Dear Listmates,
My "2 cents worth" on the IUD with progesterone discussion:
One of the physician members on this list serve wrote of her experience
with three moms who had trouble with milk supply after receiving this IUD.
Searching the archives should bring up the posts on this topic.
My bottom line is to quote the Cochrane database which looked at all the
published research and stated (I'm paraphrasing as the document is in my
office at work):
Evidence is limited and of poor quality to make recommendations regarding
hormonal methods of birth control for lactating women.
When asked about the research on hormonal methods, including progestin
only, I would tell a woman that there could be a risk "associated with" using
hormonal methods. I do not know that there has ever been causality (right
word?) proven when women use progestin only hormonal birth control (HBC). The
various populations studied have had a very different feeding pattern than
the majority of "modern women", e.g., sleep with their babies doing a lot
of nighttime feedings, wear their babies or keep them very close, do not
routinely use pacifiers or bottles or supplement their babies, or return to
work in the early postpartum period. Perhaps this is why some of these
studies show that there was no effect on milk production and these are these are
the studies which are being referenced when physicians tell a woman that
HBC with progestin only is not a problem with breastfeeding.
As far as I know, historically, women who have nursed their babies in the
ecological sense of exclusive and unscheduled feedings, staying in close
contact with them at night, etc, have not used HBC. So finding the women to
study would seem to me to be a big problem. Where would researchers get a
population to study who would agree to do ecological breastfeeding and take
HBC? And who would agree to be in the other group who nursed in a more
restrictive way and might have a risk of lower milk supply?
The Academy of Breastfeeding Medicine has a clinical protocol for
contraception during breastfeeding, Clinical Protocol #13, which discusses the
topic in depth. Go to _www.bfmed.org_ (http://www.bfmed.org) and look for the
link to protocols. This is a great site to look for well-referenced
material.
By the way, I do educate women about LAM, as no one else seems to do this.
Not many want to know about it, however.
Mary-Jane Sackett, RN, IBCLC, RLC, CCE
Pittsfield, MA
in the Berkshire Hills of Massachusetts
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