Labbok,M;  Health Sequelae of Breastfeeding for the Mother, in Clinics in
Perinatology, 1999, 26(2):499.

"The following presents child spacing and limitation options for
breastfeeding women as first, second, or third choices for presentation as
part of informed choice.  The ranking is based on potential impact on
breastfeeding, not on efficacy of the method...The nonhormonal methods are
considered first-choice methods because they have no direct impact on
breastfeeding...Second choice are the progestin-only methods, which have
been extensively tested and found safe in later breastfeeding."

Note the use of the word LATER, which seems to me to be the critical issue
in timing the initiation of oral contraceptives.

  Lawrence (1999 edition) pg. 666 states:  "The recommendation for
contraceptive use during lactation is the progestin-only products.  Use of
these methods has not been associated with adverse effects on infant growth
or development and may even increase the volume of milk.  It is recommended
that the progestin-only method not be initiated until 6 weeks postpartum on
the premise that the theoretic danger to the infant from exogenous steroids
has passed by this time.  The practice of injecting Depo-Provera immediately
after delivery can interfere with the establishment of lactation, which
depends on the dramatic natural decline in progesterone postpartum."

The standard of care seems to be there may not be an adverse effect of
hormonal birth control if the lactation is given time to become well
established.  During the early postpartum when endocrine control is more
critical, it would be prudent to heed what seems to be the standard advice
to wait a bit.  The frequency of sucking that takes place with newborns
typically prevents fertility anyway.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates, Austin, Texas
http://www.jump.net/~bwc/lactnews.html

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