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.