Breastfeeding, Infertility, and Contraception
Michal Schonbrun, MPH, CHES
www.poriutivit.com
Revised, February 2008

HAVE YOU BEEN TOLD THAT BREASTFEEDING DOESN’T PROTECT
AGAINST PREGNANCY?
 DO YOU BELIEVE THAT BIRTH CONTROL PILLS AND IUD’S ARE THE
ONLY SAFE METHODS OF CONTRACEPTION?
 WERE YOU TAUGHT THAT A WOMAN CAN NEVER KNOW WHEN SHE
MIGHT BE FERTILE, SO SHE HAS TO BE CAREFUL EVERY TIME SHE
HAS SEX?
If you answered ‘yes’ to any of these questions, you are invited to read a timely
article which could change your (quality of) life.
FACT 1: Breastfeeding, when practiced in a specific way, can be used to prolong the
period of post-partum infertility. Breastfeeding is a partial yet not complete method of
birth control. Your chances of getting pregnant during the first six months are very
small if you enable your baby to suckle very frequently (every 2-3 hrs- day and night),
avoid bottle feeds, maintain physical closeness with your baby, give minimal
supplements, and have no menstrual bleeding (This method is known as LAM, or the
Lactational Amenorrhea Method).
©Joan Relke
FACT 2: There is a direct relationship between a woman’s breastfeeding pattern (the
frequency of suckling by baby) and her natural secretion pattern. All women
experience discernable changes in the quality and quantity of their natural secretions
throughout their reproductive years. These changes are caused by fluctuating
hormone levels. Natural secretions come from crypts or crevices inside the cervix.
Most women notice these secretions as stains in their underclothes or as sensations
of wetness and dryness. While breastfeeding, women can learn how to interpret their
secretions and use this information for effective contraceptive protection during and
beyond the six months stated above (The method is known as the Billings Method or
the Ovulation Method).
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FACT 3: Regardless of whether or not a woman is: breastfeeding with menses,
menstruating regularly; peri-menopausal; coming of the pill; or after a miscarriage or
abortion- she can know if and when her body is fertile, infertile, or trying to ovulate.
Three primary fertility signs (basal body temperature, cervical secretions and cervical
position) enable a woman to ‘map’ her fertile and infertile days. (The method is known
as FAM or Fertility Awareness Method)
FACT 4: The methods which promise you this protection while breastfeeding can be
highly effective and reliable. Yet like most contraceptive methods, the effectiveness
rate will depend on the degree of correct and consistent use by the woman/couple
utilizing it.
©Joan Relke
Introduction
“Fertility Awareness Method (FAM), “Lactational Amenorrhea Method” (LAM), and
the Billings/Ovulation Method refer to scientifically-validated and researched methods
of natural contraception. They are recognized and endorsed by the International
Planned Parenthood Federation, the World Health Organization, and many other
health organizations around the world. FAM was adapted as a method of natural birth
control in the late 1970s and early 1980’ by American and European reproductive
health experts (even though the scientific facts upon which it is based have been
known much earlier). A Brief History of Fertility Charting
LAM was developed as an interim family planning method in the late 1980’s after
undergoing clinical trials in South America. It was later approved as a guide or model
for developing culturally-appropriate, international family planning programs. The
method relies on the traditional practice of prolonged breastfeeding.
The Billings or Ovulation Method (OM) was developed in Australia in the late 1960’s
and early 1970’s by Drs. John and Evelyn Billings, who were pioneers in advancing
the field of natural family planning through their applied research linking women’s
fertility with their cervical secretions.
Each of these methods offer women an opportunity to learn about how their bodies
work. “Body Literacy” enables women to understand their own unique fertility
‘language,’ while gaining a sense of personal power, autonomy, confidence and
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peace of mind. When used alone or in combination, a breastfeeding mother can
know on a daily basis whether or not she could be fertile. These methods work by
informing you when your body is trying to ovulate and when your hormonal ‘see-saw’
is shifting (link to teeter-totter). Despite what many physicians and women still
believe, breast-feeding mothers do not have to resort to birth control pills or IUD’s in
order to effectively prevent pregnancy during the breastfeeding time.
This article explains how breastfeeding and secretion changes can be used to
prevent pregnancy. It will summarize the professional literature regarding lactational
infertility, fertility and hormones, and natural birth control methods. It will provide you
with helpful, ‘hands on’ information for how you can maximize the practice of
contraceptive breastfeeding while controlling your fertility naturally and safely, without
hormones, devices, side effects, or medical intervention. Conventional birth control
methods will also be discussed.
©Joan Relke
What Happens to our Bodies Before and During Pregnancy?
During the nearly four decades of our fertile-bearing years, our bodies are
‘computer-programmed’ to create the conditions necessary for potential pregnancy.
Unlike men who are fertile round-the-clock, women’s fertility is cyclical and limited to
approximately 5-7 day period. A woman’s fertility cycle resembles the moon cycle, an
average of 29.5 days. A woman’s computerized ‘program’ utilizes a complex web of
hormones, or chemical messengers, whose job is to relay specific instructions to
various organs in the body. These hormones are activated according to an intricate
timetable. FSH (follicle stimulating hormone), and LH (luteinizing hormone) are
secreted in the brain; they travel through the blood stream to the ovaries, passing on
instructions to secrete other hormones needed for ovulation and fertilization: estrogen,
produced in the ovary, stimulates the ovarian follicles, and eggs within it, to develop.
The other hormone, progesterone, prepares the body (especially the uterine lining) for
possible pregnancy. Estrogen is also responsible for producing special changes in
our natural secretion pattern. When we are infertile, our bodies produce a thicker and
drier secretion whose acidic properties act as a natural spermicide. As ovulation
approaches, increased amounts of estrogen produce a wetter, thinner, stretchy, and
lubricative fluid that resembles egg-white whose job is to nourish and transport the
sperm while they swim through the chambers and tunnels of our reproductive tract.
When the timing and hormonal conditions are right, the sperm and egg cells have the
opportunity to meet. Estrogen prepares the lining of the uterus for implantation. It
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builds a ‘warm nest’ composed of layers of blood vessels, sugars, proteins and fluids.
Estrogen enables a ripe egg to burst from the ovary and into the fallopian tube so that
fertilization can occur. The egg will only live 12-24 hrs but the sperm can live up to 5
days. Together, these two facts create a window of fertility which is open for nearly a
week’s time. After ovulation progesterone becomes dominant. It is also secreted by
the ovary, and its job is to further prepare the uterus for the nine- month incubation
journey we call pregnancy. Our breasts also undergo cyclical changes as they too
are preparing for pregnancy and breastfeeding function.
If women are not suppressing this natural hormone cycle by taking birth control pills or
other hormonal preparations, they can experience these miraculous changes on a
daily basis.
When women are pregnant, the brain-ovarian- hormonal interplay described above
is suspended (even though hormones continue to secrete in the ovary by the corpus
luteum). Progesterone is essential for ‘holding together’ the uterus during the first
trimester of pregnancy. Later on, when the placenta develops, other hormones play a
dominant role in supporting the pregnancy in the uterus. Luteal and placental steroids
naturally suppress circulating levels of FSH and LH in the bloodstream and disrupt its
release from the pituitary gland in the brain. During childbirth and after the placenta is
delivered, the inhibiting effects of estrogen and progesterone are removed and levels
of FSH and LH gradually rise and the pituitary’s release of these hormones returns
.
What Happens After Childbirth?
If a woman does not breastfeed, her first period will most likely return within 4-6
weeks of delivery. In two out of three women, the first bleeds will occur in the
absence of a proper ovulation because of a still shifting hormonal imbalance. This
means that is highly unlikely that a woman could get pregnant so soon after giving
birth and before getting her first period. By the second and third cycles, approx 85%
of women will be ovulating normally.
Lactational Infertility
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Lactation, or breastfeeding, is what helps extend the period of infertility and
depresses ovarian function. While blood levels of FSH return to normal levels after
two months, the LH stimulation and release is depressed in the brain, thereby
confusing the body and preventing a proper ovulation. 70-80% of breastfeeding
women will have one or more annovulatory (non-ovulating) cycles before their
fertility completely resumes.
Infant suckling helps to stimulate the nerve endings in the nipple. These nerve
impulses are passed to the hypothalamus (brain), which in turn stimulate the release
of prolactin- a hormone which increases during pregnancy twenty-fold and which
controls the rate of milk production. It is thought that the more the baby sucks, the
more milk and prolactin are produced. Not all studies bear this out and the
mechanism is still not completely understood. Another hormone, oxytocin, helps
regulate the milk flow or ‘let-down’ reflex. Suckling stimulates oxytocin, by causing
contractions in the breast cells which help push forward the stored milk in the lobes so
that it can reach the ducts and nipples.
Contraceptive Benefits of Breastfeeding: LAM Method
In 1989 a group of international scientists met in Bellagio, Italy for the purpose of
reaching consensus about the ways in which women could use breastfeeding as an
effective form of contraception. The consensus reached was as follows:
For up to six months, a woman can enjoy a fertility-free honeymoon (98% effective)
if she meets the following criteria:
a) She is fully or nearly fully breastfeeding
b) If no other liquids or solids are given to the baby on a routine basis, or if
vitamins, mineral water, and juices are given infrequently.
c) If she has not experienced a first, postpartum menses or bleeding.
According to the professionals who devised these guidelines, LAM is a highly effective
method of contraception because it enables the infant to obtain nearly all nutritional
requirements through breastfeeding and maximal suckling stimulation at the breast.
As long as additional foods do not decrease the duration or intensity of suckling, small
amounts of supplements should have little or no effect on the return of fertility
The consensus grew out of a growing body of research which seemed to show that
frequent stimulation of the breast accompanied by long feeds, short intervals between
feedings, and night feeds are the primary factors which inhibit ovulation and thus
produce a contraceptive effect. This happens because frequent nursing is associated
with increased prolactin levels in the blood and to amenorrhea. Frequent
breastfeeding is also believed to cause a suppression of ovarian function.
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While the LAM Method has been actively promoted for nearly two decades
by important public health organizations and professionals, LAM has also been
criticized and discredited by other scientists and fertility specialists. Some have
challenged the entire hypothesis that frequent breastfeeding alone is the primary
ingredient in the recipe for extending infertility and achieving a contraceptive effect.
For one, they claim that research carried out mostly in the developing world cannot be
applied to the western, developed world. Breastfeeding “on demand” means different
things in different cultures. Many women mistakenly assume that ‘full’ breastfeeding
prevents ovulation, menstruation and pregnancy. According to LAM, the ‘full’ must
be implemented with a high frequency- every 2-4 hours. This is known as ecological
breastfeeding. Furthermore, critics point out that breastfeeding patterns are not just
baby dependent- they are also determined by ‘opportunity’. There are social and
cultural factors which define the meaning of an ‘opportunity.’ A traditional woman in a
tribal culture does not “plan” /schedule” her feeds as does a women in a modern,
western culture. The notion of keeping a baby on a sling close to the mother’s breast
24/7 for 2-3 years while s/he suckles every 15 minutes- is quite foreign and
unacceptable to a “modern” woman and it is this pattern of nursing which can prolong
the period of infertility for 1-2 years. Therefore the breastfeeding as contraception
formula does not hold true in all places for all women. . It is not uncommon for a ‘fully’
nursing mother to get her first period three months post-partum. We also know of
women who get pregnant while nursing even before their first period and before the
six-month mark. In ‘modern’ societies there are other factors which reduce the
contraceptive effect of frequent nursing on fertility. These include: chronic stress and
fatigue, competing demands on a mother’s time (other children, work, economic and
domestic pressures).
Critics of LAM point out that even though the majority of scientists agree that more
intensive breastfeeding does in fact extend the duration of lactational amenorrhea -no
particular pattern of breastfeeding can be associated with a specific contraceptive
effectiveness! Some studies show that prolactin levels don’t change before and after
nursing. These studies challenge the notion that frequency of nursing is the sole
deciding factor.
Some LAM critics postulate that there are physiological characteristics of the
mother (and not just behavioral characteristics) which vary in every environment and
which have an equally responsible role in determining the period of post-partum
infertility. One of these characteristics is known as the relative metabolic load or RML.
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This represents the proportion of the mother’s metabolic budget that is devoted to milk
production and this budget varies according to the amount of metabolic energy
available to her. RML is of course affected by other factors, such as nutritional status,
health status, daily caloric intake, levels of physical exercise, and the availability of
food supplements. In a mother with a constant metabolic budget, the relative load of
lactation decreases as milk production decreases. Between women, however, and for
the same woman at different times, a given level of milk production may represent a
greater RML when her overall energy budget is low, or a lesser RML when her overall
energy budget is high. Comparisons between populations must be made carefully in
order to discriminate between the two approaches- frequency and RML. Populations
in which frequent and prolonged nursing is the norm are often populations
characterized by moderate under-nutrition, making the RML of lactation greater. Field
studies show that well-nourished women who nurse their young as often as undernourished women- find that their length of post-partum amenorrhea is half as long!
Healthier women consume more calories and have more body weight and fat. As a
result, this may tip the metabolism scale and enable a woman to get pregnant againsooner than a woman who is under-nourished, underweight and with less body fat. If
this hypothesis is correct, we can appreciate the fact that a high frequency formula for
breastfeeding may not be a reliable form of birth control. While the two approaches do
not essentially contradict each other (they actually support each other), they have not
been adequately discussed in most of the literature which encourages women to
breastfeed according to the LAM criteria. The cautious conclusion, therefore, is that a
woman needs to rely on something other than breastfeeding if she desires to prevent
pregnancy.
The Billings Ovulation Method**
Unlike the LAM method which relies on a calendar formula and a certain type of
frequent breastfeeding routine, the Billings Ovulation Method relies on cervical
secretions and vaginal sensations to gauge a woman’s fertility during the
breastfeeding time. Once the bleeding and lochia from childbirth end, a woman can
start observing and charting her (cervical) secretion pattern. With the help of a
qualified teacher, a woman learns how to recognize true vaginal dryness (no
secretion), unchanging dry secretions, and wet secretions. She learns to establish her
BIP- basic infertile pattern. Once she determines her BIP, rules are applied which
enable frequent sexual relations on ‘safe’ days. A woman can rely on her BIP until a
new secretion pattern emerges and/or until she experiences a first bleed. Adherents
to the Billings Ovulation Method rely on abstinence during the fertile time because
they do not believe in using any artificial methods of contraception. Secretions are
usually checked externally even though for some women internal checking is more
precise and reliable.
It is important to reiterate that a woman’s secretion pattern parallels her
breastfeeding pattern. Women who are fully breastfeeding at high frequency (day and
night) can expect to experience continuous dryness and/or dry secretions for weeks if
not months at a time. These women may also experience discomfort or pain during
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intercourse because of low levels of estrogen. In this case, water-based vaginal
lubricants are recommended to remedy the problem.
When Secretion Patterns Change
The BIP will continue as long as the breastfeeding pattern is constant and stable.
Eventually, when solids and supplements are introduced and when the baby sleeps
for longer periods, the hormonal triggers from breastfeeding which suspend our
fertility will decrease and weaken. To reiterate, nursing mothers will notice a change
in their secretion pattern (to a more fertile one) when:
1. the baby begins to sleep longer intervals and through the night
2. the mother returns to work or is separated from baby for parts of the day
3. other foods/solids/supplements (even pacifiers) are introduced
4. the breastfeeding schedule and pattern change- weaning begins, in event of
traveling, illness, medications, etc...
Despite these changes, a woman has the knowledge and tools to diagnose her
‘fertility status’ every day.
** This method is not recommended for women who suffer from untreated or chronic
yeast/candida infections. The presence of yeast will mask a woman’s normal
secretions.
Women who notice unfamiliar secretions accompanied by symptoms should have a
vaginal culture done to correctly diagnose the infection, and then choose a
conventional or natural treatment approach.
©Cynthia Aldrich
Extending the Benefits of Natural Contraception During and After Six Months
Near the six- month postpartum time, most women will not be able to adhere to the
criteria defined by the LAM and Billings’ methods alone, and therefore will need to rely
on additional contraceptive tools. Most women will already have begun to introduce
solids to the infant’s diet, usually in the form of cereals and fruit and vegetable puree.
Artificial milk, juice, or bottled water are often included in the diet by this time. If a
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woman wants to maintain her milk supply and delay the return of fertility, she should
always nurse first and offer solids/supplements afterwards. If supplements are given
first, the baby will experience satiation earlier and have a reduced appetite for breast
milk. This will lead to a decreased milk supply. Most babies at this time are sleeping
longer hours, which means there is decreased stimulation to the breast. The
breastfeeding hormones, prolactin and oxytoxin, may ‘lose their grip’ and within a
short time, a woman might experience a first bleed, wet secretions, and attempted
ovulation. Weaning a baby or toddler, whether gradually or suddenly, could also
result in one’s fertility returning quickly. Fortunately, there is a full-proof way of
knowing in advance how and when this will happen.
Fertility Awareness Method (FAM)
While ecological breastfeeding, LAM, and Billings offer two basic approaches to
postpartum protection, Fertility Awareness provides an additional tool. For women
who want to prevent pregnancy both during and beyond the six-month window of
time, FAM involves the observation and charting of three primary fertility signs which
signal when the window of fertility opens and closes. A woman relies on her infertile
secretion pattern (as in Billings) until she either experiences a different wetter-fertile
pattern or until she experiences an episode of bleeding. This change most likely
occurs when breastfeeding becomes less frequent, when the baby is eating more
solid foods, and/or when the baby is sleeping longer intervals at night (more than 5-7
hours).
Few women have been taught that there is a distinct and clear relationship
between natural secretions and fertility, and between secretions, fertility status and
breastfeeding. Most women in developing countries understand and take advantage
of this because they practice a culturally-accepted form of breastfeeding “on demand.”
Their “lifestyle” includes staying in close proximity to their infant (often attached to the
mother by a sling) and nursing frequently, even if only for a minute at a time 2-4 times
an hour! On-going stimulation of the breast makes it possible to space pregnancies at
intervals of 2-3 years.
Natural Contraception (FAM) When Fertility and Menses Return
Once menstruation resumes, FAM includes two additional fertility signs which
enable a woman to identify the fertile and infertile days of the cycle. These signs are
basal body temperature (BBT) and cervical position (CP). BBT refers to the
temperature of the body at rest. When measured for less than one minute with a
special digital thermometer, women can learn how to identify the shift in temperature
which occurs after ovulation. A woman’s BBT stays relatively high for nearly two
weeks until the next menstruation. Safe and unprotected sex can take place for most
of this period. The second sign, cervical position, also changes at the time of
ovulation, By checking internally with a middle finger, a woman can feel the cervical
opening rise (toward the uterus), open and soften. During ovulation these changes
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allow sperm to easily enter and travel in the reproductive tract. Immediately after
ovulation, CP lowers, closes and hardens.
FAM can also be used to plan your next pregnancy and slightly increase your
chances of choosing the gender of your baby.
© David Harris
Other Contraceptive Options for Breastfeeding Women
Almost all contraceptive methods are effective when used perfectly- meaning
consistently and correctly. Yet because human behavior tends to be irrational and
inconsistent, women and couples who use contraceptives often use them imperfectly.
Women and their partners should carefully consider the advantages and
disadvantages of each method, as well as their own values and priorities, before
choosing a method.
Oral Contraceptives
Oral contraceptives containing estrogen are not recommended for nursing
mothers. Many health professionals are concerned that all hormone combinations that
suppress ovulation may have short- and long-term adverse effects on breastfeeding
infants because small amounts of hormones make their way into the breast milk.
Furthermore, most types of pills containing estrogen will reduce the milk supply.
Pills that contain progestin only are considered compatible with breastfeeding.
Femulin and Cerazette are progestin-only pills which are considered safe because
they are low-dose preparations. Low dose pills though can cause sporadic or
continuous staining in some women and they are statistically less effective in
preventing pregnancy than combined estrogen and progesterone pills.
IUD’s
IUD’s are effective methods and carry no risk to the infant, nor do they have any
effect on breastfeeding and milk supply. Insertion can take place within 48 hrs or
four-to-six weeks after delivery. Some IUD’s can be inserted after the sixth week
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postpartum. IUD’s usually increase menstrual flow and blood loss and carry a certain
risk of pelvic infection which can affect future fertility. IUD’s which secrete
progesterone (like Mirena) cause cervical secretions to become thick and pasty
thereby preventing the sperm from reaching the outer tube where fertilization occurs.
Other IUD’s contain copper coils which create an ionizing effect which inhibits sperm
motility. Eventhough some women will get pregnant with an IUD in place, the
enzymatic activity usually inhibits the sperm, making it difficult for sperm to reach the
fallopian tubes and the egg.
Barrier Methods & Spermicides
Some barrier and spermicidal methods are available without a prescription (but
there are few products available in Israeli pharmacies). This group of methods is
considered to be 75-95% effective when used consistently and correctly. Methods
such as condoms, diaphragms, sponges and caps are safe and reliable methods,
when used perfectly by responsible and unambiguous users. They all require a
degree of skill (perfected by practice), motivation and partner cooperation. Barrier
methods should not be initiated until at least six weeks after delivery, as they cannot
be fitted properly until the uterus returns to its pre-pregnancy size and the risk of
infection drops. Only two spermicides are available in Israel- Glovan suppositories
and the ProtectAid vaginal sponge. Other methods can be purchased abroad or on
the internet.
© David Harris
Why Doctors Don’t Recommend Natural Methods
Fertility Awareness tools (basal body temperature (BBT), cervical secretions, and
cervical position) have been known for many decades. Gynecologists sometimes use
BBT and secretion changes for diagnosing and treating infertility, but they are largely
unfamiliar with FAM as an effective method of birth control. Many doctors and health
professionals mistakenly confuse the scientific, natural methods with the ineffective
rhythm method (based on calculations of past cycle lengths), or they are misinformed
and/or biased about their use. Although scientifically-validated and researched, these
methods are not taught in medical school as effective methods of contraception.
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It is a fair characterization to say that in the present medical culture, hi-tech
methods are preferred over low-tech ones. The fact that women can learn and apply
natural methods without medical intervention and the fact that pharmaceutical
companies don’t profit from their use, may be additional reasons why physicians show
little interest or faith in them.
When we look at cultural and lifestyle preferences, most people seem to prefer
‘quick fixes,’ which make oral contraceptives and IUD’s look easier and better to use.
It is only in the last fifteen-twenty years that women have begun demanding safer
and effective alternatives to ‘hi-tech, ‘modern’ methods.
A growing number of holistic and complementary practitioners as well as rabbis,
niddah advisors and breastfeeding counselors are becoming informed about the
benefits of natural methods. The only hitch is that these methods cannot be
successfully learned from a friend or a book. They require the help of an experienced
and trained teacher. The process requires a few instructional learning sessions,
phone follow-up, and couple cooperation and communication. The process involves
an initial investment of time and cost. If someone tries to implement this on her
own, she will be at risk for unintended pregnancy Natural methods are not
suitable for every one.
Back to Nature
Fertility Awareness is something we all should have learned in high school biology
class. Men and women alike would be more comfortable, knowledgeable and
accepting of their bodies had they learned this vital information at an earlier age. For
the anthropologically-minded, it is worth noting that there are tribes (in Africa and
Indians in North America) which have been teaching natural fertility for generations!
When celebrating a young girl’s first menstruation, all the females in the tribe,
representing all the generations, gather upon the highest hilltop and participate in a
festival lasting a few days. Utilizing storytelling, dance, special foods, costume and
song, the tribal women celebrate the young girl’s ‘coming of age.’ The peak of the
ceremony occurs when the girl’s grandmother or a village elder removes a flat,
smooth stone from a leather pouch. She then proceeds to instruct the young girl how
to wipe her vaginal opening so she can know when she is and is not fertile…so she
can take charge of her fertility at the outset of her becoming a woman… so she can
plan her pregnancies when she is ready and sure…
The mere existence of this traditional ceremony both highlights and confuses our
definitions of primitive and modern cultures. It is strangely paradoxical that as our
society ‘advances’ in terms of medical science, technology and research, an
individual’s personal understanding and control over their bodies seems to be waning
or weakening. We live in a world where external experts are expected to know more
about our bodies than we are. It is ironic that amidst the information explosion and
the ‘freedom to choose’ mantras which pervade our culture, so many women have
lost touch with or become estranged from their feminine selves. Perhaps it is time to
reconsider the sacred and honored place of ‘primitive’ customs, if only to enable
women in the post modern world to feel empowered in and by their bodies. Perhaps
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the time has come for women to question the medicalization model of fertility and the
body- if only for the purpose of gaining greater self-confidence, control, and
autonomy. Women can be their body’s best experts-if they so choose.
© David Harris
It must be stated clearly that a natural approach to anything involves time, effort,
commitment, responsibility and discipline. While the pay-offs and benefits can be of
great worth and have a positive, direct impact on quality of life, each couple must
weigh the advantages and disadvantages these methods offer, based on their values
and present needs. They require a few minutes’ ‘work’ a day for correct practice, in
addition to partner support, communication, and cooperation. Natural methods are not
recommended for couples in non-monogamous or casual relationships. They can be
used during a woman’s entire reproductive life.
You the reader are invited to deepen the historic connection to your natural
rhythms, bodies and feminine essence. Learning to tune in to the ebbs and flows of
female cycling can help all women better trust their instincts, make wiser choices, and
ultimately take fuller responsibility for their health and well-being.
Bibliography
1. Taking Charge of Your Fertility, (10th Anniversary Revised Edition)
Toni Weschler, 2006
2. Postpartum Contraception and Lactation, in: Contraceptive Technology,
(18th Revised Edition), Ardent Media Inc. NY, pp. 575-600, 2004
3. The Art of Natural Family Planning, 4th edition. John and Sheila Kippley. The
Couple to Couple League International, Inc. Cincinnati, OH., 2003
4. Breastfeeding and Contraception, in:Harefuah (Israel Journal of Medicine)
Vol. 140, June 2001 (Hebrew)
5. On Fertile Ground, A Natural History of Human Reproduction. Peter T. Ellison.
Harvard University Press,2001
6. The Breastfeeding Handbook (Revised Edition), (Handbook for health
professionals) J. Goldfarb and E. Tibbetts, 1989
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6. Consensus statement on the use of breastfeeding as a family planning method,
in: Contraception, 39: 477-496 (1989)
7. The following groups are among those involved in researching the
relationships between breastfeeding and infertility: International Planned
Parenthood Federation, Family Health International, International Studies in
Natural Family Planning at Georgetown University, Washington, D.C., the
Population Council.
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