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Subject:
From:
"Chris Auer,Bsn,Ibclc" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sat, 27 Jan 2001 22:17:58 EST
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Cheryl, Pat, netters,

 birthcontrol discussion re b/f, including LAM and its algorithm:
ACOG Educational Bulletin #258  July 2000:  Breastfeeding: Maternal and
Infant Aspects.    (specifically acknowledges the 2 theoretical concerns
regarding supply when given immediately pp and re exogenous steroids to a
very newborn.  There is lots of other info in this 15 page paper, some great,
a few things are skewed.)

Kaunitz, A, Zimmer, D. Contemporary OB/Gyn  5/2000 Vol 45, #5, pg 74-110. A
Medico-Legal evaluation of reusable contraception.   (A lawyer and an ob
discuss the importance of informed consent...and more.   Reiterated the
recommendation to wait to intro hormonal bcontrol at 3 weeks for partial
b/fers and 6 wks for exclusive b/fers)

Contraception  9/2000  This focused on teen compliance with depo follow-up.
The show rate for coming back every 3 months for a shot (with teens) ranges
from 30-45%.  "Intensive reminders" did not increase return rate. Most quit
using it r/t irregular bleeding.

Dahlberg K: Some effects of depo: Observations in the nursing infant and the
long-term user.   Int J gynaecol Obstet  1982: 20: 43-48.  This and the one
below are one of two studies that cite use of depo at 48 hrs. It was a small
study 10 controls and 10 exper.  All moms pumped x12 weeks. The depo was
given at 4 different times and as a side note he said that a subgroup got it
at 48 hrs out. He did not say how many or include this data separately in the
charts. All women pumped sufficient amts for their babies.  The problem I saw
was statis. significance.  An interesting side note is that there was an
increase in infectious illnesses in infants who had the depo at 48 hrs vs the
latter dose. This was not confirmed in other studies

Guiloff E, Ibarra-Polo A, et al. Effects of contraception on lactation.  AmJ
ob/gyn 1974: 118: 42-5.    I have to read this monday. It is the one study
that acog references re use of depo at 2 days- stating that no adverse
effects on the newborn or b/f were identified.

Pardthaisong T, Yenchit C, Gray R:  The long-term growth and development of
children exposed to depo during pregnancy and lactation. Contraception 1992:
45: 313-24. (This is the very large study- 1,217 kids in the exp group: 1167
in the control group-  followed ages 1-18- often cited that concludes that no
increased risk of impaired growth - height/weight was found. It is important
to note that depo was given at 1-3 mo pp.

There was also a very good article that I forgot to write down that is an
interview format between two ob's re b/f promotion prenatally. The female ob
being interview is someone we know from other published works. She reiterates
the guide for hormonal methods to be 3 wks for partial and 6 wks for
exclusive b/f.  It was published in the past 6 months in either Intl OB/Gyn,
OB/GYN or J of OB/GYn.  Sorry I don't have these specifics

Acog, by the way acknowledges their concluding reco are conservative for
those using hormonal methods:
Progestin- only pill, begin at 2-3 wks
Dep at 6 wks
implants at 6 wks
Combined pill at 6 wks and only when lactation is well established and the
infants nutritional status is well monitored.
This side bar is added: There are certain clinical situations in which
earlier initiation might be considered.

There is not good data about depo and the first 2-3 days. Jack reminded me
though that Peter Hartmann's research does make the link between pp
progesterone level drops and the sensitization of alveolar cells to
prolactin. We walk a fine line when we are asked by a mom to comment on this
subject, and I have found that not all residents provide the "informed
consent" needed. I've also had others that say wow, we really don't want to
screw up b/f what should we do?  With some practitioners, we sometimes just
won't see the risk:benefit ratio in the same way.   I understand their worry,
but i still believe that open, clever minds can come up with solutions that
safeguard breastfeeding and fertility.
Chris

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