[Transcript Auto Generated]
[00:00:00] I am really excited to dig into today's topic, and it's actually going to be a series. Now, I spent the last season, right, all of last year talking about normal breastfeeding in toddlers, weaning toddlers, that side of toddler breastfeeding. And what I didn't really have much of an opportunity to talk about is fertility, pregnancy, and tandem feeding.
It's like the second most popular thing I get questions about. So I will be digging into those over the next three weeks. [00:00:30] So this week, next week, and the following week so today we're going to be talking about fertility, conception, and contraception while breastfeeding.
And then next week we'll talk about pregnancy and breastfeeding. And then the week after we'll be talking about tandem breastfeeding and what that might look like. Now, if you don't feel that these episodes resonate with you, or If the topics resonate with you, I encourage you to hang around because there's going to be a lot of great information that will be applicable to no matter where you're at in your breastfeeding journey.
And also, come back in a few [00:01:00] weeks if that's what you'd like to do. That's alright too. At the very top of the series, I want to Put out a disclaimer that this is not medical advice by any means. I am not a licensed medical doctor. I am a certified lactation counselor, , and I have education and information that I can provide for you, but it is just that.
It's just information and education, and for treatment and diagnosis and all of that stuff, please go see a licensed doctor. In [00:01:30] your area, a medical doctor to get that level of support, right? Um, so the very first question that I want to start off with is, well, two questions. One is, is it possible to get pregnant while breastfeeding?
And I think most of us know, yes, it is possible to get pregnant while breastfeeding. Uh, it's often a kind of a scary thought when you have a very young newborn breastfeeding. It's like, Oh, I don't know if I want to get pregnant right now. And then as you get further along in the journey. One year, two years, it can start to feel [00:02:00] like, I don't know, can I get pregnant while I'm breastfeeding?
Maybe I have to wean in order to get pregnant. But I want to reassure you that in most cases it is possible to get pregnant while breastfeeding. And then the second question that I want to answer right off the top is, is it safe to get pregnant while breastfeeding? And in most cases, yes, it is very safe.
We're going to get into that. topic more in the next episode. Um, of course, there are always caveats and that kind of thing, and we'll talk about that more next week when we're focusing on pregnancy [00:02:30] itself. But on this week, we're going to be talking about fertility and calling in a pregnancy or avoiding a pregnancy.
To start out with, I wanted to talk about the timing of children. And I want to bring this up because It could seem kind of obvious in a lot of ways, and there have been, thankfully, a lot of conversations that I've witnessed on social media and even amongst friends about it being okay to have lots of children or to not [00:03:00] have any kids at all or to have just one child, uh, and I want to reassure you that that is all beautiful and wonderful, uh, you know, growing up, I did grow up in an environment where having a lot of kids was praised, and And sure, there's cultural aspects to that, but my mom wanted to have more children than she had.
She had three kids, and she would have loved to have more. And I grew up hearing her often grieving or reflecting and feeling a sadness about the fact that she didn't have more [00:03:30] kids. So it felt like that was what I had to do, was have lots of kids. Like, that's what the normal thing was to do. And I had to process that, right?
And work through that. As well, the older you get, Statistically, it takes longer to get pregnant. Um, we could say that there's a lower chance of getting pregnant, but you can also think of that as it takes longer to get pregnant, uh, on average, not in all cases by any means. And then there's also the piece of infertility, and sometimes people have [00:04:00] struggled with infertility with their first baby.
And then they don't have infertility with their second. And sometimes people have no problem getting pregnant the first time around, and they do have infertility the second time around and any combination thereof. All of these things can kick off the toddler breastfeeding stress spiral. We can have a lot of discomfort inside around these things, and it can feel really unsafe to be thinking about these things and stressful, right?
[00:04:30] And that can impact. It can impact how you're showing up in your parenting, and it can also impact the frequency and duration of your child's breastfeeding. I've talked about this before, right? Turning up that dial or down that dial. I just want to bring that here to hold space for that and to shine awareness on that a little bit.
So that you can think about that and explore those things. Um, Yeah, because I think that that's important to remember and recognize. Another piece that is [00:05:00] important when we're talking about having a second child is intimacy, right? Sex. When you're breastfeeding, every time your child is latching and suckling, There is prolactin being produced.
Now, it does vary over the lifetime of your breastfeeding journey and how those levels are rising and falling and what that all means, but for simplicity's sake, we're just going to say that when you're breastfeeding, every time your child latches, you're producing prolactin. [00:05:30] And prolactin decreases estrogen.
Lower levels of estrogen, uh, can lead to low libido and vaginal dryness. Uh, and that can make sex a little bit more challenging. It can also make sex more challenging when you're bed sharing and again, when we're internalizing that. And we're not like, it's becoming this trigger for us because we don't feel like we're doing things right or we feel like there's something wrong with us.
That can all increase stress and make these things [00:06:00] really challenging. But I, if you didn't know already that your estrogen levels are lower when you're breastfeeding and it's okay if you need to use lube and it's okay if you need to really communicate with your partner about what you want and um, what feels good for you and what doesn't feel good for you.
So that you can enjoy this time and it's not stressful for you. If you're bed sharing, you know, sex doesn't have to happen in a bed, right? So there's lots of options and opportunities for you. Sometimes a [00:06:30] guest room is great. If you've created a bedroom for your child, maybe they can start out that night in there in that space and then come into your bed.
Or you could put them down in your bed and move to another space and then come back to bed with them later. If you want to have it in the evening after they go to sleep. Naptime's an option as well. You can get a babysitter, all of those options are available to you. And again, I bring them up because It can feel stressful and lonely, and I know I heard so many stories and things, I mean, people [00:07:00] were like, who knew I was bed sharing, were surprised when we got pregnant with our second, because like, how could we possibly have had sex if we were bed sharing?
Um, and when you're getting those messages and you're not hearing any alternative message, it can feel really stressful and it can feel like you're doing something wrong. So I feel like it's important to address that and talk about that. That is kind of the timing and intimacy aspect of fertility and conception.
Then I want to get into the hormonal aspect of fertility. So [00:07:30] Let me bring you back to sex ed in grade school or high school, where you're learning about menstruation and the hormonal cycle that menstruating people go through.
So when we're talking about the menstrual cycle, there's really two phases that we can talk about. The, follicular phase at the beginning and then the luteal phase kind of at the end. And they're each a In an ideal situation, in a regular cycle, about two weeks long each, an ovulation is happening in the middle.
So that first phase, the follicular phase, kicks off with estrogen and [00:08:00] the follicle stimulating hormone, FSH. So what's happening is when The FSH starts to rise, it encourages, , about a dozen or more eggs to, um, come into the little follicles and start the maturation process, right? So each egg is in its own little follicle in the ovary, and the follicle is producing estrogen.
One of the eggs will be released when estrogen levels hit a certain threshold. So, as that egg is maturing in the follicle, [00:08:30] the follicle is releasing estrogen, and it tells the body to release the egg when the estrogen hits a certain threshold. Then, that, the most, the fastest egg to mature gets released, and that triggers the follicle stimulating hormone to drop and the luteinizing hormone LH to rise.
So when that LH is rising. The follicle that had the egg in it turns into what's called the corpus luteum, [00:09:00] a little Latin for you here. And it basically, that follicle collapses in on itself and starts dissolving. But while it is disintegrating, it is producing progesterone. And the progesterone production, lasts about, about two weeks.
It's not really affected by outside variables too much because it's really happening from that corpus luteum, right? Um, and that means that that stage is Typically pretty consistent amongst different bodies, different people at different stages. [00:09:30] It typically does last around two weeks or so, 12 to 16 days ish, um, which means that a regular cycle is about 21 to 35 days and the variable stage that often changes in length is the follicular stage, that, that beginning stage.
That is what happens in a typical cycle, we have the FSH rising, the egg maturing, estrogen hitting a certain level, the egg releases, then the follicle collapses in on itself and produces progesterone until a point where that progesterone stops being produced and [00:10:00] you're either pregnant that egg has fertilized and implanted or the egg is released and the lining of the uterus sheds.
And then we have the whole cycle start over again. Okay. Obviously, we can get into many different facets of that and speak to many different pieces of it and how it relates to different things, and I'm going to, but I kind of want to just give that overview to start with. When you are breastfeeding, like I Prolactin is being produced [00:10:30] every single time your child is suckling, right?
And that is inhibiting or like decreasing estrogen levels for the time that that prolactin levels are high. So when prolactin levels are high, estrogen levels are low, which means that the FSH isn't rising, the egg isn't being matured, uh, and so you're not going to ovulate as long as those prolactin levels are high, typically speaking.
When those prolactin levels start to decrease, which can happen for a lot of different reasons, you might ovulate, [00:11:00] and you wouldn't necessarily have a bleed prior to that ovulation, which means you could potentially, be fertile at any point postpartum. Now, if you are Ecologically breastfeeding, and by ecologically breastfeeding, I do not mean exclusively breastfeeding.
I have spoken about this on previous episodes, but typically, you can think of ecological breastfeeding like you are your baby's entire ecology. So, there's no pacifiers, there's no bottles, there's no [00:11:30] restriction on when and how long they breastfeed. That Will put your body into a state where prolactin levels are so high that you will not be fertile in most people.
In fact, it is as reliable as nearly every form of birth control and more reliable than many forms of birth control. So, that is applicable during those first six months. So, if your baby is younger than six months, you can, in fact, use breastfeeding as birth control if you are ecologically breastfeeding. , that is a case where breastfeeding, [00:12:00] you wouldn't need necessarily any other forms of contraception. If you are out of that phase or you never were ecologically breastfeeding, then you might want to consider other forms of contraception.
Barrier methods typically are completely compatible with breastfeeding. But there's also hormonal methods, which may or may not be compatible with breastfeeding.
And when we're looking at any medication, there's two things that we are considering when we're considering whether or not it's compatible with breastfeeding. And the first thing is how it's impacting milk supply. So [00:12:30] again, the big thing that we're looking at here is prolactin levels when we're talking about hormones and whatnot.
And anything that would be increasing your estrogen levels, would be decreasing your palactin levels, and therefore potentially decreasing your milk supply. So, for that reason, it's typically recommended to not use birth control that has estrogen in it. Unfortunately, every person's body is unique, and even non estrogen birth control has the potential to impact your milk supply.
So, that's something that you want [00:13:00] to walk out, you know, with your care provider, and. Potentially, Lactation support and that kind of thing, depending on where you're at in your journey and what your unique needs are. The other thing that we're considering when we're looking at medication is The safety for the infant.
we're looking at something called the Relative Infant Dose, so RID. And that means if this medication was prescribed to your child what would be the safe amount for their body? And when we're looking at breastfeeding, we want to see [00:13:30] a level in the breast milk that's less than 10 percent of that number.
So whatever the relative infant dose would be, we want to see it at like less than 10 percent ideally. And again, not, not even in all of those cases doesn't mean that it's safe for the child because you, you know, that's, that's a different kind of story and conversation. Um, but for most things, if they fall under that 10 percent RID, then they're generally considered safe for breastfeeding.
And some things don't pass through the breast milk at all. So in [00:14:00] that case, the safety for the infant wouldn't be the concern. When we are looking at that information, not all things, not all medications, uh, have been examined or researched or studied. Sometimes we have some anecdotal or some small studies, and sometimes we have pretty robust information.
So it really, it really just depends. Government and health organization in different places are going to use different guidelines and recommendations. Um, so, you know, [00:14:30] information in one. Place might vary from information at another place. That being said, there's two websites which are accessible online for most people in the world that are both U.
S. based that have a lot of really great information on them. One of them would be infant risk and on infant risk they summarize a lot of the research studies and really put it more into plain language that parents can easily grab and understand. , that can be great to have conversations with your healthcare provider about.
Then there's also LactMed, uh, which is a database that [00:15:00] you can search different drugs and medications on, and that is a little bit more, um, you know, science y in the language, jargony potentially,, but they will just give you, again, a summary of different studies and different sources of information.
So, A great thing to look at when you are considering any medication and your breastfeeding. Not all doctors are aware , and they might not be up to date on the most recent findings around different medications. So it's [00:15:30] great to Ask your doctor.
If they say something's not compatible with breastfeeding, ask them why it's not compatible with breastfeeding. Does this impact my milk supply? Is it not safe for my child? Um, what's the reasoning there? And ask them if they have any sources to back up that information or where they learned that information from.
Um, because As you would imagine, a lot of them are going to err on the side of caution, and it's easier or it's safer to us to say no, that's not the right option, um, than to say yes, [00:16:00] and it causes problems. And then there's one last piece that's important to consider when we're talking about medication, and that is the fact that you You're breastfeeding a toddler, so that it's not a newborn, which means that the fact that it could impact your milk supply isn't really as big of a concern.
It's not your child's primary source of nutrition, and, it just means different things for you, so it might be okay to take the risk of it in decreasing your supply. Um, it doesn't necessarily mean that your child's even going to wean if [00:16:30] you're drying up, uh, which is actually a conversation we're going to have in the next episode, but, you know, that's something to consider.
And to think about as well, uh, there might be certain things developmentally that are not worth risking when we're talking about a newborn, right? Certain medications that could potentially have an impact that's, it's just too great to consider when we're having a newborn, but potentially for a toddler, when we're looking at that relative infant dose and all of those things, it's not as much of a concern anymore.
Even if your doctor is a little bit startled by [00:17:00] the fact that you're breastfeeding at two or whatever age, make sure you bring up the age of your breastfeeding child and the frequency that they're breastfeeding. Because that can play a role in, in these conversations and the weighing of the benefits and the risks.
So that is the medical side of contraception. And I want to just briefly talk about the medical side of conception and fertility drugs and breastfeeding now. There is not very much research on fertility drugs and breastfeeding. That being said, [00:17:30] there are people who, uh, you know, choose to take certain fertility drugs while they're breastfeeding.
They have the possibility of being compatible, anecdotally. And again, there's two concerns that we're looking at. We're looking at the impact, potential impact on supply, and we're looking at the potential impact on the infant. And some of the fertility drugs, the biggest issue is potential impact on supply.
And if you're breastfeeding, again, a two or three year old, that might not be a big issue or [00:18:00] concern. but that is by no means a generic general thing. There are some that can be very unsafe , for a child to consume through breast milk. So again, important to have those conversations with your care provider and important to look up the evidence for that particular thing that you are considering because it matters, right?
It matters. Okay, so those are the medical ways, of supporting contraception or conception. Now I want to talk about[00:18:30]
And I want to talk about fertility awareness. So, fertility awareness in and of itself is simply tracking your cycle, being aware of your fertility, aware of when your last period was and all that kind of stuff. And a lot of us have an app that tracks our period or, you know, we can keep Guesstimate when we're ovulating, but there's a more accurate way of getting information, , that is typically called fertility awareness methods.
There's lots of different types of fertility awareness methods, and they [00:19:00] all look at things from different, different angles. But the beautiful thing about Fertility Awareness Method is that it's actually tracking body signs of where your body is at and really how fertile you are any moment.
So when we talked about the hormonal cycle, the collapsing follicle, that's producing progesterone in the luteal stage that progesterone rise is doing a few different things in your body. It's preventing another egg from being released, but it's also causing the lining of your uterus to thicken, [00:19:30] and it's causing changes in cervical fluid. It's changing your waking body temperature, and it's also changing your cervical positioning.
Okay, so this is all really important information. Those little signs how much cervical mucus you have, where your cervix is positioned, um, your body temperature, all those things are actually speaking to your unique hormonal , levels, right?
So it's really, really important and powerful to have that information [00:20:00] because breastfeeding and other factors, including stress and different things can cause this and ovulatory phase. And that is a phase where your body is making a lot of attempts to build up estrogen levels high enough to ovulate. So, this can take a long time.
In the book, the second baby book by Sarah Ockwell Smith, she quotes a study and I couldn't get access to the full study. So I'm trusting her that these numbers are there. Um, but she says that according to this particular study, if you're breastfeeding, you know, [00:20:30] on demand, day and night, You have a 22 percent chance of getting your period at six months, uh, and then an 80 percent chance by 12 months and a 92 percent chance by 24 months.
So there's still people at 8 percent of people who are breastfeeding who won't have a period by 24 months. , what's happening in that time is that the estrogen levels are rising and falling. Right? Over time. And eventually they're going to hit that threshold level to trigger ovulation and to start the first period.
[00:21:00] This is like a messy time where things are not super clear cut. You're not having a super predictable hormonal pattern. And that's when tracking can become very, very powerful. And tracking all of these different symptoms that are happening inside of your body. And you can potentially know that you are about to have your first period because you're seeing signs of ovulation before that first period actually happens.
And this can be powerful for avoiding pregnancy, right? You can use barrier methods or whatever you'd like during that time that you are ovulating. Uh, [00:21:30] and you can choose to have sex during those times in order to increase your chances of conceiving. So, again, Sarah Aquiles Smith quotes another study in that book as well, and she says that full fertility is thought to be restored, um, and By restored, meaning comparable with non breastfeeding mothers, once breastfeeding is no longer affecting the follicular phase, ovulation, or the luteal phase.
And so she says that there's research that shows that this tends to happen around the seventh postpartum period. [00:22:00] So that could mean that if your period is starting at 12 months, it could potentially take, on average, seven periods in order for you to be at the state level. That's someone who isn't breastfeeding would be as far as fertility is concerned. so that can be helpful to know, right? Things can be a little bit messy. It doesn't mean you're not fertile. It just means that the statistical chances are a little bit lower compared to, um, a non breastfeeding mother. And it will come back, right? That fertility will come back and you don't necessarily have to wean in order for [00:22:30] it to come back.
So when you are tracking these different Signs in your body, you'll get that picture of what is happening in your unique body lots of different things can be really wacky and crazy in that breastfeeding time because that estrogen level can be kind of rising and falling and it can Be like almost false starting a bunch of times, right?
And then you can have different symptoms and different signs. So it's really helpful to dig into information around fertility awareness method to feel empowered to work with fertility awareness method coaches and that kind of [00:23:00] stuff. And I would like to offer a little caution when there's a big trend right now talking about hormone health on social media and that kind of stuff.
And not everyone's qualified to talk about it. And when we're talking about breastfeeding, if you're just getting, your hormones tested, and I'm kind of using, like, air quotes, um, around that, that number, whatever number comes from that hormonal test, like, test, when you're breastfeeding in particular, it's pretty arbitrary, um, it doesn't really paint a full picture, right?
[00:23:30] So, a better way of really understanding your body is by tracking these signs. So when we are talking about fertility, typically, uh, you're fertile about five days before ovulation and then the day that you're ovulating, so you're not likely to get pregnant, I hate saying things that are very like absolute.
But there was research in 1995, a particular study that I saw, um, that showed that at six days before ovulation, zero percent chance of pregnancy. And at one day after [00:24:00] ovulation, zero percent chance of pregnancy. So that means that if you're tracking the signs and you can accurately depict when you are ovulating, you can really own your fertility.
You can really be in control of your fertility and choose whether or not you want to get pregnant during that time. Okay, so now that we've talked about what options are available to get pregnant and to not get pregnant. When you are breastfeeding, let's talk about the ways that you could potentially change things in your body in order to tip you into a more [00:24:30] fertile state.
So, like I've said, when you are breastfeeding, every time your child latches, you are producing prolactin, and that is decreasing estrogen levels, and that is what is inhibiting fertility.
A lot of times breastfeeding moms jump to shortening feeds first when they are wanting to bring back fertility. And it can seem like that's a good idea if your thought is that it's the total volume of milk that you're producing. That is impacting your hormones, but it's [00:25:00] not so much the case. It's more that amount of times that they're breastfeeding during the day, the frequency, the popping on and off.
And sometimes shortening feeds can actually increase frequency. So it might feel like, well, you know what? They jump on for a few seconds every 20 minutes or every hour. Um, But they're not on for that long, but it would actually be better for them to breastfeed for a lot longer of a time, a lot less often.
And sometimes when you're shortening the feeds, it can, have almost like a rebound effect of your child to [00:25:30] breast, asking to breastfeed more frequently. So my suggestion is to start with a spacing out the feeds a little bit and not Stop the feed, like not shorten the feed first, but first start with spacing them out a little bit, because that can be an easier transition and is more likely to have an impact on your, menstrual cycle.
You want to be pushing space in between those breastfeeding sessions. There is a general [00:26:00] rule of thumb or thought that if you can be going about four hours during the day and six hours overnight, that that is likely to land you in that fertile kind of zone. And also that may or may not be true for your unique body.
So when you are wanting to move towards fertility, it can be wise to just start by spacing out those sessions a little bit. You can choose whether it's during the day or during the night, whatever you'd like to start with. Um, but creating a little bit of space for those prolactin levels to start to decrease can [00:26:30] allow for those estrogen levels to increase.
Uh, a great way to do this, right, is just by starting to create some rhythm. in your breastfeeding, um, by learning about saying no, all that wonderful stuff that I taught all last year on the podcast and that I teach inside of my program on your breastfeeding story. And if you want a practical place to start with that, you can grab my guide to saying no to the feed while still saying yes to the need.
That is perfect for you if you are wanting to, um, increase your fertility and while you're breastfeeding you can grab that [00:27:00] at ownyourparentingstory. com slash guide, and I give you lots of information there and support you to kind of like space things out.
So I wouldn't necessarily jump fully right into night weaning. You can. Sometimes that can be the thing that can bring back your period or cause your period to be more regular you can do night weaning if you'd like or you can just start to space things out.
That can be a really, really helpful thing to do. Now, generally speaking, when we're talking about fertility, things like decreasing stress, making sure you're eating regularly, um, you know, moving your body, all of those things can help your [00:27:30] body to balance those hormone levels in a way that is sustaining fertility for you too.
Remember to reflect on all those things and consider those things. When it comes to breastfeeding, the biggest thing is the frequency in which you are breastfeeding your child. Um, I just wanted to put a note out too that a lot of times when you're breastfeeding, with that kind of like start and stop of the estrogen, levels over time, right, for the year, 18 months, whatever, two years that you are, that you're [00:28:00] not having a period.
Sometimes you can have times where the estrogen levels have been rising very, very slowly, and then they have a sudden drop for whatever reason. And you can have what's called a withdrawal bleed. And that is. It can feel kind of like a period, but it seems kind of wonky maybe like there's just different things that don't aren't quite normal and, um, but that, that can be normal.
Another thing that can happen when you're in this, anovulatory phase is that the lining of the uterus gets so thick [00:28:30] that without the progesterone being, secreted from the collapsing follicle, it can't sustain it. And so it can just kind of get too heavy and fall out. And that can cause spotting and bleeding too that can appear a lot like a period from the outside, but not be a period.
And so that can contribute to what feels like a lot of irregular periods or the start and stopping around your cycle. And that can all be really normal. Um, again, talk with your doctor if anything feels wonky or strange. But those are all things that can be expected [00:29:00] around breastfeeding and fertility.
Okay, I have talked a ton. I'm losing my voice here, guys. I cannot wait to hang out with you next week and talk about breastfeeding during pregnancy. If you guys have any questions that you would love for me to answer on that podcast, Just send them over to me via email. I would love to have them or you can DM me on Instagram.
So email is jenna at ownyourparentingstory. com and on Instagram I'm own dot your dot parenting dot story. Uh, I'd love to hear what you thought of this [00:29:30] episode and if you have any questions for me to cover in the pregnancy episode, the tandem feeding episode, or any other topics that you'd like for me to talk about on the podcast.
All right, I'll catch you then.