I agree with the observations that giving a mother Depo (or other)
hormonal contraception too soon can cause havoc with breastmilk
production.

We are in very close proximity to a tierciery care OB unit.  We get
quite a few preemies (23 wks and up) from "next door".  Yet, before we
can see the mothers, a resident has pushed the Depo (figuratively, and
literally per the order).  The tell the mother's that it is "safe" for
the baby.  This is so untrue!  Mothers have such a struggle pumping milk
for these VLBW babies.  Their need for human milk is so crucial.
Therefore, when Depo does prevent adequate milk supply, their babies
*are* harmed, because of inaccessibility to their mother's milk.

For the past year, we have incorporated a paragraph cautioning these
mothers against getting Depo while in the hospital (we talk to them
about when it *might be safe* later).   For those who read our handout,
or are seen by next door's LCs "in time", quite a few have refused Depo
based on this *tip*.  However, we can't get it to everyone in time.

It hurts so much to see the expressions on the face of and listen to the
words of the mother who has taken this shot unknowing of the problems it
can cause the pumping mother of a pre-term.  There are a few, and very
few, cases where it did not *seem* to effect the supply.  Too many loose
their milk within two weeks.  The best we can offer her is to tell her
to "pump like a mad-woman", "dole out" her milk by pouring 15 cc into
each cup over the first week, and later 30, then 45 cc per cup, discuss
Reglan, etc.

It seems that the mothers who are younger *and* whose babies are older
than 28/29 weeks at birth are able to pump more (about 1 ounce max) once
the "decline" starts.

Shame on those doctors who place putting their beliefs that it is better
to convince a poor mother to avoid getting pregnant in a few months over
doing everything possible to help the baby who has just been born.  By
witholding information that even the company (which makes Depo) states
to wait at least 6 weeks before giving it to a breastfeeding mother,
they have crossed the bounds of "informed consent".  Advising out of
ignorance is just as bad.

I wish that the doctors and mothers would run into each other about 3
weeks after discharge, when the mother has seen the effect that hormonal
birth control can have.
Even then, I'm not sure that would stop this poor form of *medical
advice*.

There should be a study on this one.  Anyone game?

Sandy Hess

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