Monday, 15 December 2014

How to Get Pregnant Whilst Breastfeeding

Mother Nature is a hypocritical sod. Check this out: The raison d'etre of your existence is reproduction. So why then, does good ol’ Mother Nature muzzle our fertility while we’re lactating? And is there anything we can do to get pregnant without pulling the plug on breastfeeding? In this post I will answer both questions in turn. What gives me the confidence to speak about this issue? Firstly, I've been there (conceived under 6 month postpartum whilst exclusively breastfeeding), secondly, I've conducted a shed-load of academic research into breastfeeding fertility.

A word of warning before we begin: As a result of reading this, you may find yourself up the duff, toot sweet. Want closely-spaced siblings? Dream of tandem-feeding? Read on!

Aunt Flo takes a vacation

While breastfeeding a lot of mothers notice that ‘shark week’ no longer occurs every month. Yet, as with many physiological happenings that appear idiotic, Mother Nature has a plan. You see, every time you bring your baby to your breast, you are sending your body an important message: “I have my hands full here, this baby needs me!” Because breastfeeding is such an intensive energy-draining practice, your body halts the baby production line so that you can focus your energies on the little cherub you’ve just popped out. Aunt Flo (your menstrual cycle) goes AWOL.

Whilst this is frustrating for the broody mom wishing to get knocked up, it is legit in evolutionary terms, it makes sense. Our bodies evolved in circumstances where moms were carrying their babies 24/7 (we lived in herds and never settled in one spot for too long), where foraging for food and catching prey required significant physical exertion, where babies would suckle every 15 minutes, and where we relied on our own body heat to keep us warm. We modern moms like to whinge that we’ve got it tough, that we’re soooooo busy with multitasking overload, but we don’t know SHIT compared to our prehistoric sisters. 

Mother Nature knew that if babies were ever going to survive longer than their shrivelled cord stump, Mom couldn’t be getting pregnant anytime soon. If she did, she would be too knackered to do all that maternal stuff. And so, by the wonders of natural selection, we inherited an epidemiological quirk: our fertility pauses during lactation, a phenomena known as, yup: ‘lactational amerrhoea’ (took me several days to learn to pronounce that shit, and I still say it like ‘men’s diarrhoea’).

Interesting, but can I successfully breastfeed *and* get pregnant?

Yes, you can!

Okay, how? 

Practically every lay article ever written on breastfeeding fertility has offered the following solutions to the ‘get pregnant whilst breastfeeding’ conundrum: 1. Give your baby a pacifier. 2. Space feedings. 3. Stop night-nursing. 4. Introduce solid foods. 5. Failing all that, wean baby from the breast.

Each of these suggestions is a simplistic anti-breastfeeding knee-jerk scraping of the barrel. They all involve reducing breastfeeds in an attempt to kick-start ovulation. Recall that breastfeeding sends your body the message: “I’ve got my hands full looking after this baby”. The above solutions aim to send the contrary message: “My baby doesn’t need me that much”, or even: “my baby is dead”.

Each solution has varying degrees of success - good for your fertility, not so good for your baby. Folks who offer the above solutions have clearly not read all of the fertility research. We can’t blame them. Most of the research into breastfeeding and fertility focuses on developing countries because fertility is a huge issue to those folks. In countries where survival means strenuous daily physical activity and poor nutrition, postpartum fertility can mean the difference between life (mom doesn’t get pregnant and so can sustain her infant), or death (mom gets pregnant and infant #1 perishes).

However, if you dig around the vaults of epidemiological fertility research (and here’s where being a PhD student has slapped me on the back and bought me a pint), you can discover the dichotomy between lactational amerrhoea in developing countries and lactational amerrhoea in prosperous Western countries.

In essence:

The key to getting pregnant is sending your body a new message: “I’ve got my hands full…BUT it’s still safe to get pregnant right now”. How can you do this? Forget Fertility Friend, your new BFF may just be your local grocery store...

Introducing the ‘Relative Metabolic Load Hypothesis’

Despite its fancy label, this theory is straight forward. Ever since scientists learnt how to precisely measure reproductive hormone levels in saliva and urine, a new body of evidence opened up: the relationship between maternal nutrition and fecundity; or in other words: what you eat while breastfeeding affects your fertility status. Woah, goosebumps! Exciting, no?

This hypothesis suggests that ‘shocking’ your body through nutrition can kick-start fertility. In one study (Lunn et al 1984), a substantial increase in food consumption during lactation had negligible effects on milk production and milk quality but – and here’s the magic – it hastened the return of menstrual cycling, and shortened the interval to next conception!  Yup, turns out the female reproductive system is highly sensitive to metabolic energy availability. It’s the same kind of process as seen in anorexia, only in breastfeeding, the mechanism is way more sensitive (Rosetta and Taylor 2009).

What you eat during lactation has an important effect on fertility – an effect independent of nursing frequency (Frisch, 1978John et al., 1987). Consider this curious fact: Moms that nurse with high frequency get pregnant just as fast as moms who nurse much less frequently... providing they meet the threshold of ‘well-nourished’ (Worthman et al 1993; Valeggia and Ellison 2004; Ellison 2001; Lipson and Ellison 1996). Let’s just soak that up for a moment: Stuffing your face while breastfeeding can increase your fertility. I’ll say it again: Eating more food can increase your chances of conception. 

OMG! So how does it work? 

The studies show that resumption of menstrual cycling is closely coordinated with changing insulin levels, and whaddya know: insulin is a pretty badass stimulator of ovarian estrogen production (Willis et al 2001). Insulin reflects changes in metabolic energy balance (Valeggia and Ellison 2009), it’s a signal to your body that food is available.

So, if you want to increase your chances of getting pregnant while breastfeeding do what scientists refer to as ‘creating favourable energetic conditions’. A sudden burst of energy-dense food consumption can trigger the following cascade: Firstly, mom experiences a brief period of insulin resistance above her average levels, and then, usually a few weeks later, her ovarian cycling resumes. Within this time period, she may notice that her body begins to produce fertile quality cervical fluid (gunky eggwhite vaginal discharge) as her hormone levels pass over that all-important estrogen-threshold. To illustrate, take a gander at the diagram below (taken from the wonderful Weschler 2003). It shows your hormone levels as your body repeatedly attempts to ovulate, and then succeeds:

In other words: Sudden gorging can increase your chances of getting pregnant because it raises your insulin levels higher than your body is used to. Elevated insulin then stimulates ovarian steroid production, causing estrogen levels to rise. (Science, I could hump your leg right now!) Rising estrogen stimulates your fat cells to bring the insulin levels back into the normal range. This whole process serves to jump-start ovarian function as maternal energy availability rises above the demands of milk production. It’s all about reassuring your body that it’s safe to breed. No need to reduce breastfeeds.

This amazing process – your body’s intuition – is a pattern that we humans share with both chimpanzees and orang-utans (Ellison 2001; Emery Thompson 2005). Energy dense foods are cues we can use to satisfy our body’s drive to synchronise reproductive success with energy availability. But before you get all health-police on my butt, I’m not suggesting you should start auditioning for ‘Fat: The Fight Of My Life’ or anything like that. Rather, I'm suggesting that increasing your energy intake is a temporary strategy with the purpose of reassuring your body that food reserves are plentiful. You can always opt for those energy dense foods that come in healthier guises (nuts and honey are stellar examples), but dayuuuum, just look at that cake!

In a nutshell…

You CAN (quite literally) have your cake and eat it. It is possible to nurse all hours under the sun and still conceive. The duration of lactational amenorrhea is inter-related with the relative metabolic load of lactation: fertility will stall if the body experiences lactation as a heavy burden. So, whilst infant feeding behaviour determines absolute metabolic load, maternal nutrition impacts upon relative load. Tonight, we feast!

Good luck, and enjoy the BFP!

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TracyKM said...

While I was never trying to conceive while bf, my periods did return at 12-16 weeks after each baby. I carry a lot of belly fat. Years later, we learn about insulin resistance, belly fat, hormone levels...I go on a low carb, high fat diet...belly fat diminishes, periods get lighter and closer together. I had always wondered if the belly fat (and it's connection with hormones) was a reason for my early return of periods. many women with belly fat also have PCOS and fertility issues. I have every other aspect of metabolic disorder, but no PCOS or infertility....

nicola said...

I've had my cycle since my baby was 3 months old. Now she is 1 years old and I still breastfeed. We've been trying for baby no2 with no success for the past 5-6 months and doctor says it's because I still breastfeed. Can breastfeedin prevent conception even though I have a menstrual cycle?

Alpha Parent said...

Yes it can Nicola. You may be having anovulatory cycles or you may have luteal phase defect, both of which can be maintained through breastfeeding.

Anastasia Assimakopoulos said...

From all my research, the best way to solve a LP defect from breastfeeding is B-6/B-complex. It is a prolactin inhibitor but in small doses doesn't necessarily affect milk supply (not nearly as much as pregnancy does anyway). I took it for one cycle and lengthened my 8 day LP enough to conceive immediately. I'm still breastfeeding my 13 mo.

april said...

Thanks for the B6 information. I am having trouble conceiving while nursing my 20 month old. She doesn't nurse very much, but I seem to have the LP defect...I will try the B6. What dose did you take?

Toto said...

I'd like to conceive again as soon as we can (am exc BF my 4mo and would like to keep doing so up to 8-10mo, haven't yet menstruated) so enjoyed reading this. I'm curious however, when you say 'sudden burst of energy dense foods' do you mean a big meal, or increased consumption over a period and if so how long - a day? week? month?! I've also read that consuming high GI foods increases insulin effectively and quickly - does this mean eating high GI foods will have the best effect in triggering ovulation? And finally, what role does exercise play? If I'm doing regular exercise (e.g. Bikram yoga every second day or so) do I need to consume even more to send my body the right messages? Look forward to any comment. Thank you.

Catherine said...

This is very interesting! I am still breastfeeding my 11 month old son, and we have been hoping for the second pregnancy since he was a few weeks old (I know, crazy - he's a great sleeper). I am wondering the same thing as Toto (above)... how long should we increase consumption? And for how long?

Shawna said...

Wish I had read this six months ago. We started TTC six months ago, no luck so far. My 18 month old still regularly breastfeeds and I haven't gotten my period back yet. Guess I'm off to the grocery store!

aplomb said...

Hi! I'm also curious as to what consumtion increase entails. Is a dozen cupcakes going to be a fix? just once or isit more a double sandwich every day for a week? a month? My 14 month old still BF 3times a day...but ever since starting BF I've had a big appetite anyway. I've gained more weight after pregnancy than during. I'd love to get pregnant again without needing to wean first. I'm just cautious to jump on a sugar binge...
Thanks for some great articles!

Carolyn Morrison said...

I came across this article while googling breastfeeding and fertility and shocked to see such hatred on an article like this. You brought unsuspecting flash backs to someone who actually LOST A CHILD when you said "Send signals to your body that YOUR BABY IS DEAD" How about a warning or something because you never know who your audience is and bringing unsuspecting grief onto a person who is already grieving is ridiculous and uncalled for. I do have a rainbow baby girl and am breastfeeding her and wanted a baby close in age to her. I am really appalled by your statements in this article and will be moving forward to a more informative, less rude article.

Health Discussion said...

Since a woman releases an egg 12-16 days before her expected period, it is possible for women to get pregnant without having periods. Women who are not menstruating due to a certain condition (i.e.…low body weight, breastfeeding, perimenopause) risk the chance of ovulating at any point. For those who want to conceive, the lack of periods could make it more difficult to know the timing of ovulation if you are not charting temperature and cervical fluid changes.

Melanie Ann said...

I am in the same boat as Nicola what do you mean by it can be maintained through breastfeeding? How?
"Yes it can Nicola. You may be having anovulatory cycles or you may have luteal phase defect, both of which can be maintained through breastfeeding."

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