RE: Breastfeeding twins update

[Guest guest]

Joe (Dr. Stanford):

Good to hear from you and thanks for challenging my statement on NFP use and

Breastfeeding. I too, do not like it when research finding are over stated --

which mine " probably " was. I made my statement based on this study

Am J Obstet Gynecol. 1991 Dec;165(6 Pt 2):2031-6.

Ovulation method use during breastfeeding: is there increased risk of unplanned

pregnancy?

Labbok MH, Stallings RY, Shah F, Pérez A, Klaus H, son M, Muruthi T.

SourceIISNFP/IRH, Department of Obstetrics and Gynecology, town

University, Washington, DC 20007.

" However, the unplanned pregnancy rate was elevated among breastfeeders during

the months after menses return compared with the pregnancy rate during

nonlactating cycles. Rates were also elevated at the time when infant feeding

supplementation was started. This increase in unplanned pregnancies was not

directly attributable to nonadherence to the ovulation method rules; there was

some indication that adherence to the rules actually may be increased during

those months. "

Data from two prospective studies of the ovulation method in Nyahururu, Kenya,

and Santiago, Chile, were analyzed to assess the occurrence of pregnancy and

related behaviors among breastfeeding women. The rate of unplanned pregnancy was

less than 1% during the first six months of lactational amenorrhea, but was

elevated among breastfeeding women during the months after menses return

compared with the pregnancy rate during nonlactating cycles. Rates were also

elevated at the time when infant feeding supplementation was started. The

authors note that the increase in unplanned pregnancies cannot be directly

attributed to nonadherence to the ovulation method rules. In fact, there was

some indication that adherence to the rules may even be increased during those

months. "

And from a review of other studies that show a disassociation of natural

indicators of fertility with actual fertility:

An Australian study had 55 breastfeeding women participants rate their cervical

mucus from -1 to a +9 and collect daily 24 hour urine samples for estrogen

levels.20 The researchers discovered that the cervical mucus ratings did not

correlate with the presumed fertility (i.e., estrogen rises) about 40% of the

time. An Italian group of researchers followed 40 breastfeeding women through

their first menstrual cycle post-partum with serial ultrasound.24 The

participants also charted their cervical mucus observations and basal body

temperature. They found that eight of the women failed to record cervical mucus

changes, 12 had cervical mucus constantly present, six had cervical mucus

present greater than 20 days, and 14 had fertile mucus for 7-10 days. They

concluded that cervical mucus monitoring was inaccurate in predicting

post-partum fertility. They also found 28 of the 40 women had inadequate or no

discernable temperature shift in ovulatory cycles.

In a small sample of breastfeeding women using the symptothermal method of NFP,

researchers found that in the first ovulatory cycle, the basal body temperature

shift was four days after the LH peak +1 day estimated day of ovulation.25 In

other studies, the first BBT shift was from 6-13 days after the first ultrasound

detected ovulation, and the symptoms overestimated the actual time of fertility,

i.e., were not very specific.26,27 This dissociation of the fertility symptoms

of NFP from the actual hormonal picture is perplexing. A recent study found

that the follicular development during the amenorrhea phase of breastfeeding was

actually larger than during the follicular phase in the first menstrual cycle.28

The results showed that the number and diameter of the follicles were

significantly greater during breastfeeding amenorrhea compared to the early and

mid-follicular phase of regular menstrual cycles. They also found that

Estradiol levels were similar during lactation amenorrhea, the early follicular

phase, and the mid-follicular phase. However, compared to regular menstrual

cycles, lactational amenorrhea is associated with higher prolactin levels,

normal or slightly elevated steroidal gonadotrophins (LH and FSH), and increased

number and size of follicles, without an increase in estradiol, inhibin B, and

Pro-alpha C. The authors concluded that, during lactational amenorrhea, there

is a profound dissociation between follicular growth and follicular endocrine

activity.

20. J.B. Brown, P. son, and M.A. , " A study of returning fertility

after childbirth and during lactation by measurement of urinary oestrogen and

pregnanediol excretion and cervical mucus production, " Journal of Biosocial

Science (Suppl.) 9 (1985): 5-23.

21. L. Hatherley, " Lactation and postpartum infertility: the use-effectiveness

of natural family planning (NFP) after term pregnancy, " Clinical Reproduction

and Fertility 3 (1985): 319-334.

22. M.H. Labbok, R.Y. Stallings, and F. Shah, et al., " Ovulation method use

during breastfeeding: Is there increased risk of unplanned pregnancy?, "

American Journal of Obstetrics and Gynecology 165(Suppl) (1991): 2031-2036.

24. G.A. Tomaselli, M. Guida, and S. Palomba, et al., " Using complete

breast-feeding and lactational amenorrhoea as birth spacing methods, "

Contraception 61 (April, 2000): 253-257.

25. M. Zinaman, and W. son, " Efficacy of the symptothermal method of

natural family planning in lactating women after the return of menses, "

American Journal of Obstetrics and Gynecology 165 (Suppl) (1991): 2037-2039.

26. K.I. Kennedy, B.A. Gross BA, and S. Parnteau-Carreau, et al., " Breastfeeding

and the symptothermal method, " Studies in Family Planning 26 (1995): 107-115.

27. W. Li, and Y. Qiu, " Relation of supplementary feeding to resumption of

menstruation and ovulation in lactating postpartum women, " Chinese Medical

Journal 120 (2007): 868-870.

28. E.V. Velasquez, R.V. Trigo, S. Creu, S. Campo, and H.B. Croxatto,

" Pituitary-ovarian axis during lactational amenorrhoea. I. Longitudinal

assessment of follicular growth, gonadotrophins, sex steroid and inhibin levels

before and after recovery of menstrual cyclicity, " Human Reproduction 4 (2006):

909-915.

Breastfeeding twins update

>

> I'm posting from Yahoo homepage as it looks like my first attempt didn't post.

Apologies if this ends up posting twice.

>

> To our shock and amazement, we confirmed this weekend that number 9 is on the

way. The twins are 5.5 mo old. I had absolutely no mucus symptoms, in fact this

is the first time I have ever been dry, dry, dry while nursing. I'm guessing,

mostly based on the faintness of the test result and appearance of symptoms that

I am barely 4 weeks. I suspected pregnancy after an episode of post-coital

bleeding, followed by constant pelvic heaviness followed by nausea starting a

week later. I have decided to be happy about this and not worry about the

details, as I know no one else in our circle will feel the same. I trust the

Lord knows what He's doing. Dh is trying but struggling, so prayers for him,

please. (Update since my attempt to post yesterday: he is already feeling more

optimistic.) I have had very early return of menses before, but never without

any warning symptoms of fertility. I'm feeling quite disillusioned with NFP as

it has always been a constant struggle for us with my cycle history, but I was

convicted about the errors of contraception long before my conversion to the

Catholic Church. So we have limited options.

>

> Can dehydration affect the mucus sign? I have been struggling to stay hydrated

while breastfeeding the twins. I don't do internal checks as I have a history of

virulent GBS infection, and temps are nonsensical when you are awakened every

30m to 2h (on a good night) all night.

>

> ~Bekah <><

>

> ------------------------------------

>

>

[Guest guest]

(and Joe - Dr. Stanford):

I am not too impressed with efficacy rates based on LAM and on pre-first

menstrual cycle post-partum.

Cycle " 0 " is essentially one long cycle with ovulation towards the end -- and

many with short luteal phases that would not support a pregnancy.

Most unintended pregnancies that occur during the breastfeeding transition --

from our experience -- and from other studies (like the one previously posted)

occur within the first 6 cycles post-partum. It would probably be better to

calculate efficacy of NFP methods during the breastfeeding transition by cycles

of use -- with cycle " 0 " being counted as one cycle -- and not by months of use.

I am not fixed by the above statements -- just struggling with the concepts.

Re: Breastfeeding twins update

In this talk about the relative effectiveness of breastfeeding in postponing

pregnancy and in the transition phase, let's not forget two old studies that

found pregnancy rates of 5 and 6 percent based on the simple criterion of first

postpartum menses. That is, without periodic abstinence and relying only the

first period as a sign of potential fertility, only 5 or 6 percent of the

mothers became pregnant before that first period. I would say that compares

quite favorably with the " imperfect " or " typical " use rates of some forms of

systematic NFP. The Remfry and Prem studies are at our website.

F Kippley

NFP International

www.NFPandmore.org

Breastfeeding twins update

>>

>> I'm posting from Yahoo homepage as it looks like my first attempt didn't

>> post. Apologies if this ends up posting twice.

>>

>> To our shock and amazement, we confirmed this weekend that number 9 is on

>> the way. The twins are 5.5 mo old. I had absolutely no mucus symptoms, in

>> fact this is the first time I have ever been dry, dry, dry while nursing.

>> I'm guessing, mostly based on the faintness of the test result and

>> appearance of symptoms that I am barely 4 weeks. I suspected pregnancy

>> after an episode of post-coital bleeding, followed by constant pelvic

>> heaviness followed by nausea starting a week later. I have decided to be

>> happy about this and not worry about the details, as I know no one else

>> in our circle will feel the same. I trust the Lord knows what He's doing.

>> Dh is trying but struggling, so prayers for him, please. (Update since my

>> attempt to post yesterday: he is already feeling more optimistic.) I have

>> had very early return of menses before, but never without any warning

>> symptoms of fertility. I'm feeling quite disillusioned with NFP as it has

>> always been a constant struggle for us with my cycle history, but I was

>> convicted about the errors of contraception long before my conversion to

>> the Catholic Church. So we have limited options.

>>

>> Can dehydration affect the mucus sign? I have been struggling to stay

>> hydrated while breastfeeding the twins. I don't do internal checks as I

>> have a history of virulent GBS infection, and temps are nonsensical when

>> you are awakened every 30m to 2h (on a good night) all night.

>>

>> ~Bekah <><

>>

>> ------------------------------------

>>

>>