Billings Ovulation Method
during Breast Feeding

LACTATION NOTES

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The Billings Ovulation Method is applicable whilst breast-feeding your baby.

In order to understand how to apply this method to breast-feeding you need to first of all read the booklet Teaching the Billings Ovulation Method and in particular the sections "Keeping a Record" and "Delayed Ovulation - the Extended Pre-ovulatory Phase and the Basic Infertile Pattern".

Breast-feeding and the Billings Ovulation Method are Natural Companions

Despite fully and successfully breast-feeding, some women return to fertility within a few weeks following the baby’s birth. For others infertility may last months or years. The Billings Ovulation Method gives the lactating mother day by day understanding of her infertility and fertility. This allows the couple to enjoy their sexual relationship free from contraceptive devices or drugs and anxiety about fertility.

The couple must consider the possible damaging effects of the hormones in contraceptive drugs on breast-milk and the baby. The spacing of pregnancies gives each child the best opportunity for health, growth and development.

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Important Considerations for Breastfeeding

• Demand feeding is strongly recommended and will greatly assist to suppress fertility.

• Total breast-feeding up to six months is sufficient without the addition of fluid or other food to ensure the optimum nutrition of the baby.

• Colostrum comes from the breasts for the first few feeds and supplies the baby with an invaluable source of antibodies to protect against infection.

Infertility and Fertility Following a Birth or Miscarriage

Women not breast-feeding following a birth and those who have suffered a miscarriage may see a shift from infertility to returning fertility within about six weeks. The woman should be alert to the changes in her body which signal returning fertility.

Ovulation takes place before menstruation, therefore do not presume that you are infertile because you have had no bleeding.

Observe at the Vulva and Record Daily

Whichever category the woman is in, the key to successful fertility control is to learn her Basic Infertile Pattern and follow the Guidelines and Rules for the Billings Ovulation Method. Her first step is to keep a careful daily record.

The woman uses her own words to describe what she feels and sees.

Basic Infertile Patterns (see examples 1, 2 & 3)

A Basic Infertile Pattern (BIP) is an unchanging pattern of responses due to low oestrogens before ovulation.

1. No mucus (vulval dryness); or

2. An unchanging discharge at the vulva which accompanies a low unchanging level of oestrogen; or

3. A combination of 1 and 2 when the discharge remains unchanged during 2 weeks of observation and is interrupted by dry days.

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Guidelines of the Billings Ovulation Method

• Keep a daily record of the sensations at the vulva as well as any discharge observed at the vulva. Do this in the normal course of the day and whilst in an upright position.

• Do not examine internally as this gives incorrect information and may introduce infection.

• Commence charting at about three weeks following the birth when the lochia (blood loss) tends to stop.

• Avoid genital contact for approximately two weeks while making the initial recordings. This will help ensure correct observations. Accurate interpretations will follow.

• Learn to read your infertility/fertility accurately. Do not presume either situation. Individual teaching from an accredited Billings Ovulation Method teacher is invaluable. You may enquire about the location of a teacher near you by contacting us.

Management of the Billings Ovulation Method during Breast-feeding

Early Day Rules (see examples 4, 5 and 6)

• Apply these rules during the Basic Infertile Pattern, when ovulation is suspended, sometimes for weeks or months.

• The Basic Infertile Pattern is an unchanging pattern. Intercourse is available on alternate evenings during the Basic Infertile Pattern. Waiting a day following intercourse allows for secretions and seminal fluid from intercourse to cease.

• If there is a change from the Basic Infertile Pattern, whether in sensation at the vulva, or in the discharge, including bleeding or spotting, the rule is to wait until this change passes and the Basic Infertile Pattern has returned for three days. The couple can then resume intercourse on the fourth evening of the returned Basic Infertile Pattern. We refer to this as "wait and see 1, 2, 3".

When to Apply the Peak Rule

• The Peak Rule is applied when ovulation returns, i.e. when the Peak is recognised.

• Apply the Peak Rule only after the Peak Day is identified. Until this time arrives the woman applies the Early Day Rules only, to her Basic Infertile Pattern. The fertile phase is a changing pattern leading to the Peak and includes three days following the Peak.

Peak Rule (see example 7)

• From the beginning of the fourth day following the Peak, until the end of the cycle intercourse is available every day at any time.

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Bleeding

There may be several episodes of bleeding without prior ovulation indicating fluctuating oestrogen levels. The endometrium responds by a follicular phase growth of glands and blood vessels when oestrogens rise. This may result in bleeding for either of two reasons:

1. break-through bleeding due to high oestrogen: this may recur; it  may also occur just before ovulation and therefore signify high fertility;

2. some days after an oestrogen level rise, when the oestrogen level has fallen, withdrawing its support from the endometrium (withdrawal bleeding).

If ovulation (identified by the Peak) does not precede a bleeding episode, the bleeding cannot be classified as menstruation.

A Changing State from Infertility to Fertility

Once the cervix responds to rising levels of oestrogen, it produces mucus that allows the entry of sperm cells. The first sign of any change in a woman’s state of infertility may be intermittent days of mucus interrupting her established Basic Infertile Pattern. The woman will notice this changing situation, and it may continue for some weeks. This is a sign that her fertility will soon return with a recognisable Peak and Ovulation.

A Time Close to Ovulation

An extremely slippery, lubricative sensation at the vulva is an important symptom. The woman may also notice a soft fullness of the vulva around this time, signifying the Peak.  Menstruation will occur within two weeks. The woman is not fertile if menstruation occurs less than 11 days following the Peak. The interval of 11 to 16 days from Peak to menstruation will return subsequently, signifying fertility.

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The Return of Cycles, Rules and Re-assessing the Basic Infertile Pattern

Once cycles return there is a need to re-assess the woman’s Basic Infertile Pattern of discharge which usually is not the same as that experienced during the breast-feeding time prior to ovulation.

Reminder: If ovulation does not precede a bleeding episode, the bleeding cannot be classified as menstruation. The rule "wait and see 1, 2, 3" is applied.

If the woman identifies a Peak Day she now applies the Peak Rule. Menstruation always follows ovulation. Avoid intercourse during days of heavy menstrual bleeding.

Example Charts

The following example charts use International Charting Symbols.

(1) DRY BASIC INFERTILE PATTERN (BIP)

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(2) A BIP of an UNCHANGING DISCHARGE at the VULVA. The woman describes what she feels and sees over 2  weeks

For 2 weeks the woman keeps a DAILY record of both sensations at the vulva and the visible discharge.  The BIP is her own unchanging pattern as she observes it, with her unchanging description.  Every woman is an individual and describes a discharge in her own way.  She should not evaluate the discharge by the experience of another woman or by pictures of an isolated specimen.One woman may describe her experience as ‘sticky yellow’ daily.  Another woman may describe her experience as ‘damp-nothing seen’ each day.  Each woman will use the same description for the same symptom each day. The symbol used to record a BIP of unchanging discharge is '=' .

(3) BIP which is a COMBINATION of (1) and (2) when the discharge remains unchanged during 2 weeks of observation and is interrupted by dry days

(4) DRY BASIC INFERTILE PATTERN (BIP) - applying Early Day Rules

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(5) A BIP of UNCHANGING DISCHARGE at theVULVA. The woman describes what she feels and sees, applying the Early Day Rules to an already established BIP.

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(6) BIP which is a COMBINATION of (1) and (2) when the discharge remains unchanged during 2 weeks of observation and is interrupted by dry days - established BIP, applying the Early Day Rules.

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Example 7 - Using a Dry Basic Infertile Pattern

The record begins in the pre-ovulatory phase. Note application of the rule "wait and see 1, 2, 3"on five occasions. On day 42 the rule "wait and see " is applied and on day 46 the Peak is recognised and the Peak Rule is applied.

Reference: Evelyn L. Billings and John J. Billings, Teaching the Billings Ovulation Method Part 2. Variations of the Cycle and Reproductive Health, "Normal Fertile Cycle: Long Delayed Ovulation", Ovulation Method Research and Reference Centre of Australia, Melbourne, 1997, p 14.

(7) DRY BIP - "Wait and See 1, 2, 3" - EARLY DAY RULE and the PEAK RULE

Day

1

2

3

4

5

6

7

8

9

10

11

12

13

14

Symbol

Sensation/ Appearance of discharge

dry

dry

dry

dry

dry

dry

dry

wet

dry

dry

dry

dry

wet

wet

Phases/ Patterns

High oestrogen Breakthrough bleed

Day

15

16

17

18

19

20

21

22

23

24

25

26

27

28

Symbol

Sensation/ Appearance of discharge

dry

dry

dry

dry

dry

sticky

sticky

sticky

sticky

sticky

sticky

dry

dry

dry

Phases/ Patterns

Low oestrogen

Raised oestrogen. No normal progression of mucus. No Peak.

Low oestrogen

Day

29

30

31

32

33

34

35

36

37

38

39

40

41

42

Symbol

Sensation/ Appearance of discharge

dry

dry

wet

wet

wet

dry

dry

dry

dry

dry

wet

dry

dry

wet

Phases/ Patterns

Low oestrogen

Anovulatory withdrawal bleed (not menstruation) Low oestrogen

Low oestrogen

Day

43

44

45

46

47

48

49

50

51

52

53

54

55

56

Symbol

Sensation/ Appearance of discharge

slippery

slippery strings spotting

slippery strings bleed

slippery

sticky opaque

sticky opaque

sticky opaque

dry

dry

dry

dry

dry

dry

dry

Phases/ Patterns

High oestrogen. Pre-ovulatory breakthrough bleed. Peak (46)

Oestrogen fall

High oestrogen high progesterone

Oestrogen and progesterone fall

Progesterone rise

Day

57

58

Symbol

Sensation/ Appearance of discharge

dry

wet

Phases/ Patterns

Menstruation (withdrawal bleed), low oestrogen and progesterone