II-195
DOJENJE KOT KONTRACEPCIJA – KJE SMO DANES?
BREASTFEEDING AS CONTRACEPTION – WHAT DO WE KNOW TODAY?
Barbara Rojnik
Ginekološka ordinacija dr. Barbara Rojnik, Metelkova 15, 1000 Ljubljana
Key works: breastfeeding; lactational amenorrhoea method;
contraception;counselling
Abstract – Background. Breastfeeding plays an important
role in fertility regulation, yet only 1988 Bellagio Consensus
Statement provided relevant estimation about the contracep-
tive efficacy of breastfeeding. On the basis of prospective stu-
dies it was concluded that women are 98%protected against
a new pregnancy during first six month post-partum, provi-
ded they practice exclusive breastfeeding and remain ame-
norrhoic. For practical implementation of the Bellaggio Con-
sensus Statement lactational amenorrhoea method (LAM) was
proposed as a new family planning method. Effectiveness of
LAM was proven in different populations and socio-economic
settlements of developed and developing world, suggesting that
LAM is comparable to other effective contraceptive methods.
Moreover, studies in the last decade show that with well-defi-
ned conditions, LAM can be relied on for contraceptive pro-
tection for up to one year postpartum.
Conclusions. Despite many new data about the contraceptive
effect of breastfeeding in the last decades, many issues, con-
troversies and misconceptions remain, yet discussions for pro
and contra even in developed countries support breastfeeding
as a contraceptive method. LAM provides an effective, albeit
temporary method of contraception and helps mother to ex-
tend breastfeeding. LAM should be included in the family plan-
ning services and counselling upon its use needs to offer a
timely shift to another effective method of contraception, when
criteria for LAM no longer exist.
POSTERJI
Ključne besede: dojenje; metoda laktacijske amenoreje; kon-
tracepcija; svetovanje
Izvleček – Izhodišča. Čeprav je nesporno, da je dojenje od-
igralo pomembno vlogo pri uravnavanju rodnosti, smo šele
leta 1988 dobili prve relevantne ocene o kontraceptivnem
učinku dojenja (Bellaggio Consensus Statement). Na osnovi
prospektivnih študij so zaključili, da je dojenje v primeru ame-
noreje in polnega dojenja prvih šest mesecev po porodu učin-
kovito v 98%. Za praktično uveljavitev smernic iz Bellagia so
strokovnjaki predlagali metodo laktacijske amenoreje (lac-
tational amenorrhoea method – LAM) kot samostojno metodo
načrtovanja družine. Učinkovitost LAM so preverili v različ-
nih populacijah in socialnoekonomskih razmerah nerazvite-
ga in razvitega sveta ter zaključili, da je LAM primerljiva z
drugimi zanesljivimi metodami kontracepcije. Izsledki raz-
iskav v zadnjem desetletju pa nakazujejo, da je ob natančno
določenih pogojih moč kontraceptivni učinek LAM izkoristiti
do enega leta po porodu.
Zaključki. Kljub številnim novim odkritjem v zadnjih dveh
desetletjih ostaja kontraceptivni učinek dojenja predmet šte-
vilnih razprav, vendar diskusije za in proti tudi v razvitem
svetu govorijo v prid spodbujanja dojenja v kontraceptivne
namene. LAM služi materi kot učinkovita, a začasna kontra-
cepcija, hkrati pa je tudi spodbuda za podaljšanje dojenja.
LAM naj postane sestavni del programov za načrtovanje dru-
žine, svetovanje o njeni uporabi pa mora vključevati tudi pre-
hod na novo metodo kontracepcije, ko merila za učinkovitost
LAM izzvenijo.