August 27, 2018
By Katie Douglas 

Editor’s Note: This is the last article in this month’s series on breastfeeding, fertility, and family planning. We are grateful for our summer intern, Katie Douglas, who wrote this four-part series and conducted this interview.

We appreciate the opportunity to journey back with Sheila Kippley to learn the history of Ecological Breastfeeding. She is co-founder of NFP International along with her husband, John Kippley. To learn more about Ecological Breastfeeding and the Lactational Amenorrhea Method (LAM), read An Overview of Lactational Amenorrhea and Fertility and this brief summary. To hear about a woman’s experience using Ecological Breastfeeding, read about Jessica’s experience here.

 

Can you describe your background and what led to the development of the Seven Standards for Ecological Breastfeeding?
I graduated from the University of California in San Francisco (UCSF) with a Bachelor of Science in 1962. While pregnant with my first child two years later, a childbirth instructor stressed natural childbirth and breastfeeding and encouraged us to attend the La Leche League (LLL) classes. At the LLL meetings, discussions arose about the return of menstruation, which varied among nursing mothers who did “total” breastfeeding (now called “exclusive” breastfeeding). My good friend, the LLL librarian, suggested I research the topic and write a book. So I started researching this topic at UCSF and, after the birth of our third child, continued my research in Regina, the capital of Saskatchewan in Canada.

We published two studies on Ecological Breastfeeding in 1972 and 1989.[i] Both studies found that American mothers doing eco-breastfeeding averaged 14.5 months of breastfeeding amenorrhea. Our research was very conservative. We did not count three mothers who had over 40 months of breastfeeding amenorrhea, and we counted any menstrual bleeding or spotting as the first menstrual bleeding or period.

Personally, I did not follow any guidelines with our first baby. I used bottles and pacifiers and babysitters. I also would never sleep with my baby. I had two miscarriages after the birth of our first child, and a physician who specialized in infertility insisted that we keep trying. He taught the temperature sign but knew I wanted to breastfeed. He said I was to give my second daughter nothing but breast milk and asked me to call him when I had my first period.

I am grateful for this doctor’s advice. He did not say “use exclusive breastfeeding for only six months.” Our pediatrician was supportive and said I could continue exclusive breastfeeding for as long as I wanted. He was so impressed with her health and wished other moms did likewise. When my daughter’s first tooth came in at 8 months, I took that to be a sign to start introducing some solid food, which was a slow process and that was fine.

Why is Ecological Breastfeeding important?
Ecological Breastfeeding maximizes the many benefits of breastfeeding and extends breastfeeding amenorrhea, making it more likely to achieve recommendations from the World Health Organization[ii] and UNICEF.[iii] There are many health advantages for both mother and baby, some of which persist even after nursing. Nursing for one, two or even three years is normal when a mother uses Ecological Breastfeeding, and an early return of menstruation would be the exception.

How do you counsel parents about safety issues related to sleeping with their infant?
We refer them to our website, which links to where safe co-sleeping is discussed. In The Seven Standards of Ecological Breastfeeding, I list twenty advantages of sleeping with a nursing baby. When safe co-sleeping standards are followed, this is the safest way for a baby to sleep.

How have the Ecological Breastfeeding guidelines been updated since their conception?
The standards have not changed. They all point to the same thing: Stay near your baby and nurse whenever the child wants to nurse. All the concepts of the Seven Standards were present in my first book, Breastfeeding and Natural Child Spacing (1969). We wanted a name for this specific form of breastfeeding, since there are so many ways to breastfeed. Ecology was in the media frequently at that time, so we picked Ecological Breastfeeding for the kind of breastfeeding associated with extended amenorrhea.

In my book, The Seven Standards of Ecological Breastfeeding, I spent more time on the importance of the daily nap, the Fifth Standard, as it is the most frequently ignored even though it can be done in 30 minutes. As UNICEF said, “Breastfeeding can be an opportunity for a mother to take a few minutes of much-needed rest.”[iv] Mother-baby togetherness is the key to natural child spacing via breastfeeding. If you are with your baby, the Seven Standards are easy to do.

How can Ecological Breastfeeding be used with charting the cycle in terms of women’s health and family planning?
Eco-breastfeeding is preferred because of the health benefits of extended breastfeeding. These outcomes persist even years after nursing has ceased. It is also a wonderful way to have a natural spacing of births. For those who do not want more children at the time, they can start charting after six months of exclusive breastfeeding. Mothers can continue to breastfeed and chart for many months. Some will breastfeed through their next pregnancy.

How do women typically react to using Ecological Breastfeeding for the first time?
Experience suggests that some mothers need more help than others to start breastfeeding. Once started, our anecdotal experience is that the eco-breastfeeding moms love it.

What are some barriers for women to use Ecological Breastfeeding?
Barriers to eco-breastfeeding include the culture and work. At the May 2018 World Health Assembly in Geneva, there was a breastfeeding code with strong language against breast milk substitutes.[v] Delegates from other countries were surprised that a U.S. delegate wanted to soften or change the text. Our country does not do as much as it could to promote breastfeeding.

A culture that frowns on mothering as a full-time career creates difficulties for breastfeeding moms who must or want to work away from home. Even where nursing stations are provided, it will be difficult to duplicate the frequency of at-home full-time mothering. A mom working away from home may experience a shorter period of amenorrhea, but whatever breastfeeding she can do benefits both her and her baby. I stress that no one should feel guilty if they do the best they can in their circumstances.

I am not aware of any natural family planning (NFP) program in the States, other than our own NFPI, that teaches Ecological Breastfeeding. Some NFP teachers do teach LAM.

If a woman had never heard of Ecological Breastfeeding or LAM, what would you tell her?
Both methods are easy to teach; they just need to be properly defined. After all, they are simply maternal behaviors. I would tell a beginner to read our manual, Natural Family Planning: The Complete Approach, which describes LAM and eco-breastfeeding.

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Editor’s Note: Among its many benefits, breastfeeding is associated with a decreased risk of sudden infant death syndrome (SIDS). However, the practice of co-sleeping has been associated with SIDS in some cases (although other unsafe conditions are also present in the majority of these cases). The American Academy of Pediatrics (AAP) recommends supine positioning for sleep, room-sharing without bed-sharing, and avoiding soft beds and overheating. The AAP policy statement discusses safety considerations related to breastfeeding and co-sleeping. For the 2017 Guide for Health Professionals from UNICEF on this topic, please follow this link. For the AAFP position paper on breastfeeding, read here.

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Author Bio: Katie Douglas is a junior at the University of Illinois at Urbana-Champaign, where she studies Molecular & Cellular Biology. She has worked as a research assistant in the Nutrition and Cancer Epidemiology & Survivorship Lab on campus for almost two years. We are grateful for Katie’s outstanding contributions to our work at FACTS while serving as an intern with FACTS and FMEC this summer.

 

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References
[i] http://www.nfpandmore.org/spacingbabies.shtml
[ii] http://www.who.int/elena/titles/exclusive_breastfeeding/en/
[iii] https://www.unicef.org/nutrition/index_breastfeeding.html
[iv] Facts for Life: Breastfeeding, UNICEF, 1999
[v] The International Code of Marketing of Breast-milk Substitutes was adopted by the World Health Assembly in 1981 to protect and promote breastfeeding.

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MEDICAL STUDENTS & RESIDENTS!

Would you like to enroll in our two-week ONLINE COURSE about fertility awareness
based methods and their applications in women’s health and family planning?

Here’s what young physicians are saying about this course…

I highly recommend this elective to other medical students! Now that I have a much better understanding of the various FABMs, I am prepared to counsel and assist my future patients in determining which method is right for them.
— Emily Krach, DO 

Find out more about this elective and enroll HERE.

 

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