getting pregnant while breastfeeding
Despite what you may hear from well-meaning friends and relatives, you CAN safely get pregnant while breastfeeding. Here's how! (updated 12-13-17)
:biggirl: You do NOT need to wean in order to get pregnant. As your baby gets older and starts to get more of his/her nutrition from solids, typically they begin to nurse less and less and your fertility will return, even if you are still nursing several times a day. Breastfeeding does suppress ovulation (called lactational amenorrhea for those who like to know such things) but your baby must be nursing at least every 4 hours during the day and every 6 hours at night for this to work reliably.
:biggirl: You do NOT need to wean once you have gotten pregnant, many women (including atomic herself, twice) have successfully and safely nursed throughout pregnancy and after their next baby is born! (this is called "tandem nursing" and there is a great book available on the subject http://www.amazon.com/Adventures-Tan.../dp/0912500972)
Some people (and sadly, some of these people are doctors) will tell horror stories about the friend-of-a-friend who miscarried while breastfeeding but it is highly likely that it was just a coincidence - since 1 in 5 pregnancies end in miscarriage regardless of breastfeeding, some women who are pregnant while breastfeeding will miscarry, but the breastfeeding did not cause the miscarriage. Around the world, breastfeeding while pregnant is very common and it is believed to be perfectly safe.
:biggirl: Breastfeeding can make it tougher to tell if you're in your fertile window or not. Some women get NO EWCM at all while breastfeeding, and others get a constant supply of sticky cervical mucus that is easy to mistake for EWCM, or phases of dryness interspersed with stickiness. This is a part of the "basic infertile pattern" and as long as this pattern continues for at least 2 weeks, you are ~probably~ not fertile.
If you notice changes in your CM consistency (particularly if it gets creamy or wet) or if you have any bleeding after 56 days postpartum, you should consider yourself to be fertile. Bleeding prior to 56 days postpartum is virtually always lochia, even if you have stopped bleeding for a week or two and then started bleeding again.
:biggirl: If you're not fertile yet, there are things you can do to help your fertility return sooner. The most important thing is to play around with your breastfeeding schedule, perhaps even cut back a bit. You probably do not need to cut back radically, even eliminating just one feeding (particularly a nighttime feeding between the hours of 1 am and 6 am) may help bring back your cycle sooner. Abrupt changes restore fertility more quickly than gradual or intermittent changes do so if you are executing this plan, you can't waver even if your baby gets sick or protests giving up their nighttime feeding!! (but seriously tho - always put your baby's needs first! if it doesn't work out one month, there's always next month, and every month that passes you'll be that much further out from birth and your cycle will be that much more likely to come back on its own anyway)
Eating ample calories and nutrients can help your fertility to return sooner. Weight loss tends to keep fertility away longer. If you're following LE Diet and nursing, you need to be at upper levels of food intake - 1800-2000 calories or even beyond that and 50-60 g protein and fat. Cutting back on diet while breastfeeding will make it take much longer for your cycle to normalize.
You can also try the herb vitex. It is safe while breastfeeding and has seemed to help restore cycles in women who are breastfeeding, even if they are breastfeeding a lot and losing weight. Start off with one in the morning and one at night from AF-O ONLY.
How, one might ask, will a person know when AF-O even is if they are not menstruating? Well, one way is to take note of "practice cycles". Your body gears up to ovulate before ovulation actually returns, so you may notice uterine cramping, changes in CM and CP, and even PMS (on a personal note, the PMS I get when I am breastfeeding and don't even have my period is 1000 times worse than "real" PMS and my family will testify to that! :sigh:) People have noted very realistic fake ovulations, with pain and EWCM - only their period never arrived. Their bodies prepared to release an egg and the eggs probably even formed in the ovaries, but were never released and were reabsorbed.
Also, refer back to your cycles before you got pregnant with your previous child. Many women have noticed that they resume ovulation/menstruation at about the same time of the month that they did before their pregnancy. If your labor was induced, if you had a premature baby, or if you have a very large age gap between children, this may be less effective a method for you. If this sounds farfetched or unreliable, my first two sons were both born on the 9th of the month and then 13 years later my second two sons were born on the 21st and 22nd of the month, so my ovulation probably tends to resume at the same time of the month after pregnancy. (obviously it changed during the 13 year age gap, but that it happened twice seems to be evidence in favor of this theory.)
If you are noticing practice cycles at the same time of the month that your ovulation/menstruation was - that is a VERY good indication of when to TTC even if you have not had AF yet, and you should take your vitex for 2 weeks prior to your "practice" ovulation. Updated note about vitex - it's really caused more trouble than it's been worth for people and so while I'm keeping the how-to up for those who want it, I can't really recommend using it for anyone any more.
Clomid is also believed to be compatible with breastfeeding, although most doctors insist that you wean before seeking fertility treatment. Femara is less proven safe while nursing than Clomid and most doctors will prefer that you take Clomid while breastfeeding and not Femara.
:biggirl: It is possible to get pregnant before you even have your period! It's less likely, but it is possible. You may be more likely to conceive twins this way.
:biggirl: If your menstrual cycle has returned but is irregular, we still may not be out of the woods yet. Wacky cycles may indicate that hormones are not right for maintaining a pregnancy. The uterine lining may not build up properly, and/or the luteal phase may be less than 12-14 days and not allow enough time for a fertilized egg to implant.
If you do become pregnant while breastfeeding, you may want to check with your doctor right away to see if you need any progesterone support to maintain the pregnancy.
