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Billings Ovulation Method® and Physiology of Lactation and its Effects on Fertility

Written by Dr Evelyn L Billings
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The benefits to both mother and child which result from breast-feeding provide a good example of the wisdom of living in accordance with the laws of nature. The Billings Ovulation Method® is very appropriate for use during lactation because it provides for the recognition of infertility in the absence of ovulation – it is just as easy to recognize infertility as it is to recognize fertility, and to learn rules which can be applied in either circumstance.

During pregnancy the glandular tissue of the breasts has been preparing for the production of milk, under the influence of pregnancy hormones. After birth, the stimulus caused by the baby’s sucking stimulates the activity of the pituitary gland through that part of the brain called the hypothalamus. The more the demand for milk, the more the breast will respond by producing milk. Nature has provided mother and baby with many reflexes, for example, the rooting reflex of the baby whereby he turns his head to take the nipple when it touches his cheek, the sudden “let-down” of milk when he sucks and the production in the mother of the pituitary hormone, oxytocin, which not only causes the let-down of milk but also causes the uterine muscle to contract so that it expels clots and lochia, thereby promoting the return of the uterus to its normal size and tone. Colostrum comes from the breasts for the first few feeds and supplies the baby with an invaluable source of antibodies to protect him against infection. The colostrum also has a beneficial effect upon the delicate skin of the nipples and should not be washed away with soap.

The breast-milk continues the protection provided by the colostrum, guarding not only against infection but also against the development of certain allergic disorders, for example, allergy to cows’ milk. Breast-milk is a physiologically active tissue fluid containing important enzymes.

The baby should be suckled when he is hungry, which not only satisfies him but ensures an adequate supply of milk while helping to prevent painful engorgement of the breasts. High levels of the hormones needed for production of breast-milk will usually suppress the hormones needed for a return to fertility. Promotion and maintenance of a good supply of milk will usually help to postpone another pregnancy until the baby is at least many months old and is thriving. Even under ideal conditions with a vigorous baby who sucks well, ovulation may return as soon as 6 weeks after delivery but as long as the baby is being totally breastfed and “mothered” with the breast, without recourse to a pacifier, it is unusual for ovulation to return until more than 3 months after the birth.

Each mother and baby duo is unique. The length of time which elapses between the birth and the first ovulation varies with different women but sooner or later ovulation will occur even if the baby remains fully breast-fed and is thriving and contented. More often ovulation returns when weaning is commenced by giving the baby solid food. In some cases, there is warning of the likelihood of the return of ovulation in a spontaneous decline in the amount of milk so that the baby is no longer satisfied, or in the occurrence of bleeding. In any case, the daily charting of the cervical mucus will indicate what is happening.

Intercourse during lactation may be dry and painful because of the thinning of the vaginal epithelium resulting from the low level of circulating oestrogens. The absence of cyclical oestrogenic mucus from the cervix also contributes to the discomfort. A rapid and effective neurohormonal reflex operates during sexual stimulation to provide vaginal lubrication and facilitate coitus. Thus, if the emotional climate is loving and considerate on the husband’s part, there will be a physiological response by his wife which will overcome the problem.

A thoughtful husband will readily appreciate the effect of fatigue on his wife who is spending many hours each day caring for her baby, which is a new and surprising experience. The father who develops a close bond with his child early in life acquires many insights into his role in the family.

The frequency and duration of suckling are important in establishing and maintaining an adequate supply of milk. The mother-baby relationship is unique and many factors influence it. Some babies are born vigorous, wakeful and demanding so that comforting and suckling are frequent.  Mothers of these babies usually find that infertility is prolonged and easily identified.

Some babies who are fat, sleepy and happy are not so demanding; they spend hours asleep and are often described as “good babies”. While they may stimulate the secretion of enough milk for their own well-being, the suppression of ovulation may not be so effective. This may lead to ovarian activity early in lactation with the rise in oestrogens reflected by changing patterns of mucus and even early ovulation.

If the supply of breast milk appears to be failing, the mother may decide to proceed with weaning or to make additional efforts to establish a better supply. The restoration of full breast-feeding may be achieved by increasing the frequency of suckling episodes and by the restoration on night feeds. An increased supply of milk may be stimulated by physical rest, nourishing food and extra fluid for the mother together with more frequent feeding of the baby. The woman may observe that the re-establishment of a good supply of milk causes the disappearance of indications of returning fertility that she has observed in the cervical mucus pattern. On the other hand, if there has been the reappearance of the mucus but no ovulation as yet, lessening the number of feeds and the advancement of weaning may be quickly followed by the development of an ovulatory pattern of mucus leading to a Peak symptom and then a menstrual bleed.

Charting should commence from 3 weeks after the birth or as soon as the lochia diminishes sufficiently for the woman to identify the sensation at the vulva. For many women this sensation will be one of total dryness, in which case, abstinence is not required to establish a Basic Infertile Pattern and the couple can commence intercourse applying the Early Day Rules of the Billings Ovulation Method®. If the woman does not experience dryness, 2 weeks of abstinence should be suggested while she makes her first chart. As soon as she reveals, by discussion of her record, that she understands her charting, the couple may apply the Early Day Rules with intercourse available on alternate evenings of any unchanging pattern which indicates infertility.

There must be careful attention to the mucus pattern when there are any indications of the possibility of the return of fertility and it is recommended that the couple abstains from genital contact until the pattern is revealed, if it is the intention to avoid a further pregnancy. The rise and fall of hormones, which may occur at this time, can produce patches of mucus which may or may not result in the return of fertility. The return of bleeding does not necessarily mean that ovulation has returned. When the mucus pattern reveals increased hormonal activity there may be some bleeding a week or so later as a further manifestation of the fluctuating hormonal pattern. This should not be confused with the occurrence of ovulation which can be clearly recognized by the Peak mucus symptom – a changing developing pattern, ending with the slippery sensation (and perhaps a swollen vulva), followed by an abrupt change to “no longer slippery”.

It is important to note that the discharge which constitutes a Basic Infertile Pattern during lactation may be peculiar to that time, sometimes being fairly profuse and milky. When the normal cycles return, a Basic Infertile Pattern of discharge must be reassessed. Even if the discharge appears to be the same as that recognized as the Basic Infertile Pattern prior to the return of fertility, it should not be assumed to be infertile until three cycles have been studied.

The sensible encouragement given by a cheerful, experienced teacher of the Billings Ovulation Method® can accomplish wonders in assisting a timid young mother, both in adapting to the dramatically new lifestyle occasioned by the birth of her baby and in managing her fertility during lactation and the return to normal cycles. Regular contact between teacher and couple is advisable during what can be a rapidly changing and quite volatile time. A confident, relaxed teacher will ensure a confident, relaxed couple able to manage their fertility happily during this exciting time.

This article is an extract from Billings Atlas of the Ovulation Method: the mucus patterns of fertility and infertility by Evelyn L Billings, John J Billings and Maurice Catarinich, Fifth Edition 1989, pp 56-59, revised 2010.