For any of you that were at ILCA in Philadelphia last July, I presented a  
poster on the affects of Depo on milk supply for pumping NICU moms when given  
<72hrs after delivery (abstract published in fall issue of JHL). In doing a  
lit search as part of my research, I could not find any research addressing  
early administration of Depo. American College of OB/GYNs (ACOG) recommend  
administration after 4 weeks so when administered early, these physicians are  
going against what their professional organization recommends as standard of  
practice. In my retrospective study of 10 NICU exclusively pumping moms, none  
obtained an adequate milk supply, in spite of routine lactation support in our  
NICU and use of galactagogues. I know it is a small study group and only a  
retrospective study, but it is a start and I would love to see a bigger study  
completed and published. Coincidentally, my medical director, who is a  
Neonatology Fellow, was asked to speak at an OB/GYN Grand Rounds about  breastmilk and 
lactation. She shared the information we gathered in her  presentation and 
for the past year have only seen 1 NICU mom who has received  Depo prior to 
discharge. We did make progress. 
I make it a point to talk to all of my NICU pumping moms prior to 1 month  
post partum about birth control and share information about the potential  
effects of hormonal birth control on their milk supply, which is already  fragile. 
I provide them with information, from a lactation perspective, before  they go 
back to their doctors for their PP check up. At least they are going to  this 
appointment with the knowledge I have provided to them and they have a  
better knowledge base with which to make an informed decision when they see  their 
doctor. Most choose another form of birth control, but some still choose  
hormonal birth control. But at least they have made a more informed choice than  
if I had not said anything.
Chris Smith, RN, IBCLC

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