Hi Everybody: I have some thoughts on the topic of Depo-Provera, the mini-pill, and the implants used before the six week postpartum visit, especially before the mother is discharged from the hospital. For one thing, use of these contraceptives often comes from a paternalistic or authoritarian base: "We have to make certain that 'these women' ( i.e. teens, non-white, multiparous, and/or poor) don't get pregnant again." The emphasis here is that it is the HCP's responsibility to manage the woman's fertility, not the woman's. It also may save time as it is quicker and easier to give a woman a shot rather than take the hour or more that good contraceptive counseling requires. Secondly, if LAM is presented as an option, the woman will be protected from pregnancy until that 6 week check-up and it may be more of a motivator to breastfeed (imagine a family planning method that is free and has health benefits)! Thirdly, secondary lactogenesis is triggered by the drop in progesterone and the rise in prolactin-inhibiting factor inhibitor that occurs after delivery of the placenta. Giving a woman a progestin contraceptive before the milk volume has increased has had repercussions, at least anecdotally. And fourth, the manufacturer recommends delay of at least one these methods (the implants) until the 6th week postpartum. I hope that we all can give the best information to the mothers, so that they can make the best choices for themselves. Personally, I have had women be skeptical of LAM, as they are concerned that they will be in the 1-2% of very fertile ladies.Tell those mothers that two methods of birth control are more than 100% effective; so if she uses LAM plus a drugstore method, she will be protected and can take a holiday from the decision to use hormonal methods until the baby is older, even to the time of starting solids.