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Date: | Mon, 23 Apr 2007 07:05:24 EDT |
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Dear Friends:
Michelle, another lovely nursing student asks questions about this important
issue.
If you read the package insert for Depo-Provera, you will find a
recommendation to give this shot at 6 weeks if the woman is exclusively breastfeeding.
Hale also talks about the theoretical risk of giving progestin during the time
that progesterone levels are plummeting (opening the prolactin receptors) during
the early postpartum, thus creating an environment for optimum milk making.
Shabaan found that progestin-only contraceptives had no impact on
breastfeeding when given at about 6 (or was it 8) weeks........to poor rural Egyptian
women that were mandated by their culture to breastfeed for several years and
that had no access to any substitute.
When looking at this type of research, it is important to know what is the
researcher's definition of breastfeeding. The Labbok/Krasovec definitions are
the gold standard.
I know that in practice, and with the endorsement of ACOG, that depo-provera
or the progestin-only Pill are given to women at 2-5 days postpartum. We don't
have anything except anecdotal reports of diminishing milk supplies. The
definitive research study on this important topic has not been done.
_http://www.cochrane.org/reviews/en/ab003988.html_
(http://www.cochrane.org/reviews/en/ab003988.html) says:
We found five studies that varied in quality. Some trials lost many women
during the study. Two reports compared birth control pills to a 'dummy' and they
had different results. Another study found that progestin-only did not affect
breast milk. One trial found less breast milk produced with combined birth
control. That study also lost many of the women, though. We found no major
difference in infant growth or weight due to these types of birth control.
The results did not show whether hormonal birth control affects breast milk
or the baby. At least one good randomized trial is needed to address these
issues. Right now, information is too limited to say whether breastfeeding women
should use hormonal birth control or not.
warmly,
Nikki Lee RN, MS, Mother of 2, IBCLC, CCE, CIMI
_http://www.breastfeedingalwaysbest.com/_
(http://www.breastfeedingalwaysbest.com/)
www.myspace.com/adonicalee
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