Greetings.  I have been lurking for a month or so and would like to introduce
myself . I am a CNM (Certified Nurse-Midwife) and Infant Mental Health
Specialist (glad to explain that later if anyone wants to know what it is).
Prior to becoming a nurse-midwife (1987), I was a Psychiatric/Mental Health
Clinical Nurse Specialist in Women's Health.  I have been in Maternal/Child
and Women's health since 1978. I took Jan Riordan's lactation course last
winter and I just passed the IBCLE exam this past July.  It is so great to
have access to all of your collective wisdom.  I look forward to learning from
all of you.

Re: Kym's post about her client with low milk supply.....What a complicated
case.  Hat's off to you for your dedication to the baby.  I just wanted to
make a comment about the Depo Provera (DMPA)and client going off Zoloft.  I
give about 10-15 Depo injections a week.  One of the possible side effects of
Depo is depression.  "Severe endogenous depression" is a relative
contraindication for giving DMPA.  DMPA can cause moderate to severe
depression in some women and we can't predict which women will experience
this.  Since there is not evidence that Zoloft causes a decrease in milk
supply,  it would seem prudent for her to stay on the Zoloft in an attempt to
prevent depressive symptoms.  She has so many factors that can contribute to
PPD.  And an episode of post partum depression can certainly put her baby and
toddler at risk for depression and it's developmental sequela.

She's got six weeks left of this Depo dose.  Since this is her last baby,
maybe she would benefit from information about sterilization (depending on
age, health status, etc.).  An IUD might also be a consideration for her, if
she is unsure about future pregnancies.  So many times women in clinics don't
get thourough, sound, updated information about contraceptive choices.  She
does't seem like a good Depo candidate to me(IMHO).  Breastfeeding and Depo
are usually fine, but you never know.  Why not err on the side of caution and
get off of it if there's any problem with supply. I realize she's got many
other issues, but that one jumped out and me and I decided to take the plunge
and post.

Later,

Priscilla Tait, MS, CNM, IBCLC
where I'm snowed in in my farmhouse with my dh and loving it!