Well, here we go again.  When one intervenes (as in gives a medication), it
is up to him/her to provide evidence that this intervention does not cause
harm.  Not up to those who warn against it to provide evidence.  There is a
theoretical basis to avoiding early depo provera, and that comes from Dr.
Peter Hartmann in Perth Australia.  He believes, based on his research, that
it is the *drop* in progesterone that comes with the delivery of the
placenta which sensitizes the alveolar cells of the breast to the action of
prolactin.  Thus, if the progesterone does not drop, the cells will not
produce milk.  Based on this theoretical evidence, any anecdotal impressions
become strong warnings.  The problem with depo provera is that once given,
it cannot be taken away.

What is the rush to give it?  I do not believe that women in the immediate
postpartum period can truly give informed consent, they are too overwhelmed.
Does the doctor say to mothers that some LC's believe that this drug may
decrease their milk supplies?  No of course not.  It is unethical to treat
when the patient cannot give informed consent.

Jack Newman, MD, FRCPC