Dear Nikki,

Why not consider a barrier method for at least a few months?  I switched to a diaphragm after the birth of my first child and found it to be very easy to use.  If used properly, I believe that it has a fairly low failure rate, somewhere around 5%.  It does have to be refitted if mom loses or gains more than ten pounds.  Condoms and spermicides are also quite effective, when used consistantly and properly.  The mom could use natural family planning, since she seems to be resuming her periods, or could use mucous changes in addition to a  diaphragm - no sex when seem to be most fertile, diaphragm used at other times.  I wonder how many choices GYNs actually present to moms.  Or do they present many choices, but indicate that they really think that the pill is the only truly reliable option.  Most moms mention only the pill when they ask me about birth control options while breastfeedings - which kind of pill to take rather than what else to use besides the pill.  I must admit, I was a bit apprehensive about using the diaphragm and then pleasantly surprised when it turned out so well.  There are moms who cannot use it due to allergic response to the rubber and/or spermicide (can be used without spermicide, but not as effective.)  I think that working moms are poor candidates for the pill in that if there are changes in supply, it is difficult to determine if the cause is going back to work or the effect of the pill or a combination of the two.  Why take the chance if it can be avoided?
Warmly,
Sharon Knorr, BSMT, ASCP, IBCLC
Newark, NY (near Rochester on Lake Ontario)
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