In response to Fritz & Sara Reuning re:  birth control pills & low milk
volume:
This has been a big concern for me over the past few years.  I have observed
in the clinical setting, this very thing happening to mother's of preemie
infants in the neonatal intensive care.  In particular, the mother who is
pumping & storing milk for her special care baby is only marginally
maintaining lactation.  Most mothers are able to pump approximately 40-50% of
the milk they could actually produce if they were able to nurse their infant.
 The pumping stimulation, no matter how faithful a mom is, is not the same as
the actual nursing experience.  Over time, these moms experience a diminished
milk volume.  Because they have been pumping & storing, and in the early
weeks most premature infants may only receive small amounts of mother's milk
for feedings, i.e., 10-15 cc per feeding every 2-3 hours, and, their milk is
sometimes supplemented with a human milk fortifier, many moms have an
adequate milk volume or a notion that they have excessive amounts of milk
stored for further use.  What generally happens, at our facility, is that
over time, once the infant begans to take more of mother's milk at each
feeding, the mother's volume at each pumping session seems to coincidentally
begin to fall to approximately 30 cc.  There may be many reasons for this.
 Perhaps the mother isn't pumping as frequently as she did in the beginning.
 Whatever the reason, almost all mother's in our facility seem to have a
diminished milk volume over time.  The addition of a low-dose, combined, oral
contraceptive, seems to totally eliminate the mother's milk supply.  When I
started investigating this situation, I was horrified to learn, that our
postpartum mothers are instructed to begin taking the oral contraceptive on
the Sunday following their discharge from the hospital.   I read the
information insert in the medication package which clearly states that the
company recommends that lactating mothers not take the oral contraceptive
until they have been breastfeeding at least 6 full weeks.  I contacted the
biomedical researcher at the pharmaceutical corporation which manufactures
this product and he also reinforced the same information.  In the United
States, little information & research is available about the impact on low
milk volume and the use of the combined, low-dose oral contraceptive.  For
the most part, most of the information available today has been researched in
Australia.  Education seems to be the keyword here.  Sharing this information
& requesting information from the pharmaceutical companies seems to be one
avenue to convince our physicians that a problem exists between the early
introduction of the combined, low-dose oral contraceptives & the loss of
breastmilk volume.  While this may not necessarily be a serious problem for
the mother of the robust healthy full-term infant who just may need to nurse
more frequently to stimulate the mother's milk supply, this has serious
implications for the mother of the premature or sick infant who needs the
protective properties of  human milk.  A final suggestion to those of us who
teach prenatal breastfeeding classes or rent electric breastpumps, inform
your clients of the implications on breastmilk volume when using oral
contraceptives.  Most mothers who are determined to breastfeed will consider
another form of contraception if they know that the use of oral
contraceptives may negatively impact their breastfeeding success.

Mary Lou McGee, RNC, IBCLC
El Paso, Texas