In a message dated 12/29/0 1:47:01 AM, [log in to unmask] writes:

<< Her take was "innocent until proven guilty" when I asked if she had
studies to say it was safe to use. >>

Really??? Is this the standard by which we put drugs into our bodies??

<< It is true that only about 3% of our clinic patients return
for their 6 week check up, but i have to wonder how many come back for their
3 month shot. I also know that this segment of our population often intends
to supplement by 1 month.>>

There are so many issues here. First off, so what if only 3% come back for
the 6 week check-up?  Choices in birth control should be just that--choices.
Made by the mother, that is, not by the doctor who thinks s(he) knows what is
best for her. You are absolutely right that many, if not most of those moms
will not come back for the next shot. Anyone ever wonder why? First of all,
many women hate the side affects, including the weight gain--after all, they
are interested in losing weight after having a baby. Another reason is that
there is no trust between them and the HCP's who the mothers are very aware
have coerced them into taking drugs they may not have chosen in a free and
fully-informed manner. Further, who has decided that women must have a 6 week
appt? I only had them with my babies so I could visit with the midwife. I
take real issue with the idea that women must follow a particular schedule,
which tends to includes words like "compliant" to be considered "acceptable"
mothers by those who deem themselves qualified to make such designations..

 << Today she told me that several patients had refused their depo and she
took the
issue up with our medical director and he was livid. Actually they were just
wanting to delay it.>>

So what? Mothers have the right to delay, refuse, change their minds, form a
new opinion, whatever!!! In the hospital where I worked, women were actually
told they could not go home unless they chose and received a method of birth
control. Oh, did I specifically mention these were poor women who went to the
clinic? We once had a client who changed her mind and decided to wait until 6
weeks to decide about birth control. Her husband told this to the nurse, but
while he was in the cafeteria, a different nurse came in and gave the mother
the depo shot. She did not tell the mother what it was until the mother asked
*after* the shot was given. I know many HCP's will say this could not have
happened, but it did. If the nurse had told the mother what she was about to
do, the mother would have told her she didn't want it. The mother was
hysterical, b/c she thought her husband would think she had gone behind his
back and made the choice w/o his knowledge. I was told in no uncertain terms
by an OB that "it is the decision of the doctor, not the mother, which form
of birth control is appropriate for her". I was told that for me to give the
mother the package insert to read before she received her shot was
"practicing medicine w/o a license".  The only thing going for us was the
fact that the head of the newborn nursery gave mothers info all of the time,
including info about LAM. She was very much an advocate for the mothers,
although it didn't always benefit her.

<<All this to say - any data out there?  In the absence of data, do i have a
leg to
stand on that the manufacturer recommends waiting? >>

I think Pat is right, your leg to stand on is the big fat lawsuit. It is only
a matter of time before it happens--which head of OB wants to explain it to
the hospital administrators when it happens on his/her watch? I have
mentioned before that there is supposedly a study showing increased milk
supply w/ depo, but I do not know how supply was measured. My thoughts are
that if supply is reduced, as with cigarette smoking, you may see that
mothers are nursing more often to accomodate.

<<  This also reeks of the great white doctor god trying to control the
reproductive life of her poor, irresponsible patients...and it makes me
sick.>>

I actually often heard people say things like this in their paternalistic
ways. If they weren't trying to control mothers (women), they would not be so
concerned about mothers returning at 6 weeks. The idea is, we'll get them
while we've got them. What if they don't want to be gotten? What if they want
information and respect instead of selective misinformation and coercion?
    Chris, you need to stand for what is right, even if it makes people mad.
It is often very hard, b/c the moms often won't stand up to the doctors and
if you try to advocate for them, they will often back down and do what the
doctor wants anyway, making you feel foolish. It is a complicated thing in
the world to feel powerless. The ways to gain power often do not benefit the
Self in the long run and reinforce people's perceptions that you don't
deserve to make your own choices. This is, IMO, a seductive trap which we
need to avoid.
    There is this whole idea that there is a correct way for women (in the
US) to have babies. You get your prenatal care according to a schedule as
decided upon by the HCP's, you have your baby under their control (and be
sure to be grateful afterwards) and you get your birth control right away.
The thing is, you can actually decide to do it differently, if you can afford
it. You can choose your HCP (midwife, for example), you can choose your place
of birth (birth center, home, as examples) and you can actually expect to be
informed about LAM or natural family planning, a fertility lens, etc, if you
are motivated enough to learn. If you are poor, you better not stray from the
path. You will have people knocking on your door and social workers will talk
about you in meetings, referring to your "lack of compliance" as a "risk
factor" to your baby.  When my toddler was born, I was well-practiced at
growing babies and birthing them at home. I chose to skip most prenatal
visits, skip the physician back-up and use LAM after birth. If I were a poor
woman, I wouldn't "be allowed" to do this. Arghh!!!! This whole inequity is
just insane. And you are right, it is racist, too.
Jennifer Tow, IBCLC, CT, USA--off on one of my biggest issues with American
"health care".

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