Hello, Elise.
You wrote:
<<Or does anyone have anecdotal information or a published case study?
On thinking this over, it does actually seem as if there must be a loophole
of some kind, since if Depo-Provera affected the milk supply as
definitively as retained placental fragments, there would presumably be no
question about it by now (we do after all know what retained placenta
does). >>
OK, first off, we don't "know" what retained placenta "does"; we know
what it "can" possibly do. While there have been a couple of moms in my area
who did not have a drop of milk until a small "tip of my little finger"-sized
piece of retained placenta was removed by D&C, I also know a mom here who had
twins, had lots of retained placenta and accompanying pain, fever, etc., but
who had all the milk she needed for two babies. So although the placental
hormones have the capability of completely preventing milk production, they don't
always cause that problem.
Same way with progesterone and milk production. It can wreak havoc
with a milk supply, cause no problems whatsoever, or have an effect somewhere in
the middle. While I have talked to plenty of moms who use the mini-pill
(progesterone-only) and have no problem with supply, I have also worked with a lot
of moms who report supply problems anywhere from immediate (within 48 hours)
to delayed (a month or more) after they started the pill. Once they stop the
pill, the problem seems to resolve, although how long it takes to resolve
seems to depend on how long it took to become apparent. Those who've only taken
it a week or less seem to get their supply back up to normal in 3-4 days, while
those who've been taking it for two months (or longer) can easily take up to
3 weeks to get back on track.
The problem with Depo-Provera is that once it's in your body, its
effects last three months. So if I get a call from a mom who has her heart set on
using a chemical birth control, I always suggest she use the mini-pill, since
she can stop that if there are problems. She's just stuck if she chose Depo
and has problems. I once got a call from a mom whose twins were then 4 months
old. They had been born 3 months premature, and mom had just finally
succeeded in getting both babies to be totally fed at breast. She got a Depo-Provera
shot, and within 48 hours, her breasts were back to pre-pregnancy size and
she had absolutely no milk. She was devastated. And of course, with two babies
to take care of, she was in no position to pump regularly for three months
until the chemical got out of her body, so that her body would make milk again.
There is a doctor in my area who believes it is his civic duty to be
sure that teen moms don't get pregnant again, and he gives these moms a Depo
shot before they leave the hospital after birth, without telling them about the
risks. A lot of them never get their milk supply really established, and end
up giving up on breastfeeding before one month.
The problem (as I see it) with the studies that say progesterone is OK
is that the body of the research report shows that some numbers of women had
supply problems. Statistically, these numbers are reported as
"insignificant". So then the abstract, needing to be short, leaves out those numbers
altogether and says "progesterone is OK." The doctors just read the abstracts and
make their decisions from there. But if you're one of the women whose milk
supply disappears due to progesterone, it is *not* "insignificant" to you!
Dee Kassing, BS, MLS, IBCLC
Collinsville, Illinois, in central USA
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