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].

Pour que la méthode MAMA soit efficace il faut remplir trois critères :
- Je n’ai pas encore eu mon retour de couches, ET
- Mon bébé est allaité entièrement ou presque entièrement, ET

- Mon bébé a moins de six mois.
 

Dans ces conditions, la protection contraceptive est assurée à plus de 98 %[2]
 

Quand l’un de ces critères n’est plus satisfait, une autre méthode doit être utilisée pour ne pas tomber enceinte.) 

SI je suis séparée régulièrement de mon bébé pendant plus de quatre à six heures, je ne peux pas espérer une protection contraceptive efficace de MAMA, même si je tire mon lait pendant la séparation.
 

En effet, le tire lait n’est pas aussi efficace que le bébé au sein en ce qui concerne la suppression de l’ovulation.
 

Dans le cadre d’une étude sur MAMA et les femmes qui travaillent, le taux de grossesse était passé à plus de 5% [5].
 

Après 6 mois, même si on allaite “complètement”, il ne faut plus attendre le retour de couches pour se considérer comme possiblement fertile. On doit commencer à observer ses signes de fertilité ou choisir une autre méthode de contraception si on souhaite pas de nouvelle grossesse.
 

Certes, le retour de couches marque clairement la remise en route d’un cycle régulier. Mais, en l’absence de règles, il arrive qu’il y ait ovulation (l’ovulation survient 15 jours avant le retour des règles). Pour en savoir plus, allez voir notre article sur comment calculer son ovulation.
 

Si des anomalies de cycle peuvent en effet persister jusqu’au sixième cycle après l’accouchement (cycles anovulatoires cycles plus longs et irréguliers, phase de températures hautes raccourcie), après 6 mois, la probabilité qu’une ovulation survienne avant le retour de couches et que celle-ci soit “fertile” est plus grande.
 

Selon les études, sans retour de couche et avec un allaitement complet ou presque complet, on observe entre 4 à 8 % de grossesses jusqu’à la fin du douzième mois [6]. Donc attention si on souhaite éviter une grossesse !

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.).