Hi Linda, 2 of the MDs here have changed their practice too. They give the
Depo before dischg. I argued the point with them. However looking for
support statements I found there aren't any studies that prove that giving
it TOO EARLY cuts milk production. However, they know that progesterone
needs to drop before milk production starts. So the questions are when is
too early and does introducing progesterone too early inhibit that drop? I
tried to encourage the MDs to at least wait until the first well baby check
(about 3-7 days post discharge, or 5-11 days post delivery). The reason the
MDs want to give the Depo early is because at 6 weeks the women may already
be pregnant-pretty unlikely but then if there is a possibility they need to
do a pregnancy test BEFORE administering the Depo. Depo is listed as
pregnancy category X: Giving it during a pregnancy shows "that it can cause
fetal abnormalities or there is evidence of fetal risk based on human
experience.." As far as doing this only with the Medicaid population that is
discrimination. They should be doing this with private or HMO insurances
carriers also as the cost of doing a pregnancy test effects insurance rates
as well as taxes. For those of you that say these moms are bf and so they
won't get pregnant correct if they are still bf but unfortunately many have
already stopped by 6 weeks. And many of those have  received cases of
formula in the mail-from 3 different companies. The easily persuaded mother
has been enticed into the formula trap. Mary Ann Krainz RN, IBCLC in central
WI
----Original Message-----
From: Janet Simpson, IBCLC [mailto:[log in to unmask]]
Sent: Monday, August 19, 2002 5:41 PM
To: [log in to unmask]
Subject: Re: Depo shots...


Hi Linda,
I am sorry I don't have any specific references to give you for these Drs
other than Tom Hale Medications and Mother's Milk 10th Ed.  However, have
they thought about reading the package insert that says wait 6 weeks??  How
about asking the OB/GYN dept to give the LC dept proof that it is safe to
give at discharge.  And - hmmm - any particular reason they are giving it to
ALL the medicaid patients??  grrr...  In Hale 2002 10th Ed. (pg 444) there
is a lot of information. Hale states that, re: Depo, waiting until 6 wks pp
is preferrable.  It also states:  "With progestins, it has been suggested
that some women may experience a decline in milk production, or arrested
early production, following injection of DMPA <Depo Medroxyprogestrone>,
particularly when the progestin is used in the early postpartum (12-48 hrs).
...snip... No progestin should be used before at least 3 days postpartum and
perhaps longer."

Hope this helps...

Warmly,
Jaye

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