Hi Barb

Thanks for sending in the abstract of the Am J Obstet Gynecol article 
on progestin-only hormonal contraceptive methods vs non-hormonal 
methods, and their effect on breastfeeding.

My experience is that progestin-only contraceptive methods do have a 
real, negative impact on milk production for some mothers.  So a 
couple of comments:

1)  I can't see from the abstract whether Depo or pills were used as 
the progestin-only methods of contraception.
2)  There was a high drop-out rate of exclusive breastfeeding in both 
groups.  (Supplementation or perception of insufficient milk 
production did not differ between groups.  By week 6, 23.5% of women 
discontinued breast-feeding, and 64.5% of those breast-feeding were 
supplementing)  This means that a full half of all mothers from both 
groups were supplementing even by 6 weeks ???
3)  The conclusion is based on women's perception of adequate milk 
production, which IME is notoriously inaccurate.  I'd want to know 
whether the supplementation was due to perceived or real insufficient 
milk production.  I'd want to check out which mothers of which group 
were using what contraceptive method, and I'd like to closely 
scrutinize the weight charts of the supplemented babies to see if 
supplementation was really justified....

It looks like there are too many unknowns in this abstract to reach 
an accurate conclusion about whether Depo depresses milk production.

Pamela Morrison IBCLC
Rustington, England

At 17:50 03/03/2008, you wrote:
>Date:    Mon, 3 Mar 2008 11:59:05 -0500
>From:    Barbara Berges <[log in to unmask]>
>Subject: Depo study - No adverse impact on BF
>
>*Here is an abstract from 2002 that shows no adverse effect on breastfeeding
>from depo initiated in the first 3 days postpartum:*
>**
>*Barb Berges BS, RN, IBCLC*
>*near Cleveland, OH*
>
>
>
>
>Am J Obstet Gynecol. <javascript:AL_get(this, 'jour', 'Am J Obstet
>Gynecol.');> 2002 Jun;186(6):1250-6; discussion 1256-8.[image: Click here to
>read]<http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3048&itool=AbstractPlus-def&uid=12066106&db=pubmed&url=http://linkinghub.elsevier.com/retrieve/pii/S0002937802000285>
>Links <javascript:PopUpMenu2_Set(Menu12066106);>
>  Impact of early postpartum administration of progestin-only hormonal
>contraceptives compared with nonhormonal contraceptives on short-term
>breast-feeding patterns. *Halderman
>LD*<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Halderman%20LD%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1>,
>*Nelson 
>AL*<http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Nelson%20AL%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlusDrugs1>
>.
>
>Department of Obstetrics and Gynecology, Harbor-University of California,
>Los Angeles, Medical Center, USA.
>
>OBJECTIVE: The purpose of this study was to identify the impact on
>breast-feeding patterns of early postpartum initiation of progestin-only
>birth control methods compared with nonhormonal methods. STUDY DESIGN: A
>prospective, nonrandomized trial was performed comparing progestin-only
>contraceptive methods administered before hospital discharge with
>nonhormonal methods on breast-feeding continuation rates, exclusive
>breast-feeding, and supplementation at 2, 4, and 6 weeks after delivery.
>RESULTS: Three hundred nineteen women provided complete data until hospital
>discharge. The hormonal group had higher risk factors for not
>breast-feeding, but there was no difference among any of the subgroups in
>breast-feeding continuation rates except at week 4. Supplementation or
>perception of insufficient milk production did not differ between groups. By
>week 6, 23.5% of women discontinued breast-feeding, and 64.5% of those
>breast-feeding were supplementing. CONCLUSION: This study demonstrates that
>there is no detectable adverse impact on breast-feeding attributable to
>progestin-only contraceptive methods initiated within the first 3 days post
>partum.
>
>PMID: 12066106 [PubMed - indexed for MEDLINE]

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