My name is Michelle, and I am currently a junior in a baccalaureate nursing
program I took interest in a recent post and did some research to find out
more on this topic.  What I found was an apparent lack in research on this
subject. 

The few studies I found on the subject were on the topic of breastfeeding
and birth control and not specifically the effects of the new low-estrogen
combination pill.  Despite your clinical findings the studies are reporting
mixed results. 

One study claimed that doctors can safely prescribe progestin only
contraceptives immediately after birth, and estrogen containing pills at
six-weeks postpartum in the breastfeeding woman.  The study goes on to say
that the hypercoagulability woman experience after birth resolves by three
weeks postpartum, so doctors can begin to prescribe combination pills in
non-breastfeeding woman at that time.  The study refutes its prior statement
about beginning combination pills at six weeks postpartum in breastfeeding
woman, stating that the risks of diminished quality and quantity of
breast-milk may not be worth the benefits until six months postpartum when
the baby begins other forms of feeding.  Recommendations by WHO (the World
Health Organization) state that progestin only pills should not initiated
until six weeks postpartum in breast-feeding woman because of the
controversy and unknown effects of steroid exposure on the infant. 
(Lesnewski, Prine, 2006)

A related study was a long term study, looking at the effects of the
Norplant contraceptive (a slow releasing progestin implant) and child growth
rates over six years in woman who breast-fed and received the Norplant two
months postpartum.  The study findings report no significant differences in
growth between the two study groups (Norplant group and T-Copper IUD).  An
important finding was while growth did not differ, the incidence of disease
in the infants exposed to progestin (Norplant) was higher.  (Schiappacasse,
Diaz, Zepeda, Alvarado, Herreros, 2002) 

Progestin, while it may affect the rate of disease in the breastfed baby was
shown in a third study I examined, not to affect breastfeeding even when
prescribed within three days postpartum.  The study found their to be no
differences in the women who received progestin-only shots, progestin-only
pill contraceptive, and no birth control; but did find that only 25% of the
women were exclusive breastfeeding at six weeks.  Birth control methods
would be necessary in women at that time, if they had not already started,
due to the decreased feedings.  (Halderman, Nelson, 2001)

When looking at the prescribing practices of physicians, it is clear that
they are confused about the recommendation as well.  One bias they may hold
is the belief of the superiority of the combination pill that most doctors
included in the stud held.  More than half the practitioners interviewed
stated that they had prescribed combination pills to woman after six-weeks
postpartum.  Shockingly 70% of practitioners reported that they exclusive
prescribe progestin-only methods with breastfeeding woman up to six weeks
postpartum, so what happened to the 30%? (Espey, Ogburn, Leeman, Reddy, Lee,
Qualls, 2006)

It is clear that more research needs to be done on hormonal methods of
birth-control and postpartum breastfeeding women.  Practitioners prescribing
the medications seem to need more education as well.  The studies found the
progestin only methods, while safe immediately after birth, the effects of
the hormone exposure may have adverse effects on the infant’s health. 
Clearly from your practice results, estrogen containing pills can be
prescribed at six-weeks, but the negative effects on breastfeeding lead us
to believe it is not worth the risks.  I am curious where you found the
statistics of only 5% of women experience a reduction in milk production
with low-dose pills, as clearly you experienced much greater rates.  

What has been your clinical experience with birth control and breastfeeding?  

 

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