Hello, all. I hope you can help me with this one. Another midwife asked me
my opinion on this case and I haven't a clue.

A client of the midwife's has a baby who is 2 !/2 months old. Exclusively
breastfeeding. The midwife prescribed Micronor (a progestin only oral
contraceptive).  The the mom was taking this. Then three weeks ago, she
saw a doctor who told her that the Micronor would not be "effective
enough" and prescribed combined OC's.  Now the baby is extremely gassy,
seems to be in lots of GI distress. Bowel movements have changed to a more
brown color and are malodorous (apparently almost as if other foods were
being given).  Mom has not noticed an appreciable decrease in milk supply.
No change in mom's diet, feeding patterns, etc. The only change is the
OC's and the change in bowel movements, etc. seemed to begin very soon
after the change to the combined OC's.

 The questions are: Could the combined OC's have caused enough change in
composition of this moms milk or cause some other reaction and be
responsible for this change in the baby's bowel movements, and the
digestive disturbances?  Does anyone have any ideas about what could be
going on otherwise?

I have never encountered a situation like this and am stymied.  I did
suggest changing back to the Micronor or to Depo if hormonal
contraceptives must be used.  I also suggested that perhaps the
possibility of infection be considered with malodorous stools in an
exclusively breastfed baby.  But, beyond this, I am without  a clue. Has
anyone else run into something like this?  Any ideas?  Suggestions
appreciated. The midwife would really like to know anything she can pass
on to the parents.

TIA,

Ione Sims, CNM, IBCLC