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Miriam H. Labbok - One of the best experts on this subject based on the ideXlab platform.
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Postpartum sexuality and the Lactational Amenorrhea Method for contraception
Clinical obstetrics and gynecology, 2015Co-Authors: Miriam H. LabbokAbstract:This chapter reviews the literature on postpartum coital behavior, anovulatory and ovulatory bleeding episodes, and the Methodology and efficacy of Lactational Amenorrhea Method and progesterone-only oral contraceptives. Of interest is the finding that breastfeeding women may resume coital behavior earlier postpartum, but report increased discomfort over time. The high efficacy of the Lactational Amenorrhea Method is confirmed and data illustrating possible relaxation of some criteria are presented. The conflicting guidance of CDC and WHO concerning immediate postpartum use of progestin-only Methods is presented. The dearth of recent studies calls for new research on these topics.
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Post-Marketing Study of the Lactational Amenorrhea Method (LAM): Impact of Putting LAM in Women’s Hands
Advances in Experimental Medicine and Biology, 2002Co-Authors: Miriam H. Labbok, Anne E. PetersonAbstract:The Lactational Amenorrhea Method for family planning, based on the physiology of Lactational infertility, has undergone extensive clinical study. Concern remains, among clinicians and demographers alike, that this is a behavior-based Method and is therefore unreliable. This study was undertaken to observe Method use under conditions that would more approximate use outside of a research setting.
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post marketing study of the Lactational Amenorrhea Method lam impact of putting lam in women s hands
2002Co-Authors: Miriam H. Labbok, Anne E. PetersonAbstract:The Lactational Amenorrhea Method for family planning, based on the physiology of Lactational infertility, has undergone extensive clinical study. Concern remains, among clinicians and demographers alike, that this is a behavior-based Method and is therefore unreliable. This study was undertaken to observe Method use under conditions that would more approximate use outside of a research setting.
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Breastfeeding Patterns and Menses Return: Findings from Research on LAM
Advances in Experimental Medicine and Biology, 2002Co-Authors: Miriam H. Labbok, Verónica Valdés, Ricardo AravenaAbstract:Much has been learned in the past 30 years concerning the physiological relationship of lactation and Lactational infertility. Studies of maternal seemed to indicate that maternal nutritional status, parity and age were key.1 More recent work has indicated that characteristics of the infant feeding that may explain more of the difference.2,3,4 A recent study of the Lactational Amenorrhea Method (LAM) allowed study of the return of menses in two similar populations in urban Santiago Chile. Data from this prospective research were re-analyzed to assess patterns of breastfeeding and menses return.
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The efficacy of the Lactational Amenorrhea Method (LAM) among working women.
Contraception, 2000Co-Authors: Verónica Undurraga Valdés, Miriam H. Labbok, Edda Pugin, Alfredo PerezAbstract:The purpose of this study was to assess the efficacy of the Lactational Amenorrhea Method (LAM) for family planning among mothers who are separated from their infants by work. The study population, 170 urban middle class women who planned to return to work before 120 days postpartum, were interviewed monthly for 6 months postpartum and contacted at 12 months. The study population received clinical support for expressing their milk and exclusively breast-milk feeding the infants and for the use of LAM for birth spacing. The cumulative life table pregnancy rate by 6-month was 5.2%, with 3 pregnancies, one at each of months 4, 5, and 6. LAM for working women, as described in this article, might be associated with a higher pregnancy risk than LAM use among non-working women. Therefore, women using LAM should be informed that separation from the infant might increase their risk of pregnancy.
Kathy I. Kennedy - One of the best experts on this subject based on the ideXlab platform.
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Efficacy and effectiveness of LAM.
Advances in experimental medicine and biology, 2002Co-Authors: Kathy I. KennedyAbstract:Two major protocols of non-randomized clinical trials of the efficacy of the Lactational Amenorrhea Method of contraception (LAM) were performed in the 1990s that suggested LAM to be a highly effective albeit temporary Method of contraception. Data from a longitudinal study of over 4000 breastfeeding women performed by the World Health Organization provide supporting information as to the efficacy of LAM. Effectiveness data are scarce, as is information on the use of LAM in industrialized countries. Issues surrounding LAM efficacy and effectiveness are reviewed, and the existing information from industrialized countries is highlighted.
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Users' understanding of the Lactational Amenorrhea Method and the occurrence of pregnancy.
Journal of Human Lactation, 1998Co-Authors: Kathy I. Kennedy, Cynthia M. Visness, Afroze Kazi, Milton Kotelchuck, Rebecca RamosAbstract:This study aims to determine 1) the proportion of Lactational Amenorrhea Method (LAM) users who understand the Method; 2) whether any known factors can distinguish those who understand LAM from those who do not; and 3) whether an understanding of LAM is related to subsequent pregnancy. Data were collected from 876 LAM users in Pakistan and the Philippines. It was found that 75% of LAM users could consistently recite the LAM guidelines correctly for a full year postpartum. However 38% of users failed to display at least once an understanding of LAM during the first year postpartum mainly by failing to abstain to use another Method or to explain their nonuse of another Method when their LAM protection expired. Also the sociodemographic factors could not predict the level of understanding of LAM users. Therefore the occurrence of pregnancy during the first year postpartum was not related to LAM understanding regardless of how LAM understanding was defined nor could it be predicted by any other measured characteristics of the users.
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Policy considerations for the introduction and promotion of the Lactational Amenorrhea Method: advantages and disadvantages of LAM.
Journal of human lactation : official journal of International Lactation Consultant Association, 1998Co-Authors: Kathy I. Kennedy, Milton KotelchuckAbstract:This paper explores the advantages and disadvantages of the Lactational Amenorrhea Method (LAM) and their implications for policy and use. Clinical trials of LAM have upheld the Bellagio Consensus that the chance of pregnancy is less than 2% in the first 6 months postpartum in amenorrheic women who are fully or nearly fully breast-feeding. Secondary data analyses in numerous settings have resulted in the same conclusion. LAM if used correctly or even if used imperfectly should be a reliable strategy or a Method to avoid pregnancy. To the extent that LAM represents an additional contraceptive option this is also positive because a broad array of contraceptive options maximizes the likelihood of finding a good fit between user and Method and increases contraceptive use. Other characteristics of LAM represent potentially positive impacts. If LAM is shown to be an effective conduit to other modern Methods the implications are profoundly positive. If LAM is cost-effective for households and/or programs this will also make the Method extraordinarily attractive. Conversely some aspects of LAM are negative such as the fact that it offers no protection against sexually transmitted diseases it requires counseling from a well-informed provider and intensive breast-feeding can make heavy demands on the womans time. Because LAM is effective in preventing pregnancies and because it extends the range of contraceptive choices considering LAM at the policy level is always appropriate.
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The Frequency of Coitus During Breastfeeding
Birth (Berkeley Calif.), 1997Co-Authors: Cynthia M. Visness, Kathy I. KennedyAbstract:Background: New mothers and clinicians would benefit from an understanding of typical sexual behavior during breastfeeding. Unfortunately, little information is available about both the typical length of time to resumption of coitus and the frequency of sexual relations during breastfeeding. This paper describes the commencement and frequency of coitus among breastfeeding women in a variety of settings. Methods: The analysis draws on data from two separate research studies. The first was undertaken in three sites (Birmingham, United Kingdom; Montreal, Canada; Sydney, Australia), the purpose of which was to correlate natural observations of fertility with the underlying hormonal profile among breastfeeding women using the sympto-thermal Method of natural family planning. The second was a clinical trial of the Lactational Amenorrhea Method of family planning conducted in Manila, the Philippines. Results: Coital frequency reported by these populations of breastfeeding women appears to be lower than that reported in other studies for married women in general. As other research demonstrated, we found coital frequency and postpartum resumption of coitus to be associated with age, but not with the number of children in the household. Conclusions: A better understanding of the level of sexual activity among breastfeeding women could inform and improve programs that offer postpartum support and counseling about family planning. (BIRTH 24:4, December 1997)
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Lactational Amenorrhea Method for family planning
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 1996Co-Authors: Kathy I. Kennedy, Miriam H. Labbok, P.f.a. Van LookAbstract:In December 1995 a conference on the Lactational Amenorrhea Method (LAM) for family planning was held in Bellagio Italy to review the findings of studies expressly designed to test the consensus of the 1988 meeting on LAM also held in Bellagio and findings of other relevant research. At the 1988 meeting on LAM participants came to a conclusion now referred to as the Bellagio consensus: women who are not using family planning but are fully or nearly fully breast feeding and amenorrheic face a risk of pregnancy less than 2% during the first six months postpartum. 1995 conference participants found that the findings clearly confirmed the Bellagio consensus. The criteria to meet LAM guidelines are Amenorrhea full or nearly full breast feeding and the first six months postpartum. The 1995 participants concluded that it is impossible to eliminate the Amenorrhea criterion. It may be possible to relax the criterion of full or nearly full breast feeding and to extend LAM beyond six months postpartum. They defined the end of Amenorrhea to be two consecutive days of bleeding/spotting or of the womans perception that her menses have returned. The LAM guidelines advise women who no longer meet any of these criteria or no longer wish to use LAM that they should immediately begin using another family planning Method to avoid pregnancy. Family planning programs and policies should support LAM so it can be available worldwide. Programmatic research needs are studies on the LAM performance under a wide range of field conditions impact of LAM on family planning use LAM use in mothers who are separated from their babies for a prolonged period each day and in mothers of premature babies integration of LAM into family planning and other health services and the level and nature of support needed for effective LAM use. Biomedical research needs are studies on the factors that determine whether a woman ovulates before or after her return to menses the levels and patterns of infant feeding needed to maintain low pregnancy rates and the relative importance of the various factors that contribute to Lactational infertility.
Anne E. Peterson - One of the best experts on this subject based on the ideXlab platform.
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Post-Marketing Study of the Lactational Amenorrhea Method (LAM): Impact of Putting LAM in Women’s Hands
Advances in Experimental Medicine and Biology, 2002Co-Authors: Miriam H. Labbok, Anne E. PetersonAbstract:The Lactational Amenorrhea Method for family planning, based on the physiology of Lactational infertility, has undergone extensive clinical study. Concern remains, among clinicians and demographers alike, that this is a behavior-based Method and is therefore unreliable. This study was undertaken to observe Method use under conditions that would more approximate use outside of a research setting.
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post marketing study of the Lactational Amenorrhea Method lam impact of putting lam in women s hands
2002Co-Authors: Miriam H. Labbok, Anne E. PetersonAbstract:The Lactational Amenorrhea Method for family planning, based on the physiology of Lactational infertility, has undergone extensive clinical study. Concern remains, among clinicians and demographers alike, that this is a behavior-based Method and is therefore unreliable. This study was undertaken to observe Method use under conditions that would more approximate use outside of a research setting.
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Multicenter study of the Lactational Amenorrhea Method (LAM) III: effectiveness, duration, and satisfaction with reduced client–provider contact
Contraception, 2000Co-Authors: Anne E. Peterson, Helena Von Hertzen, R. Peŕez-escamilla, M.h. Labboka, V. Hight, P.f.a. Van LookAbstract:Abstract The objective of this effort was to assess the use and efficacy of the Lactational Amenorrhea Method (LAM) with reduced numbers of client–provider contacts. A co-sponsored multicenter study of LAM was performed to test the efficacy and acceptability of the Method under “post-marketing” conditions, with investigator-initiated contact occurring only twice: at the time of intake and then again at month 7 of postpartum. These data are assumed to provide an assessment of LAM’s use, efficacy, and performance that more closely reflects the prevailing conditions of these populations during normal use. Three hundred and sixty-two subjects were recruited through centers that had participated in the previous, more contact-intensive studies. Using a cooperatively developed protocol, data were gathered prospectively on at least 10 and up to 50 LAM acceptors at nine sites, and entered and cleaned on site. Data were further cleaned and analyzed at the Georgetown University Institute for Reproductive Health (IRH) and the Department of Nutrition at the University of Connecticut. Using country-level and pooled data, descriptive statistics and life tables were produced. LAM efficacy in this sample is 100% because there were no pregnancies at any of the participating sites. Satisfaction with the Method was high, and the rate of continuation on to another Method after LAM was 66.7% at 7 months postpartum. Of the women who had never used family planning prior to LAM, 63.0% went on to use another Method of family planning in a timely manner. LAM can be highly effective as an introductory postpartum family planning Method when offered in a variety of cultures, health care settings, and industrial and developing country locales. Under conditions of limited client–provider contact, LAM remains effective and leads to acceptance of another Method by about two-thirds of the acceptors. Women are able to use LAM effectively without extensive counseling or follow-up, with a high level of user satisfaction.
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Multicenter study of the Lactational Amenorrhea Method (LAM): II. Acceptability, utility, and policy implications
Contraception, 1997Co-Authors: Virginia Hight-laukaran, Miriam H. Labbok, Anne E. Peterson, Veronica Fletcher, Helena Von Hertzen, P.f.a. Van LookAbstract:A multicenter study of the Lactational Amenorrhea Method (LAM) was carried out to determine acceptability, satisfaction, and utilization in 10 different populations, and to confirm the efficacy of the Method. Efficacy data are presented in a companion paper. A protocol was designed at the Institute for Reproductive Health (IRH), Department of Obstetrics and Gynecology, Georgetown University Medical Center, and reviewed and modified in collaboration with the co-sponsors, the World Health Organization, the South-to-South Cooperation for Reproductive Health, and the principal investigators from each site. Data were gathered prospectively on LAM users at 11 sites. Data were entered and cleaned on-site, and further cleaned and analyzed at IRH, using country-level and pooled data to produce descriptive statistics. The overall satisfaction with LAM was 83.6%, and continuation with another Method of family planning was shown to be 67.6% at 9 months postpartum, in most cases exceeding previous use of contraception prior to use of LAM. Knowledge and understanding of the Method at discontinuation were high, ranging from 78.4 to 88.6% for the three criteria. LAM can be used with a high level of satisfaction and success by women in a variety of cultures, health care settings, socio-economic strata, and industrial and developing country settings. The results confirm that LAM is acceptable and ready for widespread use, and should be included in the range of services available in maternal and child health, family planning, and other primary health care settings.
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Multicenter study of the Lactational Amenorrhea Method (LAM): I. Efficacy, duration, and implications for clinical application.
Contraception, 1997Co-Authors: Miriam H. Labbok, Anne E. Peterson, Virginia Hight-laukaran, Veronica Fletcher, Helena Von Hertzen, P.f.a. Van LookAbstract:Abstract A multicenter study of the Lactational Amenorrhea Method (LAM) was carried out to test the acceptability and efficacy of the Method. Additionally, the data are used to test new constructs for improvement of Method criteria. A protocol was designed at the Institute for Reproductive Health (IRH), Department of Obstetrics and Gynecology, Georgetown University Medical Center, a World Health Organization (WHO) Collaborating Center, and was reviewed and modified in collaboration with the co-sponsors, the World Health Organization and the South to South Cooperation for Reproductive Health, and the principal investigators from each site. Data were gathered prospectively on LAM acceptors at 11 sites. Data were entered and cleaned on-site and further cleaned and analyzed at IRH, using country-level and pooled data to produce descriptive statistics and life tables. The 98+ % efficacy of LAM is confirmed in a wide variety of settings. In addition, the results yield insight on the possibility of continued use beyond 6 months. LAM is found to be highly effective as an introductory postpartum Method when offered in a variety of cultures, health care settings, socioeconomic strata, and industrial and developing country locales. In addition, LAM acceptance complements breastfeeding behaviors without ongoing breastfeeding support services. The parameters studied yield high efficacy and Method continuation. Therefore, the basic tenets of the 1995 Bellagio consensus on LAM is reconfirmed and it is recommended that LAM be incorporated into hospital, maternity, family planning, maternal and child health, and other primary health care settings.
Polanco-reyes L - One of the best experts on this subject based on the ideXlab platform.
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Lactational Amenorrhea as a family planning Method
Salud Publica De Mexico, 1996Co-Authors: Canto-de Cetina T, Polanco-reyes LAbstract:The contraceptive effects of breast feeding still play an important role in child spacing in developing countries; however its use as a Method of family planning was untested until 1988 when an international group of researchers met in Bellagio and reached a consensus statement that reads "The maximum birth spacing effect of breast feeding is achieved when mothers fully or nearly fully breastfeed and remain amenorrheic (and no menstrual bleeding has occurred before the 56th postpartum day). When these two conditions are present breast feeding provides more than 98% of protection in the first six months. That became the basis for a Method of family planning called Lactational Amenorrhea Method (LAM). This is a new introductory family planning Method that simultaneously promotes child spacing and breast feeding with its optimal nutrition and disease prevention benefits for the infant. It is based on the natural infertility caused by the hormonal suppression of ovulation. (authors) (summaries in ENG SPA)
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Lactational Amenorrhea as a Method of family planning
Salud publica de Mexico, 1996Co-Authors: Canto-de Cetina T, Polanco-reyes LAbstract:The contraceptive effects of breast-feeding still play an important role in child spacing in developing countries; however, its use as a Method of family planning was untested until 1988, when an international group of researchers met in Bellagio and reached a consensus statement that reads "The maximum birth spacing effect of breast-feeding is achieved when mothers fully or nearly fully breast-feed and remain amenorrheic (and no menstrual bleeding has occurred before the 56th postpartum day). When these two conditions are present, breast-feeding provides more than 98% of protection in the first six months. That became the basis for a Method of family planning called the Lactational Amenorrhea Method (LAM). Which is a new introductory family planning Method that simultaneously promotes child spacing and breast-feeding, with its optimal nutrition and disease preventive benefits for the infant. This Method is based on the natural infertility caused by the hormonal suppression of ovulation.
Salahuddin Ahmed - One of the best experts on this subject based on the ideXlab platform.
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Transition from the Lactational Amenorrhea Method to other modern family planning Methods in rural Bangladesh: barrier analysis and implications for behavior change communication program intervention design.
Evaluation and Program Planning, 2014Co-Authors: Robin Anthony Kouyaté, Jaime Haver, Catharine Mckaig, Nargis Akter, Angela Nash-mercado, Salahuddin Ahmed, Abdullah H BaquiAbstract:The timely transition from Lactational Amenorrhea Method (LAM)22The Lactational Amenorrhea Method, also known as LAM, is a modern, temporary contraceptive Method based on natural infertility resulting from patterns of breastfeeding. to another modern family planning Method contributes to healthy spacing of pregnancies by increasing the adoption of family planning during the first year postpartum. Yet, literature suggests challenges in completing a timely LAM transition. To guide program implementation in Bangladesh, this study identified factors influencing women's transition decisions.
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Transition from the Lactational Amenorrhea Method to other modern family planning Methods in rural Bangladesh: barrier analysis and implications for behavior change communication program intervention design.
Evaluation and program planning, 2014Co-Authors: Robin Anthony Kouyaté, Jaime Haver, Catharine Mckaig, Nargis Akter, Angela Nash-mercado, Salahuddin Ahmed, Abdullah H BaquiAbstract:The timely transition from Lactational Amenorrhea Method (LAM)(2) to another modern family planning Method contributes to healthy spacing of pregnancies by increasing the adoption of family planning during the first year postpartum. Yet literature suggests challenges in completing a timely LAM transition. To guide program implementation in Bangladesh this study identified factors influencing womens transition decisions. Eighty postpartum women comprising 40 who transitioned from LAM(3) and 40 who did not(4) participated. Half of each group participated in in-depth interviews to explore the decision-making process. All participants responded to a "Barrier Analysis" questionnaire to identify differences in eight behavioral determinants. More than half of transitioners switched to another modern Method before or within the same month that LAM ended. Of the 18 transitioners who delayed(5) 15 waited for menses to return. For non-transitioners key barriers included waiting for menses to return misconceptions on return to fertility and perceived lack of familial support. The LAM transition can help women prevent unintended pregnancy during the first year postpartum. Increased emphasis on counseling women about the risk of pregnancy and misconceptions about personal fertility patterns are critical for facilitating the transition. Strategies should also include interventions that train health workers and improve social support. Copyright (c) 2015. Published by Elsevier Ltd.
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Operations research to add postpartum family planning to maternal and neonatal health to improve birth spacing in Sylhet District, Bangladesh.
Global health science and practice, 2013Co-Authors: Salahuddin Ahmed, Maureen Norton, Emma K. Williams, Saifuddin Ahmed, Rasheduzzaman Shah, Nazma Begum, Jaime Mungia, Amnesty E Lefevre, Ahmed Al-kabir, Peter J. WinchAbstract:This quasi-experimental study integrated family planning, including the Lactational Amenorrhea Method, into community-based maternal and newborn health care and encouraged transition to other modern Methods after 6 months to increase birth-to-pregnancy intervals. Community-based distribution of pills, condoms, and injectables, and referral for clinical Methods, was added to meet women's demand. ABSTRACT Background: Short birth intervals are associated with increased risk of adverse maternal and neonatal health (MNH) outcomes. Improving postpartum contraceptive use is an important programmatic strategy to improve the health and well-being of women, newborns, and children. This article documents the intervention package and evaluation design of a study conducted in a rural district of Bangladesh to evaluate the effects of an integrated, community-based MNH and postpartum family planning program on contraceptive use and birth-interval lengths. Intervention: The study integrated family planning counseling within 5 community health worker (CHW)-household visits to pregnant and postpartum women, while a community mobilizer (CM) led community meetings on the importance of postpartum family planning and pregnancy spacing for maternal and child health. The CM and the CHWs emphasized 3 messages: (1) Use of the Lactational Amenorrhea Method (LAM) during the first 6 months postpartum and transition to another modern contraceptive Method; (2) Exclusive, rather than fully or nearly fully, breastfeeding to support LAM effectiveness and good infant breastfeeding practices; (3) Use of a modern contraceptive Method after a live birth for at least 24 months before attempting another pregnancy (a birth-to-birth interval of about 3 years) to support improved infant health and nutrition. CHWs provided only family planning counseling in the original study design, but we later added community-based distribution of Methods, and referrals for clinical Methods, to meet women's demand. Methods: Using a quasi-experimental design, and relying primarily on pre/post-household surveys, we selected pregnant women from 4 unions to receive the intervention (n52,280) and pregnant women from 4 other unions (n52,290) to serve as the comparison group. Enrollment occurred between 2007 and 2009, and data collection ended in January 2013. Preliminary Results: Formative research showed that women and their family members generally did not perceive birth spacing as a priority, and most recently delivered women were not using contraception. At baseline, women in the intervention and comparison groups were similar in terms of age, husband's education, religion, and parity. CHWs visited over 90% of women in both intervention and comparison groups during pregnancy and the first 3 months
