Shortly after giving birth there are dynamic hormonal changes in the female body that strongly affect the mood and the emotions. The level of endorphins, which role has been to give the feeling of euphoria and ease the pain, is reduced. With the expulsion of placenta the level of sex hormones - estrogens and progesterone – is reduced as well, which leads to worsening of mood, feeling constantly tired or sometimes the state of apathy. However, the level of prolactin, called motherhood hormone - responsible for milk production, blocking the secretion of follicle stimulating hormone (FSH) and stopping the growth and maturation of follicles with an egg, is increased.
Return of fertility in the postpartum period depends mainly on a high level of prolactin, which is produced by a woman during lactation, but also on lifestyle, stress level or the fertility prior to pregnancy and childbirth.
To identify the days of fertility and natural periods of infertility effectively, you should start your self-observations as soon as possible to define the parameters typical for your menstrual cycle again.
- Carrying out your daily observations will allow you to get to know your body again, control your fertility and to identify the fertile and infertile days properly.
- After the cessation of bleeding you should start your temperature measurements and observation of the mucus features to determine the basic model of infertility for you ( or the presence of a constant secretion).
- After 12 weeks (or 6 at the partly breastfeeding), and before the first postpartum period, you should apply the peak rule, which allows you to determine the phase of infertility from the evening of the fourth day after peak symptoms of cervical mucus or cervix.
- The measurement of basal body temperature (BBT) will help to determine whether the occurring bleeding is a menstrual period (it must be preceded by at least 3 days of high temperatures phase), or it occurs in the periovulatory phase and means fertile days.
You should start the observations after childbirth just after the disappearance of puerperal blood. As often as possible you should measure the temperature just after waking up to see if prior to the first menstrual period the higher temperatures phase occurs. It may also happen that during the low temperatures phase the mid-cycle bleeding occurs. Remember that getting up at night to feed a child is not a distortion of the temperature measurement.
You can also use the following tips:
- try to rest at least one hour before measuring the temperature,
- ask your partner to look after your child for a while,
- set the alarm clock just before the time your child usually wakes up
- measure your temperature while feeding your child.
The temperature chart during breast-feeding period is very typical - it is unsettled, so there are ups and downs of temperature. But just before the first postpartum ovulation and the appearance of a fertile mucus, the chart visibly calms and stabilizes. After giving birth, you must learn to recognize the signals sent by your body again. They are different from those you got used to before pregnancy. You can see the difference especially during the self-examination of your cervix, because after the birth there is a small gap. There could be also
a change in the level of basal body temperature both the lower and higher temperatures phase. However, the most often observed difference is the change in the secretion of mucus by the cervix.
If, after the cessation of bleeding after childbirth and the disappearance of any puerperal droppings you don’t observe any presence of the mucus, then after the end of postpartum infertility - 6 weeks (no or partial breastfeeding) or 12 weeks (full breastfeeding), such observations will also mean infertility. The appearance of any mucus will mean days of possible fertility.
If, however, after the cessation of puerperal bleeding you can observe the continuous presence of certain mucus that even after the end of the postpartum infertility period (6 or 12 weeks), the same symptom can be a symptom of infertility, and only the change in the nature of the secretion means the days of possible fertility. In the case of the constant presence of secretion or extended phase of the mucus taking magnesium can be helpful.
Extending the intervals between feedings, or switching to partial breast-feeding can cause the occurrence of long-lasting phases with symptoms of mucus, which can make the interpretation much more difficult. Then the self-examination of the cervix, that can be performed from the 8th week after birth, may be helpful .
After the end of the period of infertility - 6 weeks (partial breastfeeding or lack thereof) or 12 weeks (full breastfeeding), and before the occurrence of menstruation – you should use the peak rule, which says:
- you can determine the infertile days from the 4th evening after the peak of mucus, unless there was the increase of temperature and you observed some signs of fertility;
- the bleeding which is not preceded by the phase of higher temperatures (mid-cycle) is regarded as a symptom of mucus and its last day should be marked as the peak of mucus, and if just after the bleeding you observe any signs of fertility, the last day of the occurrence of mucus phase should be marked as the peak of mucus
Increasing of temperature which can be observed for at least three consecutive measurements indicates the occurrence of two-phase cycles and possible ovulation. After starting a new menstrual cycle, fertile and infertile days should be determined according to the normal rules. You should know that the first postpartum menstrual cycles tend to be irregular, usually they are shorter due to the shortened postovulatory (luteal) phase, but there are also cycles when women must wait for menstruation for a very long time.
The use of hormonal contraception after childbirth and during lactation is not recommended. Breastfeeding is a contraindication to the use of binary contraceptive pills. But it often happens that doctors prescribe the mini-pill contains only progesterone that lowers the quantity and quality of food produced by the mother. In Poland, they are often Cerazette pills containing desogestrel, which, as the result of hydroxylation and reduction of the active metabolite (etonogestrel), is excreted in breast milk in small amounts. It should be noted that a mini-pill does not completely stop the natural menstrual cycles, the ovulation occurs and the effect of mini pills is reduced to the changes in the cervix, endometrium and fallopian tubes activities modification. It may therefore come to the fertilization of the ovum, but the activity of mini-pill prevents implantation of the embryo in the uterus. The effectiveness of such means is also relatively low compared to multisymptomatic methods of fertility recognition and it is about 0,3-4,0.
