With regard to hormonal birth control pills.  They are safe for the
baby since the amount of hormone in the milk is very tiny indeed.  The
main concern with any of these pills is that the oestrogens in the pill
may decrease the milk supply in some mothers, often very significantly.
Breastfeeding itself (LAM) is a good method of child spacing, but the
method has to be understood.  Still, if the mother feels she needs the
"pill", a progesterone-only pill (e.g. micronor) is supposed to be
better as far as not affecting the milk supply.

        As far as expressing milk after weaning is concerned, ask the mother
not to express any, and she won't know.  I have heard two years from
other women, sometimes more.  Who knows what is normal?  Here is a study
that could be done.  Ask women to start expressing a little (until they
get a drop or two) once a month after weaning until they are unable to
get any.  Document length of breastfeeding, how many children, age of
mother etc.  Publish.  As it is, many of these mothers are getting
unnecessary tests done, including CT scans and MRI's for possible
pituitary tumours (microadenomas).  This has to be considered, but it is
a rare problem.

Jack Newman, MD, FRCPC