Brief explanation

Breastfeeding can affect fertility after childbirth. However, it does not automatically provide reliable protection against pregnancy while breastfeeding.

The S3 guideline ‘Duration of Breastfeeding and Interventions to Promote Breastfeeding’ provides evidence-based recommendations on the duration of breastfeeding for full-term infants. Contraception after childbirth is not covered by this guideline. The recommendations on the duration of breastfeeding cannot therefore be applied to the duration of protection against unintended pregnancy.

What does the S3 guideline recommend regarding breastfeeding duration?

For full-term infants, the guideline sets out two key recommendations:

These recommendations provide scientifically based guidance for advice on breastfeeding duration. However, the actual duration of breastfeeding depends on individual factors, including the health of the mother and child, as well as personal circumstances and needs.

Not every woman is able to or wishes to breastfeed. Professional counselling should therefore provide information and support informed, autonomous decision-making.

How does the new S3 guideline change the previous recommendations on breastfeeding duration?

With the new S3 guideline, Germany now has its first evidence-based guideline on the duration of breastfeeding. It is intended to provide consistent, scientifically grounded guidance on how long infants should be breastfed.

The main change is the more specific timeframes: previous German recommendations specified a period of four to six months for exclusive breastfeeding. The decision on how long to continue breastfeeding overall was left to the mother and child. The new S3 guideline, however, recommends that full-term infants be exclusively or predominantly breastfed until they are six months old and that breastfeeding continue for a total of at least twelve months.

This represents a change from the previous German recommendations and brings them more closely into line with international recommendations. However, these recommendations are intended as guidance. How long breastfeeding actually continues still depends on the individual circumstances of the mother and child, as well as their personal needs.

How well are the recommendations on breastfeeding duration supported by scientific evidence?

The guidelines group assesses the scientific evidence for many of the health issues examined as low or very low.

A large proportion of the findings comes from observational studies. Therefore, an observed association does not automatically mean that breastfeeding is the cause of the respective health effect.

Can breastfeeding be used as a method of contraception?

Breastfeeding alone does not automatically provide protection against unintended pregnancy. Under certain conditions, the so-called lactational amenorrhoea method (LAM) can be used as a form of contraception for a limited period. 

For this, three conditions must be met simultaneously:

• The baby is under six months old
• The baby is breastfed exclusively or almost exclusively and frequently, including at night
• No menstrual bleeding has occurred since the birth

As soon as any one of these conditions is no longer met, LAM should no longer be used as the sole method of contraception.

The first ovulation can occur even before the first menstrual period after the birth. A pregnancy is therefore possible even before the first period.

What methods of contraception are suitable while breastfeeding?

The choice of contraceptive method after childbirth depends, amongst other things, on the time since the birth, your health and your personal preferences.

If you wish to use hormone-free contraception after giving birth, you may also consider a diaphragm. A diaphragm is always used in combination with a diaphragm gel and can also be used while breastfeeding. After giving birth, a diaphragm can be used from six weeks postpartum; the fit should be checked by a qualified professional before use.

More on this topic:
Contraception after childbirth – breastfeeding, fertility and the diaphragm

Conclusion

The new S3 guideline provides recommendations on the duration of breastfeeding for full-term babies. However, these recommendations cannot be applied to the duration of contraceptive protection.

Anyone wishing to avoid pregnancy after giving birth should choose a suitable method of contraception in good time.

This article is for general information purposes only and is not a substitute for individual medical advice. When using a diaphragm, please follow the relevant instructions for use and observe the contraindications and usage instructions specified therein.