I work in a level III NICU where occasionally I will see an OB give a Depo Provera shot before discharge. I currently have a mother with a 24 weeker who this occurred with. I brought my concerns to the OB attention- She was great in opening up a dialogue about the subject. OB's want to do what is best for patients. Anyone have thoughts on the comments below. I am finding that LC's and MD's are often using different resources for guidance. The ABM does not have recommendations although ACOG recommends waiting for at least 6 weeks to order this medication for breastfeeding mothers.

From MD (who would love perspective from people who have different strategies for birth control and gave permission to post)
I would love to look into this topic again and review the best options for the patients.

Amy-
As you may know, I am a BIG supporter for breast feeding and still nurse my daughter almost 2.5 years old 

Thoughts from our MD perspective:

1.  I need your help to stay current on the medications and pros / cons of the meds we use.

2.  The patients with unplanned pregnancies are at high risk for another unplanned pregnancy.

3. When we looked into the studies at the Univ of Louisville we found there was not in reality a drop in milk supply. I just want to let you know I did think about this when I ordered the medicine DMPA.

4.  Logistically- this patient will loose her insurance for medical care at 6 weeks post partum.  If she doesn't get the DMPA there  is a really good chance they will not be able to schedule her for the long acting contraception she wants before she looses insurance. The patients have to have a period and negative pregnancy tests and then come back at the time of their next menses for insertion of the contraceptive. This process takes at least 6-8+ weeks when you count how many nursing moms who also don't get regular periods- many patients give up and don't ever get the contraception and then they are pregnant.


Yes, I have had patients pregnant before thier babies are out of the NICU.


THOUGHTS ? on the topic or best practice recommendations anyone using based on current evidence based information???

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