Chris wrote:

In a message dated 10/19/0 2:15:11 AM, [log in to unmask] writes:

<<  I do not believe in the theory of lets give the poor woman protection
right from the starting gate. There is no data to suggest that a woman who is
committed to
birthcontrol will not return for her 4 week check up to get it, or that those
they give it to will more likely return in 3 months for the next shot.  Again
its risk benefit and the b/f takes a back seat. I would be great to have
someone look at this b/c when the residents ask me if it affects the milk
supply I can't point to hard data that it does. I have seen mothers dry up in
the first 6 weeks of pumping for a premie and some who do quite well, both of
whom who got the depo.  But I have never tracked it in a way to show evidence
either way. >>

I really grilled the company rep about this a few years ago. She avoided
direct answers, but admitted there were no studies before 6 weeks. After
that, a nurse at the hospital told me that she heard of one study where milk
supply was actually increased. I asked if this might be b/c there was an
initial decrease and those mothers committed to bf nursed more often to make
up for it, (as often happens w/ mothers whose supply is decreased b/c of
cigarette smoking). This had not been addressed, apparently. I was also told
by a ped that there had been several calls to a local bf drug hotline
coplaining of decreased supply.

Nikki Lee wrote:
     <<It is outrageous and clearly malpractice to give depo before the
manufacturer's recommendation. It is paternalistic for the health care system
to feel responsible for "those women" getting pregnant again. It also
reflects a societal belief that women are sexually active all the time, no
matter what else is going on. The assumption is that women will not take care
of themselves either. Women are subtly encouraged to go home and jump in the
sack right away; why else give a powerful contraceptive on day 2 or 3
postpartum?
    How long will women tolerate such attitudes?>>

This is an interesting comment. I was told by an OB that it was "practicing
medicine w/o a license" for me to give a mother the package insert to read
before she decided about depo. He absolutely *forbid* me and my staff to give
information about birth control to mothers. (Compliance was not one of our
strong suits.)
    I agree w/ you completely that such attitudes as you describe are
paternalistic and I believe they are also often racist. They also assume that
mothers will fail at bf and thus will need hormonal contraceptives. I'm not
sure it is an issue of feeling responsible for "those women" getting pregnant
as much as it is an arrogance about feeling justified in impacting who *ought
to be having babies*. There are so many implications for disepowerment of
women in this issue. I find it unacceptable that physicians are not fully
versed in LAM and natural family planning and that they would intentionally
withhold this information from any women or from certain women. Also, I think
it is not just that women are encouraged to have intercourse, but that men
are given the message that it is normal to expect their partners to be
sexually available immediately. The implications for how this affects the
lives of some women is frightening.

Linda wrote:
 <<This physician is very up on research, and

practices what is recommended.  He says he will change his practice when a

good study shows that depo indeed reduces milk supply when given on the 1-3

postpartum day.  I have even given him the drug manufacturer's

recommendations to know avail.  It is my understanding that there is only

anectdotal evidence that depo reduces milk supply.  Any researchers looking

for a study?>>

So, don't we assume that we avoid any risk to bf? Don't we place the
responsibility on the drug company to prove it is safe, not on bf advocates
to track the failures?

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