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It can be confusing trying to figure out whether you are indeed fertile while nursing, and, if you are, what to do to avoid or achieve pregnancy. This article separates the myths from the facts.

When to Expect Your Period

Breastfeeding frequency affects the return of fertility.
The more frequently you nurse, day and night, usually the longer until your period returns. In general, with exclusive nursing during the first six months, the average time for return of the menstrual period is 14 months following birth.

Some moms do get their period as early as three months postpartum, even with frequent feeds and no supplementation. Other moms don't menstruate as long as their baby nurses -- up to two years or more. If you decrease the time your baby spends at your breast or your baby starts to sleep through the night, you may very well see a return of your period. If your baby is 6 months or older, your period may be preceded by ovulation. Take precautions if you want to prevent pregnancy.

You may feel like your period is coming for weeks or months.
This is probably your body's way of preparing for a return to fertility. Since the cramping and PMS feelings are similar to normal early pregnancy symptoms, this makes some moms who have not started to menstruate again wonder if they are pregnant. This is unlikely in the first six months postpartum, though it does happen rarely.

If you've breastfed previously, you can often predict the return of your period.
Unless you've changed the way you breastfeed (meaning the frequency, duration, or supplementation), it's very likely that you will experience a return of fertility, including menstruation, around the same time you did with previous pregnancies.

Avoiding Pregnancy

Exclusive and almost-exclusive breastfeeding helps to space pregnancies.
The lactational amenorrhea method is more than 98 percent effective (almost as effective as hormonal birth control) for the first six months if you:

• breastfeed exclusively (your baby receives all sucking and nourishment by breast -- no pacifiers) or almost exclusively (your baby receives no more than one or two mouthfuls a day of food, juice, water, or vitamins)
• have no longer than four-hour stretches between feeds during the day and a six-hour stretch at night, and
• have no bleeding or menstruation (after day 56 following birth)

Once your period returns, consider yourself fertile.
If you aren't fertile now, you probably will be soon. If you want to prevent pregnancy it's important to use birth control.

The later your period returns, the more likely it is to be preceded by ovulation.
If your period returns in the first six months of breastfeeding it's unlikely that you'll ovulate ahead of time.

Non-hormonal contraceptive methods are the first choice while breastfeeding.
Once your fertility returns, non-hormonal methods such as condoms, diaphragms, non-hormonal IUDs, cervical caps, and contraceptive sponges are considered safest while nursing.

If you decide you'd like to take the pill, talk to your doctor about using a progestin-only pill, which has less chance of affecting your milk supply. Combination pills containing estrogen can significantly decrease your milk supply and are not recommended while breastfeeding.

Trying to Get Pregnant

Alter your pattern of nursing to encourage the return of fertility.
If your baby is at least 6 months of age and getting significant nutrition aside from breastfeeding, you can consider gradually making these changes:

• Allow at least one six-hour period without nursing
• Space out daytime feeds to more than four hours between feeds
• Decrease the length of feeds
• Increase the amount of solid foods your baby consumes

It's important to be aware that changing your nursing pattern in this way can also encourage weaning.

Pay attention to your cervical mucus.
Fertile mucus is stretchy and slippery. You may have several periods of fertile-looking mucus before you're actually fertile. Make love each day when your mucus is fertile.

As silly as is sounds, sometimes conception is difficult during lactation because not much lovemaking is going on. A book that explains your fertility in depth is Toni Wechsler's "Taking Charge of Your Fertility."

Some nursing moms can't get pregnant as long as they're breastfeeding.
Breastfeeding not only affects the ability to conceive but also can affect implantation. Every mother's body is different. Some moms easily conceive while nursing, once their period returns, while others can't get pregnant no matter how much they try tweaking their baby's feeds.

Safety Note

If the frequency and duration of your baby's nursing suddenly increases once your menstrual cycle has returned, you may experience an extended length of time between periods. It's important to still consider yourself fertile at this time.