This was my Brick Wall when I worked in hospital. The OBs were determined that the women had to have a birth control plan, if not a prescription, or if depo was chosen that it be given before discharge.
They grumbled about my info on the dual hormone pill and other forms of estrogen, but were willing to substitute depo.
They grumbled about micronor (mini pill) as not reliable. One MD said it was more effective at 23 hours rather than 24 hours.
The big stumbling block in the USA is mothers who are on govt-supported health care. It covers delivery expenses, including prescriptions obtained in the hosp pharmacy prior to discharge. That means the shot is covered. But coverage ends at discharge, so if they wait for 4-6 weeks before getting the depo shot (per mfg recommendation), there is no insurance. It's out of pocket and they won't or can't pay it. (Things may be different under the new national health care law. We are all still trying to find out what it covers.)
So the docs were in my face saying she MUST have birth control (unless mother is refusing) and if the cheaper pill messes her mlk supply then it has to be depo, and if she's back here with another baby in less than a year, it's YOUR (my) FAULT!
And the literature results were on both sides of that fence on whether the depo shot affected milk supply or not.
My personal belief is, there is much less of an effect if mother and babe get BrFdg started very well in hospital. But if there is anything that interferes with that then mom's supply is vulnerable to the depo shot. Can't prove that - just my observation. It's the WIC counselors who are after ME saying WHY does your hosp insist on depo?
My other discussion with the docs was, if she won't get the shot at 4-6 weeks, why do you assume she will get the renewal shot at 3 mos? But to them, it's all about delaying the next baby for at least a little bit. Yes, we all know the health benefits of spacing pregnancies, but this is almost a control issue for some of these OBs.
One Attending OB said that the ACOG journal states that depo has NO effect on milk supply. So I got the article, found the study that article and read it. The proof that depo had no effect of milk supply? The babies in the study didn't lose weight. Yes, most, if not all were being at least partially supplemented with formula. My suggestion that the study had no exclusively breastfed control group fell on deaf ears. My suggestion that, of course the babies didn't lose weight because they were getting formula. The mothers weren't going to let them go hungry and probably didn't recognize their slowly depleting supply. But the OB stood by the article's conclusion that depo had no effect on milk supply and who am I to say differently?
So at that time I was pushed into the corner of "choose one" because we must give them something reliable to hold down the premature births and threats to mothers' health for multiple, closely spaced pregnancies. It was a lively but professional email discussion with constant CC and Fwd, and opinions and journal articles, for over a week until it came to Rank. I had to defer at that time to the Attending OB. The only good thing is, they finally cut dramatically the dual hormone pill prescriptions.
Well, I'm retired from that now and taking a bit of a break before going out to renew business licenses and re-setting my PPLC practice. It's been a month of Saturdays ... mmmm snooze.
Phyllis
---- Dolores Lopez <[log in to unmask]> wrote:
=============
Can some one please give me some evidence based information to present to
OB doctors so that they can stop giving Depo to the mom's prior to
discharge.
Dolores [log in to unmask]
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Phyllis Adamson, BA, IBCLC, RLC
Glendale, AZ.
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