I heard Dr. Robert Hatcher speak on the subject of contraception at the
recent Emory Breastfeeding Conf. in Atlanta, GA.  He is author of a  book on
the subject.  I thought his presentation was very balanced.  One thing he
said that surprised me was how soon after delivery many women are resuming
sex.  In spite of the advice to wait 6 weeks-2 months, many resume much
earlier.  His book, A Pocket Guide to Managing Contraception, talks about
"perfect" use of the LAM method having a failure rate of 0.5%,  and a
"typical use failure rate in first 6 months of 2%."  This matches the
wording from the Belagio meeting.  Women relying on this method should be
well-informed about its particulars.

I have had a mother fully nursing twin boys (round the clock, very
successfully) get pregnant at 5 months postpartum using LAM.  I also have
had moms who were amenorrheic for over 2 years, used no other method of
birth control except for frequent breastfeeding, and who very successfully
spaced kids with this method.  No birth control measure except for
sterilization is 100%, but the problem is that a woman who falls into the 2%
risk category winds up 100% pregnant.

Dr. Hatcher mentioned that the contraceptive community is beginning to
recognize that a certain percentage of moms on the low dose progesterone
pills DO have the reaction of a diminished milk supply.  This is not the
COMMON response, but it does occur, and his next edition will contain this
observation and the warning that nursing moms should begin with a form of
low-dose hormone contraception that can be discontinued (like pills or patch
rather than injection) if the mother does have this reaction.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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