I have reviewed the breastfeeding information in the new CCL manual, The Art of Natural Family Planning: Student Guide, and it is disappointing. There are two statements that are seriously incomplete and therefore possibly misleading.
1) “Some studies show that 97% of mothers who exclusively breastfeed can be assured of postpartum infertility for at least six months” (page 161).
2) “Exclusive breastfeeding: Generally, highly infertile during the first six months postpartum” (Reference guide, page 254; italics in the original).
For “exclusive breastfeeding” to be considered a time of infertility, it is essential that the mother still be in amenorrhea, at least after 56 days postpartum. Bleeds up to 56 days postpartum are not to be counted as menses. This “exclusive breastfeeding” rule is often called the Lactational Amenorrhea Method (LAM). Amenorrhea means the absence of menstruation. To repeat, the absence of menstruation is crucial for this method to be highly effective. Mothers who count on natural infertility for six months may become pregnant while relying on the CCL statement if their menstruation returns before six months while exclusively breastfeeding.
On November 7, I wrote CCL for the studies mentioned in the first statement above. Executive Director Andy Alderson did me the courtesy of a reply on November 14, as follows: “Sorry for the delayed response. While I understand your request, I’ve read your ongoing blogs against CCL. I don’t think it is productive for the League to get into communications with you at this time.”
I find it regrettable that Mr. Alderson regards our blog exposure of what CCL is doing and saying as being “against CCL.” Our hope has been that CCL teachers, promoters, and other interested parties will recognize that CCL’s changes are not in the best interests of CCL. We still hope they will be able to lead CCL’s current management back to its previous and successful path that was helpful to so many.
What our blogs are showing is what CCL is doing. Is what CCL does going “against CCL?” Eventually others would have learned what we have exposed and may have blogged on the new changes. CCL is welcome to present their viewpoint at each blog of ours if they choose to do so. Of those who have told us they wrote to CCL about their concerns, none have received a reply.
CCL’s definition for exclusive breastfeeding in their new manual is not clear. Here is the CCL definition:
“Exclusive breastfeeding is defined by the World Health Organization (WHO) and the American Academy of Pediatrics (AAP) as the standard of care for babies during their first six months of life. It is characterized by breastfeeding whenever the baby indicates a desire (day and night) with each feeding fully emptying the breast of milk. Initially, a minimum of 8-12 feedings per day is required to establish the breastfeeding, with baby kept in close proximity to the mother” (page 154).
Could a mother believe she is following the requirement for breastfeeding infertility if she nurses according to the definition of exclusive breastfeeding given above? I certainly think so, so I will call it a “rule.”
Do you see anywhere in that definition that the baby is to receive only breast milk for its nutrition during the first six months of life? Could a mother read that definition, believe she is completely nursing and yet think it’s okay to give solids to her baby when her baby is three to five months old? It looks that way to me.
Also, nothing is said about the absence of pacifiers or sleeping with the baby or specific behaviors that would help the mother maintain breastfeeding amenorrhea during those first six months postpartum.
During the mid-60s, as a La Leche League member and later as a LLL leader, I learned that many exclusively breastfeeding mothers have an early return of menstruation or become unexpectedly pregnant during the first six months after childbirth. I learned that more than just “exclusive breastfeeding” is required to maintain amenorrhea. If mothers want to have the 97% effectiveness rate (98% by most studies that include amenorrhea in their definition) during the first six months postpartum, they must not have any menstrual bleeding after the 56th day postpartum. Exclusively breastfeeding mothers can become pregnant during the first six months postpartum if they are having menstrual cycles.
The point is this. If a mother does exclusive breastfeeding and hopes that this will give her natural infertility for at least six months, she needs to do more than just not give her baby other liquids or foods. She needs to follow the Seven Standards of Ecological Breastfeeding.
Changes by CCL’s new management
We think it is unfortunate that the new CCL management has chosen to delete the major charisms that John and I brought to the League: ecological breastfeeding with its Seven Standards, the covenant theology of human sexuality, and a form of systematic NFP that offered different rules for different situations. Another change is the dropping of ecological breastfeeding as a baby spacer. On page 100 of the Student Guide the spacing of children is mentioned three times, but this is attributed to abstinence during the fertile time of the cycle. In the new CCL manual, the natural spacing of births is not associated with breastfeeding except in the incomplete and misleading statements quoted above.
History Repeats Itself
CCL has previously had these problems with incorrect or inadequate instruction. I know because in my last three years with CCL, I blew the whistle on mistakes in teacher training and instructional materials, and I received the typical whistleblower treatment. CCL should have learned from their past mistakes. Some of CCL’s previous mistakes involved the Lactational Amenorrhea Method. I regret that I have to bring up this mistake again, but I feel obligated to point this out publicly in the hopes that the word will get out to CCL teachers. CCL should include a corrections sheet with each manual.
All of us in the NFP movement need to be accurate and clear, no matter what rules or method we teach. I really do wish CCL well, but it needs to get substantive things right the first time when teaching others.
Sheila Kippley
NFP International
www.NFPandMore.org
Author: Breastfeeding and Catholic Motherhood and Natural Family Planning: The Question-Answer Book (e-book at this website)