The Mama Method

MAMA stands for Lactational Amenorrhoea Method.

"Amenorrhoea" means the absence of menstruation, and "method" means a contraceptive technique.
 

It is based on the natural infertility resulting from certain breastfeeding practices.

MAMA provides planning protection comparable to other family planning methods.

No pregnancies were observed during the first 3 months postpartum in women who were breastfeeding and amenorrhoeic. For women who are exclusively breastfeeding and amenorrhoeic, fewer than 2% will become pregnant within the first 6 months postpartum [1].

For the LAM method to be effective, three criteria must be met:
- I have not yet had my return of periods, AND
- My baby is fully or almost fully breastfed, AND

- My baby is under six months old.
 

Under these conditions, contraceptive protection is assured at over 98% [2]
 

When one of these criteria is no longer met, another method must be used to avoid becoming pregnant.) 

If I am regularly separated from my baby for more than four to six hours, I cannot rely on LAM for effective contraceptive protection, even if I express milk during the separation.
 

Indeed, a breast pump is not as effective as a baby at the breast when it comes to suppressing ovulation.
 

In a study on LAM and working women, the pregnancy rate had risen to over 5% [5].
 

After 6 months, even if you are breastfeeding "fully", you should no longer wait for the return of your period before considering yourself potentially fertile. You should start monitoring your fertility signs or choose another method of contraception if you do not wish to become pregnant again.
 

Of course, the return of menstruation clearly signals the restart of a regular cycle. However, in the absence of periods, ovulation can still occur (ovulation takes place 15 days before the return of periods). To find out more, read our article on how to calculate your ovulation.
 

While cycle irregularities can indeed persist up to the sixth cycle after birth (anovulatory cycles, longer and irregular cycles, shortened high-temperature phase), after 6 months the likelihood that ovulation will occur before the return of menstruation — and that this ovulation will be "fertile" — is greater.
 

According to studies, without the return of menstruation and with full or near-full breastfeeding, pregnancy rates of between 4 and 8% have been observed up to the end of the twelfth month [6]. So do be mindful if you wish to avoid a pregnancy!

MAMA can be started at any point during the first six months of the postpartum period. It is best to find out about it before the birth, so you have all the information and can begin using it in the postpartum period.

If I wish to start MAMA during the first two months postpartum, I must have practised full or near-full breastfeeding since giving birth.

If I wish to start using MAMA when I am more than two months postpartum, I need to make sure I meet all 3 criteria listed above.

The role of prolactin and its impact on ovulation

Full breastfeeding leads to suppression of ovarian activity, resulting in the absence of ovulation and amenorrhoea. This suppression is due to the secretion of prolactin observed at each feed [7]. It is the baby's suckling that stimulates its production.

A high prolactin level (aka hyperprolactinaemia) desynchronises the pulsatile hypothalamic secretion of GnRH. This results in abnormalities in FSH secretion (the hormone that stimulates follicle maturation), and therefore impaired follicular growth. LH secretion is also affected. No ovulation can be triggered.

There is a correlation between the frequency and duration of feeds on the one hand, and the plasma prolactin level on the other. Experts estimate that breastfeeding with at least 6 feeds per 24 hours (day and night) with a total duration of 65 minutes suppresses ovarian activity [8], [9], [10].
 

Prolactin levels are highest between midnight and 5 a.m. This is why night feeds are important not only for maintaining lactation but also for restarting the menstrual cycle.
 

On-demand breastfeeding
 

For this full breastfeeding to be "protective", it must be led by the baby's demand.

If the baby is genuinely hungry, they will feed more effectively and stimulate the breast more efficiently, thereby boosting prolactin production.
 

The suppression of ovulation varies from woman to woman.
 

Why this 6-month period?
 

If full breastfeeding is maintained up to 6 months, a fertile ovulation before the return of menstruation is uncommon: the pregnancy rate is 1% or less.
 

This means that a mother following the MAMA method can calmly wait for her first bleed — known as the return of menstruation — before considering herself potentially fertile, and this applies until her baby reaches 6 months of age.
 

The first menstrual cycles, if they occur before 6 months, are anovulatory in 45% of cases, and ovulatory cycles followed by luteal phase deficiency in 41% of cases. This means that if the first ovulation does occur despite everything, it will most often be followed by a corpus luteum lasting so briefly (approximately 3 days) that implantation cannot take place. This is referred to as an infertile ovulation [9].

You can ask your doctor to prescribe a low-dose progesterone-based pill.

A note on spermicides: they can be useful during the postpartum period as a "bridge" method, but are not recommended during breastfeeding. Spermicides may pass into the bloodstream and breast milk, and their effects on the infant remain poorly assessed.
 

Otherwise, there is always the condom, to be combined with fertility awareness methods (observation of the cervix, cervical mucus, etc.).