Can you be pregnant while breastfeeding and not know it

You’ve just emerged from a 9-month roller coaster ride and you’re breastfeeding the baby you carried — which is another adventure all on its own. Whether you want to get pregnant again or not, you may want to put some distance between this child and the next.

Rather than go on the pill or choose another prescription birth control method, you may wonder whether breastfeeding itself can ensure you don’t get pregnant again for as long as you nurse — be it for 2 months or 2 years. Here’s what you need to know.

The scoop is that yes, exclusive breastfeeding is a pretty good form of temporary birth control. (See how carefully we qualified that?)

In fact, this form of birth control has its own name: the lactational amenorrhea method of birth control (LAM). (Don’t let the name throw you. Amenorrhea just means the absence of menstruation.)

How good is pretty good? According to one source, out of 100 women who correctly use LAM during the first 6 months following childbirth, only 1 to 2 of them may become pregnant.

If you’re using LAM and want to be among the majority of women who don’t become pregnant while breastfeeding, here’s what you should do:

1. Practice exclusive nursing. That means you should delay introducing solids and avoid supplementing with formula or anything else.
2. Nurse on demand. Follow your baby’s lead and let them nurse when they want — at least every 4 hours during the day and every 6 hours during the night. Pumping is not an adequate substitute when using LAM.
3. Avoid using pacifiers. Instead, let your baby satisfy their sucking needs by snuggling up and letting them breastfeed.

Keep in mind that for LAM to be effective, your period (including spotting) shouldn’t have returned and your baby has to be under 6 months old. (That’s what makes this a temporary form of birth control.)

Here’s where hormones come in — specifically, oxytocin. This multi-functional hormone doesn’t just make you feel relaxed and generally happy. It’s also responsible for your let-down reflex (that needling feeling that comes just before your milk lets down).

Oxytocin also helps prevent ovulation. It does this by sending signals to the brain that tell it to suppress the main hormone that stimulates ovulation. No ovulation, no pregnancy.

When your baby breastfeeds, they’re stimulating the nerves in and around your nipples in exactly the right way to send that message to your brain. Expressing milk by using a pump doesn’t cause the same effect.

If you’re breastfeeding and hoping that you’ll be among the 98 percent of women who use LAM successfully as a birth control method, here’s what you need to know:

• For LAM to work, you need to be breastfeeding exclusively. If you supplement baby’s diet with formula or even pumped breast milk, your chances of ovulating and getting pregnant increase.
• Ditto for solids. Once your baby hits 6 months and starts eating solids, your chances of ovulation increase. Some older research shows that by introducing food slowly and reducing suckling time gradually, you may be able to push off ovulation for a little longer. However, updated research is needed.
• Watch out when you return to work. One study shows that women who returned to work and were using LAM and expressing their milk to exclusively feed their babies breast milk were more likely to get pregnant than non-working moms using LAM.
• This may sound like a no-brainer, but it bears mentioning: When your period returns, you have a higher chance of getting pregnant. However, keep in mind that some women ovulate even before they get their first postpartum period. Others begin menstruating before they begin ovulating. No hard rules here.

Want to get pregnant but don’t want to stop breastfeeding? The good news is that even though you’re breastfeeding, your chances of getting pregnant increase as you move further away from the day your baby made their appearance.

If you want to further increase your chances of ovulation, try making abrupt changes. Some people find that suddenly cutting out one nursing session instead of stretching out the time between feedings increases their chances of ovulating. Bear in mind that your baby might not appreciate the abrupt changes to their feeding schedule.

There’s no need to wean your baby: You can breastfeed and prepare for your next pregnancy at the same time. Many breastfeeding mothers find that once they go back to work or the coveted full-night’s sleep becomes a reality, ovulation starts up and they begin to menstruate again.

Hasn’t happened yet? Hang in there — most people find that their periods return between 9 and 18 months after their baby’s birth, even if they’re breastfeeding.

You certainly can. But make sure to get enough calories to feed yourself, your baby, and your developing fetus. Aim for 500 extra calories per day if your baby is eating other foods besides your milk and 650 extra calories if they’re less than 6 months old.

In addition, you’ll want to factor in an extra 350 calories in your second trimester and 450 extra calories in your third. Sound complicated? Make it easier for yourself by listening to your body and making healthy food choices.

You may find that your nipples are more sensitive and that your let-down reflex makes you nauseous. This too will pass.

If you’ve had a miscarriage or generally deliver early, keep an eye out for uterine contractions. You may feel a cramping sensation when your baby suckles. This is because your body releases small amounts of oxytocin, and this hormone causes contractions. (Yes, it’s that multi-functional hormone again!) If you’re concerned about the rare risk of preterm labor, discuss this with your OB or midwife.

Don’t be surprised if, after the first few months of pregnancy, your baby starts to refuse your breast milk. Your milk supply will probably diminish, and the taste of your breast milk may change as well. Either of these changes may cause your baby to refuse breast milk and eventually wean themselves.

On the other hand, some parents successfully breastfeed throughout pregnancy and might go on to tandem nurse their newborn and an older child. (In these cases, the newborn’s breastfeeding needs should always take the highest priority.)

If you had fertility treatments to get pregnant with your current little one, you may wonder whether you need to stop breastfeeding before undergoing fertility treatments to get pregnant again.

The answer is that it depends. Some drugs used in fertility treatment are safe to use while breastfeeding. Others will affect your milk supply but not harm your baby. Meanwhile, others could be dangerous to your baby.

Since the jury is still out on this one, you may have to choose between cutting short the time you’d like to breastfeed and starting fertility treatments later. Best practice is to discuss all your concerns with your healthcare provider.

While exclusive breastfeeding is a pretty good form of temporary birth control, talk to your midwife or OB to learn more about other methods of birth control if you want to avoid getting pregnant.

On the flip side, if your period hasn’t returned and you’re aiming to grow your family again, reach out to your healthcare provider to hear about your options. Either way — happy breastfeeding!