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Subject:
From:
"Linda J. Smith" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Mon, 23 Apr 2007 11:33:51 -0400
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Coach Smith here.

The more important question: WHY RISK milk synthesis by using hormonal
contraception in the first place? There are many other ways to avoid getting
pregnant. 

Linda J. Smith, BSE, FACCE, IBCLC
Bright Future Lactation Resource Centre Ltd.
6540 Cedarview Ct, Dayton OH 45459 USA
(937) 937-438-9458 / fax (937) 438-3229
www.BFLRC.com


-----Original Message-----
From: [log in to unmask] [mailto:[log in to unmask]] 
Sent: Monday, April 23, 2007 7:05 AM
Subject: hormonal contraception and breastfeeding


Dear Friends:
 
Michelle, another lovely nursing student asks questions about this important

issue.
 
If you read the package insert for Depo-Provera, you will find a 
recommendation to give this shot at 6 weeks if the woman is exclusively
breastfeeding. 
Hale also talks about the theoretical risk of giving progestin during the
time 
that progesterone levels are plummeting (opening the prolactin receptors)
during 
the early postpartum, thus creating an environment for optimum milk making.
 
Shabaan found that progestin-only contraceptives had no impact on 
breastfeeding when given at about 6 (or was it 8) weeks........to poor rural
Egyptian 
women that were mandated by their culture to breastfeed for several years
and 
that had no access to any substitute.
 
When looking at this type of research, it is important to know what is the 
researcher's definition of breastfeeding. The Labbok/Krasovec definitions
are 
the gold standard.
 
I know that in practice, and with the endorsement of ACOG, that depo-provera

or the progestin-only Pill are given to women at 2-5 days postpartum. We
don't 
have anything except anecdotal reports of diminishing milk supplies. The 
definitive research study on this important topic has not been done.
 
_http://www.cochrane.org/reviews/en/ab003988.html_ 
(http://www.cochrane.org/reviews/en/ab003988.html)  says:
 
We found five studies that varied in quality. Some trials lost many women 
during the study. Two reports compared birth control pills to a 'dummy' and
they 
had different results. Another study found that progestin-only did not
affect 
breast milk. One trial found less breast milk produced with combined birth 
control. That study also lost many of the women, though. We found no major 
difference in infant growth or weight due to these types of birth control. 
The results did not show whether hormonal birth control affects breast milk 
or the baby. At least one good randomized trial is needed to address these 
issues. Right now, information is too limited to say whether breastfeeding
women 
should use hormonal birth control or not. 
warmly,
 
Nikki Lee RN, MS, Mother of 2, IBCLC, CCE, CIMI
_http://www.breastfeedingalwaysbest.com/_ 
(http://www.breastfeedingalwaysbest.com/) 
www.myspace.com/adonicalee



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