Dear Rachel

Ask the mother with the sudden bf/production problem if she has recently
started taking a contraceptive pill, including the mini-pill.  I get so many
of these stories (sudden unexplained drop in production or breast refusal)
that I have given up exploring for other possible causes until I have asked
this question.  We know the combined pill can decrease supply, and I was so
relieved last week to hear Miriam Labbok present a summary of her study if
the literature on progesterone-only contraceptive methods and their effect
on breastfeeding.  She has isolated 13 studies that used a proper definition
of real breastfeeding and 11 of them had a negative effect on breastfeeding
under 8 weeks postpartum. The 2 that didn't were depot provera, not pills,
which has lower blood levels.

This is fantastic news.  Not because they can stuff up breastfeeding, but
because someone has finally validated what I have known clinically for a
long time.  Many, many of our mothers go onto the mini-pill t 6 weeks, quite
a few come home from hospital already on it.

Of course your mother is beyond 8 weeks, but I don't think that makes her
safe from possible pill effects, we just don't have the studies.  The other
question I would ask is whether she is about to menstruate or resume
menstruation?  Keep us informed.
Ros Escott    ( Tasmania, Australia)
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