This question falls into my arena of expertise, so I felt I ought
to respond.  I'm afraid this is going to be long.  Recommendations
for family planning (FP) in BF women fall into 3 categories: 1st
choice method are all non-hormonal methods, i.e. barriers,
sterilization, IUDs, LAM (see below); 2nd choice methods are those
hormonal methods containing only progestins, i.e. "mini-pills",
Depo-provera, Norplant; and 3rd choice methods are those containing
estrogen and progestin, i.e. combined pills (regular birth control
pills), (combined injectables, too, but I don't know that those are
available in the U.S.).  Estrogen-containing methods are the last
choice because of the documented milk reduction.
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The Lactational Amenorrhea Method:  BF women are *at least* 98%
protected from pregnancy if:
=091-they are still amenorrheic
=092-they are still *fully* breastfeeding (no regular
supplementation) AND
=093-the baby is less than 6 months old.
When any ONE of these criteria no longer holds, the risk of
pregnancy rises.  (Vaginal bleeding in fully BF women in the first
8 weeks doesn't count as menses, but any bleeding seen after that
means that the woman should forget about BF as birth control and
use something else). =20
=20
LOTS of research has been done on BF women using hormonal
contraception with no documented adverse effects on the infants in
the short term.  Given that, and the fact that the amount of
hormone that is ingested by the infant is so small, most scientists
believe that the possibility of long term adverse effects is
remote.  However, I do personally know at least two
doctors/endocrinologists who have concerns about effects on brain
development and reproductive system.  Research on long term effects
has not been done.  Exposure in the earliest weeks postpartum has
the greatest likelihood of risk, since the brain is developing so
rapidly and the infant's metabolism of these hormones is less
effective/mature.  Since FULLY BF women do not need birth control
during at least the first 6-8 weeks, it would seem wise to avoid
hormonal FP at this time.  In fact, in most research protocols,
these methods were not started until this time, and Norplant and
Depo are labeled for use beginning at 6 weeks postpartum (I think).
=20
You all seem to like reference lists, so here goes:
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Visness CM, Rivera R.  Progestin-only pill use and pill switching
during breastfeeding.  Contraception 1995; 51:279-281.
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WHO Task Force for Epidemiological Research on Reproductive Health.=
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Progestogen-only contraceptives during lactation: I. Infant growth.=
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Contraception 1994; 50:35-53.
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WHO Task Force for Epidemiological Research on Reproductive Health.=
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Progestogen-only contraceptives during lactation: II. Infant
development.  Contraception 1994; 50:55-68.
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McCann MF, Potter LS.  Progestin-only oral contraception: A
comprehensive review.  Contraception 1994; 50(suppl 1):S140-S148.
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Harlap S.  Exposure to contraceptive hormones through breast milk:
Are there long-term health and behavioral consequences?  Int J
Gynaecol Obstet 1987; 25(suppl):47-55.
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Labbok M, Cooney K, Coly S.  Guidelines: Breastfeeding, family
planning and the Lactational Amenorrhea Method-LAM.  Washington,
DC: Institute for Reproductive Health.  1994.  *WRITE TO THEM AND
THEY'LL PROBABLY SEND YOU A COPY.  It has a table of all the FP
methods and advantages/disadvantages, also Labbok's BF
definitions/categories*
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D=EDaz S, Peralta O, Juez G, et al.  Fertility regulation in nursing
women: III. Short-term influence of a low-dose combined oral
contraceptive upon lactation and infant growth.  Contraception
1983; 27:1-11.
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WHO Task Force on Oral Contraceptives.  Effects of hormonal
contraceptives on breast milk composition and infant growth.  Stud
Fam Plann 1988; 19:361-369.
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My colleague, Kathy Kennedy, has a paper on the very early
postpartum initiation of Depo-provera, which hopefully will be
forthcoming in the Lancet (or somewhere) in the not-too-distant
future. =20
=20
Cindy Visness
Research Associate, Breastfeeding and Postpartum Contraception EX-
Unit
Family Health International
[log in to unmask]
=20
P.S.  I did manage to express enough few oz. of milk while I was
away at APHA, that I didn't have to wean Sarah (7 mos.) completely.=
=20
Though I am not meeting her nutritional needs, we nurse as a
welcome-home after work and through the night.  My main goal and
motivation was to keep nighttime peaceful -- I can live with this.