Dear Lactnet Friends:

Both the omission of a discussion about exclusive breastfeeding versus
partial, and the omission of exclusive breastfeeding's impact on fertility
to be significant!


Abstract

Background: Breastfeeding has numerous maternal and infant benefits.
Progesterone contraception after birth is frequently recommended, but
because a decrease in progesterone is required to initiate lactation, early
postpartum progesterone contraception use could inhibit lactation. The
purpose of this article is to critically evaluate the scientific basis for
conflicting clinical recommendations related to postpartum
medroxyprogesterone use among breastfeeding women.

Methods: Relevant peer-reviewed literature was identified through a
comprehensive search of PubMed through December 2010. The search was
restricted to clinical trials, randomized clinical trials, or comparative
studies written in English and conducted among humans. The studies included
in this review addressed the effect of medroxyprogesterone administration
at < 6 weeks postpartum on breastfeeding exclusivity and/or duration and
measured breastfeeding outcomes at ‡ 6 weeks postpartum.

Results: Of the 20 articles identified, only three studies satisfied the
inclusion criteria. However, all three studies were of low-quality
methodological rigor, and none accounted for potential confounders.

Conclusion: Current evidence is methodologically weak and provides an
inadequate basis for inference about a
possible causal relationship between early postpartum medroxyprogesterone
use and poor breastfeeding outcomes. However, given the presence of a
strong biological model describing the potential deleterious effect
of postpartum medroxyprogesterone use on lactation, further research that
improves on current literature is warranted. Meanwhile, we recommend that
potential breastfeeding risks associated with early (<6 weeks) postpartum
medroxyprogesterone use be disclosed to allow for a fully informed consent
and decision-making process.

A Systematic Review of Early Postpartum Medroxyprogesterone Receipt and
Early Breastfeeding Cessation: Evaluating the Methodological Rigor of the
Evidence

Elizabeth A. Brownell,  Diana Fernandez, Cynthia R. Howard, Susan G.
Fisher, Sharon R. Ternullo,
Ryan J.J. Buckley, and Ann M. Dozier

warmly,
Nikki Lee RN, BSN, Mother of 2, MS, IBCLC, CCE, CIMI, ANLC, CKC
craniosacral therapy practitioner
www.breastfeedingalwaysbest.com

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