North American Registry of Midwives (NARM) Practice Exam

What is an important guideline for using the LAM (Lactation Amenorrhea Method) of birth control?

1. Baby must be over 6 months old

2. No vaginal bleeding after 56 days postpartum

3. Breastfeeding must be intermittent

4. Woman must be on hormonal birth control

The correct answer is: No vaginal bleeding after 56 days postpartum

An important guideline for using the Lactation Amenorrhea Method (LAM) of birth control is that there should be no vaginal bleeding after 56 days postpartum. This is significant because LAM is highly effective in the first six months after childbirth when certain conditions are met, including exclusive breastfeeding. The absence of vaginal bleeding can indicate that the woman is not ovulating, making her less likely to conceive. In the context of LAM, the primary mechanism of action is the hormonal changes that occur due to breastfeeding, which suppress ovulation. Therefore, the guideline regarding the absence of menstrual bleeding aligns with the principle that the body is still in a non-ovulatory state, providing effective birth control as long as the other criteria of LAM, such as breastfeeding at least every four hours during the day and every six hours at night, are also met.