It is advisable not to add sugar, salt, or spices to the baby’s food• The mother can be reassured about her baby’s health and adequate nutrition

by regular visits to the MCH center for follow-up of the baby’s growth anddevelopment