Regarding the issue of the mom on combination ocs with diminished milk supply... Why won't MDs believe this happens. I have seen 3 cases in the last month of diminished milk supply due to LOW-Dose OCs . In all cases I immediately switched the moms to Micronor , which is the progesterone only pill (sometimes also called the mini-pill) with grateful moms expressing normal milk supply again in a few days. This mom has several options but if she wishes to continue on oral contraceptives I would suggest she start Progesterone only pills as her next pill pack. Several important points...She must take them at the same time every day and they are less forgiving in terms of missed pills and pregnancy. Also, there are no "sugar pills" in the mini-pill pack all are active and must be taken. With her desire not to be pregnant and her proven fertility I would Not advise her to stop the pill without another plan!!!! Mini-pills should not impair breast milk production in any way. Has she considered Depo-Provera? It is more effective in preventing pregnancy than having a tubal and has the added benefit of increasing the milk supply in some women. Women receiving Depo tend to have less problems with supply and breastfeed longer than those who do not receive it. She could receive it now -with her period on the current pill pack and not have to worry about a back-up method. The copper IUD may also be an alternative for her. Completely non-hormonal it will certainly not affect breastmilk. These are now approved for 10 years of use! They are very effective and can be recommended in moms with no history of STDs and monogamous relationship. There was one study implicating breastfeeding and IUD use with increased risk of uterine perforation but this relationship has not been shown in other studies. This could be inserted with her period coming up as well. Unfortunately for women whose insurance does not cover it the cost may be prohibitive. (Between $500 and $1000 in the US.) Hope this helps. Beth Hall CNM, MSN in private practice in Maryland