Billings Method during Breast Feeding

Lactation Notes

Billings Method is applicable whilst breast-feeding your baby

In order to understand how to apply this method to breast-feeding you need to first of all read Understanding the Billings Method and in particular the sections "Keeping a Record" and "Delayed Ovulation - the Extended Pre-ovulatory Phase and the Basic Infertile Pattern".

Breast-feeding and the Billings Method are Natural Companions

Despite fully and successfully breast-feeding, some women return to fertility within a few weeks following the baby’s birth. For others infertility may last months or years. The Billings Method gives the lactating mother day by day understanding of her infertility and fertility. This allows the couple to enjoy their sexual relationship free from contraceptive devices or drugs and anxiety about fertility.

The couple must consider the possible damaging effects of the hormones in contraceptive drugs on breast-milk and the baby. The spacing of pregnancies gives each child the best opportunity for health, growth and development.

Important Considerations for Breastfeeding

• Demand feeding is strongly recommended and will greatly assist to suppress fertility.

• Total breast-feeding up to six months is sufficient without the addition of fluid or other food to ensure the optimum nutrition of the baby.

• Colostrum comes from the breasts for the first few feeds and supplies the baby with an invaluable source of antibodies to protect against infection.

Infertility and Fertility Following a Birth or Miscarriage

Women not breast-feeding following a birth and those who have suffered a miscarriage may see a shift from infertility to returning fertility within about six weeks. The woman should be alert to the changes in her body which signal returning fertility.

Ovulation takes place before menstruation, therefore do not presume that you are infertile because you have had no bleeding.

Observe at the Vulva and Record Daily

Whichever category the woman is in, the key to successful fertility control is to learn her Basic Infertile Pattern and follow the Guidelines and Rules for the Billings Method. Her first step is to keep a careful daily record.

The woman uses her own words to describe what she feels and sees.

Basic Infertile Patterns (see examples 1, 2 & 3)

A Basic Infertile Pattern (BIP) is an unchanging pattern of responses due to low oestrogens before ovulation.

1. No mucus (vulval dryness); or

2. An unchanging discharge at the vulva which accompanies a low unchanging level of oestrogen; or

3. A combination of 1 and 2 when the discharge remains unchanged during 2 weeks of observation and is interrupted by dry days.

Guidelines of the Billings Method

• Keep a daily record of the sensations at the vulva as well as any discharge observed at the vulva. Do this in the normal course of the day and whilst in an upright position.

• Do not examine internally as this gives incorrect information and may introduce infection.

• Commence charting at about three weeks following the birth when the lochia (blood loss) tends to stop.

• Avoid genital contact for approximately two weeks while making the initial recordings. This will help ensure correct observations. Accurate interpretations will follow.

• Learn to read your infertility/fertility accurately. Do not presume either situation. Individual teaching from an accredited Billings Method teacher is invaluable. You may enquire about the location of a teacher near you by contacting us.

Management of the Billings Method during Breast-feeding

Early Day Rules (see examples 4, 5 and 6)

• Apply these rules during the Basic Infertile Pattern, when ovulation is suspended, sometimes for weeks or months.

• The Basic Infertile Pattern is an unchanging pattern. Intercourse is available on alternate evenings during the Basic Infertile Pattern. Waiting a day following intercourse allows for secretions and seminal fluid from intercourse to cease.

• If there is a change from the Basic Infertile Pattern, whether in sensation at the vulva, or in the discharge, including bleeding or spotting, the rule is to wait until this change passes and the Basic Infertile Pattern has returned for three days. The couple can then resume intercourse on the fourth evening of the returned Basic Infertile Pattern. We refer to this as "wait and see 1, 2, 3".

When to Apply the Peak Rule

• The Peak Rule is applied when ovulation returns, i.e. when the Peak is recognised.

• Apply the Peak Rule only after the Peak Day is identified. Until this time arrives the woman applies the Early Day Rules only, to her Basic Infertile Pattern. The fertile phase is a changing pattern leading to the Peak and includes three days following the Peak.

Peak Rule (see example 7)

• From the beginning of the fourth day following the Peak, until the end of the cycle intercourse is available every day at any time.

Bleeding

There may be several episodes of bleeding without prior ovulation indicating fluctuating oestrogen levels. The endometrium responds by a follicular phase growth of glands and blood vessels when oestrogens rise. This may result in bleeding for either of two reasons:

1. break-through bleeding due to high oestrogen: this may recur; it  may also occur just before ovulation and therefore signify high fertility;

2. some days after an oestrogen level rise, when the oestrogen level has fallen, withdrawing its support from the endometrium (withdrawal bleeding).

If ovulation (identified by the Peak) does not precede a bleeding episode, the bleeding cannot be classified as menstruation.

A Changing State from Infertility to Fertility

Once the cervix responds to rising levels of oestrogen, it produces mucus that allows the entry of sperm cells. The first sign of any change in a woman’s state of infertility may be intermittent days of mucus interrupting her established Basic Infertile Pattern. The woman will notice this changing situation, and it may continue for some weeks. This is a sign that her fertility will soon return with a recognisable Peak and Ovulation.

A Time Close to Ovulation

An extremely slippery, lubricative sensation at the vulva is an important symptom. The woman may also notice a soft fullness of the vulva around this time, signifying the Peak.  Menstruation will occur within two weeks. The woman is not fertile if menstruation occurs less than 11 days following the Peak. The interval of 11 to 16 days from Peak to menstruation will return subsequently, signifying fertility.

The Return of Cycles, Rules and Re-assessing the Basic Infertile Pattern

Once cycles return there is a need to re-assess the woman’s Basic Infertile Pattern of discharge which usually is not the same as that experienced during the breast-feeding time prior to ovulation.

Reminder: If ovulation does not precede a bleeding episode, the bleeding cannot be classified as menstruation. The rule "wait and see 1, 2, 3" is applied.

If the woman identifies a Peak Day she now applies the Peak Rule. Menstruation always follows ovulation. Avoid intercourse during days of heavy menstrual bleeding.