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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