Sandra Munezero gave birth to a healthy son and immediately put him on exclusive breastfeeding until he turned six months old. At six months, she introduced him to solid food but continued to breastfeed as well. Munezero wished to stop until her son made at least two.

She had heard that with constant breastfeeding she was totally safe from another pregnancy which made her shun all other methods of contraception.

When her baby tuned eight months, she started nauseating and getting mood swing, and when the symptoms persisted she decided to look for medical support. To her surprise, the results of the pregnancy test came in positive.

Uwamaliya, and many more like her, continue to carry unexpected pregnancies, either due to ill-advice or not seeking correct information.

According to medical specialists, after the birth, breastfeeding may or may not work as a birth control measure.

While breastfeeding can be a great natural birth control method, it can also have drawbacks. It doesn’t last for a long time, and you must breastfeed around the clock for it to work.

According to experts breastfeeding can work well as a method of birth control, like any other form of contraceptive. Frequent and regular breastfeeding as a form of contraception is called lactational amenorrhoea method (LAM).

John Muganda, an obstetrician gynecologist at Polyclinique La Medicale, Kigali, says LAM is about 98 per cent effective. With LAM, one’s breasts need to supply all the baby’s suckling needs, meaning the baby shouldn’t have a dummy or use a bottle. Here, the baby’s suckling stimulates the hormones that suppress ovulation.

"Breastfeeding delays the return of periods. It means that the baby is fed on demand exclusively, usually a minimum of six times every 24 hours. If you want LAM to work, don’t leave a gap between feeds of longer than four hours during the day, or six hours at night. Also, don’t give other fluids or solid food to your baby at all, or only give the baby other liquids from time to time,” he says.

Muganda, however, says the mother will ovulate before they have their first period.

So there’s a chance that one could become pregnant if they rely on their periods returning as a sign that they are fertile again, he adds.

"Some women have lower levels of the hormone progesterone than others in the months after giving birth. If this is the case, they are more likely to become fertile earlier. The average period for the return of periods in breastfeeding women is about 28 weeks after having a baby. However, periods can return anywhere between 15 weeks and 48 weeks after one have had a baby. So it’s possible to be menstruating again about three-and-a-half months after having a baby, or as late as 11 months,” he explains.

Muganda also says the mother needs a strong nursing relationship (meaning your baby is really good at suckling) to use breastfeeding for birth control.

Some studies have shown that weak suckling can make LAM slightly less effective.

"Using a breast pump won’t work for LAM. Many people, especially working mothers just have a hard time to nurse without turning to pumping or formula,” he adds.

On the other hand, Josephine Murekezi , a senior midwife at King Faisal Hospital, Kigali, says once the baby stops exclusive breastfeeding and they are suckling at the breast for comfort, breastfeeding becomes less effective as a method of contraception. So if one starts combining breastfeeding with formula feeds or solid food, even if their periods still haven’t returned, they could become pregnant.

"Breastfeeding isn’t a long-term natural birth control method as one can only rely on it for the first six months of the baby’s life. Sometimes, one might get periods even before that. After getting periods or when the baby is 6 months old, they will need another kind of birth control to be on the safe side. Luckily, there are lots of options,” she says.

What’s the best birth control option while breastfeeding?

Dr Iba Mayele, a gynecologist at Polyclinique de l’etoile, Kigali, says breastfeeding moms have many safe and effective birth control methods to choose from. He says one can safely use non-hormonal birth control while breastfeeding. A mother can get advice from a health facility on the right methods that fit her condition.

"The copper IUD is one of the most effective birth control methods, and it lasts for up to 12 years (but can be removed whenever one wants). It’s a pretty convenient option for new moms who don’t want to add birth control to the list of things they have to remember,” he says.

Mayele says other non-hormonal birth control options are male and female condoms, implants, diaphragms and cervical caps.

However, for the first three weeks after giving birth, a method that has the hormone estrogen, like the pill, patch, or ring is ideal.