A client comes in and Midwives We asked: "I've heard that breastfeeding can be used as a natural family planning. Is this true?" Now the mother wants to know the answers and scientific explanation? Lactation Amenorrhoea Method (LAM) or the Lactational Amenorrhea Method (LAM) is a temporary contraceptive method that relies on giving Mother's Milk (ASI) exclusively, meaning that is given only breast milk alone without additional food and other beverages. Lactation Amenorrhoea Method (LAM) or the Lactational Amenorrhea Method (LAM) can be said as a method of natural family planning (NFP) or natural family planning, if not combined with other contraceptive methods.




Exclusive breastfeeding is a contraceptive method while quite effective, as long as the client has not had my period and the time is less than six months postpartum. Effectiveness can reach 98%.MAL effective when feeding more than eight times a day and the baby is getting enough intake per lactation (Saifuddin, 2003).
Pospartum concentration of estrogen in women, progesterone, and prolactin (PRL) is high during pregnancy dropped drastically.Without breastfeeding, gonadotropin levels rise rapidly, the concentration of PRL returned to normal within about 4 weeks and at week 8 postpartum, most women who give their babies formula milk showed signs of follicular development and will evolve soon.
Conversely, in women who are breastfeeding, PRL concentrations remained elevated during the suction are common and occur at every feeding acutely increases PRL secretion. Although the concentrations of Follicle Stimulating Hormone (FSH) returned to normal within a few weeks postpartum, but concentrations of luteinizing hormone (LH) levels remained depressed throughout the period of lactation. Importantly, the normal release of LH pulse pattern of impaired and this is expected to be a fundamental cause of the occurrence of normal ovarian function suppression. Women who breastfeed their babies in full or nearly full and permanent amenorrhea has less than 2% likely to conceive during the first 6 months after delivery.
Profit For infants:
1. get passive immunity (antibody protection received through breast milk)
2. The best source of nutrition and perfect for baby's optimal development body,
3. avoid contamination of breast milk or formula or other device used to drink.
For the mother:
1. reduce post-partum blues
2. reduce the risk of anemia
3. improve maternal and infant psychology relationships (Saifuddin, 2003).

Effectiveness of LAM are:
1. High effectiveness
2. active immediately
3. do not need medical supervision
4. do not need drugs or devices
5. no cost.
MAL benefits to the baby that is a food that has nutritional intake that is useful to increase endurance in infants, whereas maternal benefits to prevent pregnancy (Pinem, 2009).

LACK MAL is a shortage of contraceptives:
1. necessary preparations from prenatal care to breastfeeding immediately after delivery in 30 minutes
2. may be difficult to implement due to social conditions
3. highly effective only until the return period of up to 6 months
4. does not protect against sexually transmitted infections, including hepatitis B / hepatitis B and HIV / AIDS (Saifuddin, 2003).
CONS INDICATION
1. Postpartum women who already had my period.
2. Women who do not breastfeed exclusively.
3. Women who work and separated from their infants more than 6 hours.
4. Women should use additional contraceptive method.
5. Women who use drugs that alter mood.
6. Women who use drugs ergotamine type, anti-metabolism, cyclosporine, bromocriptine, radioactive drugs, lithium or anti-coagulants.
7. Baby is older than 6 months.
8. Infants who have metabolic disorders.
SIDE EFFECTS
Measuring and safety of various family planning methods are also difficult, but why in this case is that most methods are so safe that serious adverse events are very rare. Less serious adverse events is often quite subjective.
Here are some side effects from the use of contraceptives using Lactation Amenorrhoea Method (LAM):
Effectiveness · high only until the return of menstruation or up to 6 months
• No protection against STIs including hepatitis B virus / hepatitis B and HIV / AIDSKesulitan in maintaining exclusive breast-feeding patterns.
· Difficulty in maintaining breastfeeding patterns exclusively.
Criteria Criteria A Mother Who Uses Lactation Amenorrhoea Method of family planning (LAM)
Terms mother to use natural family planning method MAL namely:
1. mothers who breastfeed exclusively
2. mother has not been menstruating since melahikan (not menstruation)
3. mothers give their babies breast milk in a "full" (only sometimes one or two sips of water, such as the ceremonial / religious)
4. babies aged 6 months (Saifuddin, 2003).
Women who use the Lactation Amenorrhoea Method (LAM), have to feed and pay attention to the things below:
1. Do Menyueui immediately after delivery.
2. Frequency of breastfeeding frequently and without a schedule.
3. Breastfeeding without a bottle or pacifier.
4. Not taking supplements.
5. Breastfeeding is still being done well when the mother or baby is sick.
Mom Who Can not Use MAL
Lactation Amenorrhoea Method (LAM) can not be used by:
1. Postpartum women who already had my period.
2. Women who do not breastfeed exclusively.
3. Women who work and separated from their infants more than 6 hours.
4. Women should use additional contraceptive method.
5. Women who use drugs that alter mood.
6. Women who use drugs ergotamine type, anti-metabolism, cyclosporine, bromocriptine, radioactive drugs, lithium or anti-coagulants.
7. Baby is older than 6 months.
8. Infants who have metabolic disorders.
Lactation Amenorrhoea Method (LAM) is not recommended on the condition of mothers who have HIV / AIDS positive and active tuberculosis. However, LAM can be used with consideration of medical clinical assessment, the severity of maternal condition, availability and acceptance of other contraceptive methods.Effectiveness
• Pregnancy occurred in 2 per 100 women at 6 months postpartum and 6 per 100 women after 6-12 months after delivery.
• incidence of pregnancy in the use of MAL is relatively very small, because the effectiveness of the LAM is very high reaching 98% (Sarwono, 2003).
• Exclusive breastfeeding is a contraceptive method while quite effective, as long as the client had my period, and time is less than 6 months postpartum. Effectiveness can reach 98% and is very effective when feeding more than 8 times a day and the baby is getting enough perlakrtasi intake (Ministry of Health, London).

"How to be breast-feeding as a natural contraceptive?"
You must follow the rules of the game to get the full benefits of breastfeeding effects on fertility. In the MAL, breastfeeding mothers can rely on protection from pregnancy if she could answer "no" to the following questions:

1. Have your menstral cycle back /'ve got your period?
2. Do you regularly or allowing long periods without breastfeeding, either during the day (more than three hours) or at night (more than six hours)?
3. Is your baby more than six months?
Research has shown that most mothers who are breastfeeding exclusively remain fertile for more than six-month period covered by the LAM. Ovulation and menstruation returned only when the baby begins to nurse less frequently and prolactin levels fall.

4 TIPS TO BREASTFEEDING Can be used to delay ovulation
1. The practice of breastfeeding is limited regardless of the schedule. Usually six to eight times a day will suppress ovulation.
2. Do not train your baby to sleep through the night. (Milk-making hormones that suppress ovulation produced the highest at 1:00 a.m. to 06:00) breastfeeding at night / early morning is important to suppress fertility.
3. Avoid using extra bottles and teats.
4. Delaying the introduction of solid foods until the age of six months or more. Solid foods should provide additional nutrients, not a substitute for breastfeeding.
The key to using breastfeeding to delay the return of fertility is the frequency of breastfeeding.
If you follow these rules, you can enjoy a period of lactation amenorrhea (no menstrual period) that lasts 13-16 months. In fact, research has shown that women who practice natural mother in accordance with the above rules will average 14.5 months without a menstrual period after melahirkan.I very, this is just average.some women will experience a return of menstruation in six months, others up to two or three years.
When the menstrual periods returned, the former often anovulatory, meaning that not preceded by ovulation (egg release), and thus you can not get pregnant before this. However, about 5 percent of women ovulate before their first menstruation, so it possible to get pregnant while breastfeeding, even if you do not menstruate.