Dear Lactnetters, esp. Dr. Hale,
  A client who called me Sat. with a milk supply problem--a significant
decrease to the point where she is supplementing.  She has an 8 wk old, &
her OB put her on mini pills 3 wks ago, and she has been back to work 2 wks.
I quizzed her about the pump (P in S--I just put in all initials & took a
look at them!), x pumping/day, growth spurts, job stress, supplementing,
diet, fluids, baby sleep patterns, etc. before I asked (btw) about pills.  I
really think it's the pills!
  I have seen 4-5 other mothers in this same situation (one began pills at 1
wk pp as per dr. instructions); all were very upset because they had been
assured by dr. that pills were "safe for bf".  One woman had already called
her dr., had been assured that it was job stress & not to worry; supply did
not get better, it dropped a little more during the following days & before
she called me.  Another woman, an at-home mom, had been on one cycle of
pills before her supply bottomed out; it took her almost a month of
heavy-duty nursing & extra pumping to rebuild supply completely.
  Upon hearing that pills were a possible cause of supply downturn (which
seemed to occur suddenly at 3-4 wks after starting pills), all chose to
discontinue pills rather than have to supplement more or take a chance with
milk not rebuilding.
  The woman I mentioned first is reluctant to give up the security of her
pills, but she really values bf, and I have no experience with women who do
not choose to stop taking them & use some other method of birth control.  In
your experience, if she continues to take the pills, can she expect her milk
supply to return?
  A second concern of the woman is about the use of spermacides.  Do they
get into the milk, are they a problem if they do, do they also cause
decrease in milk supply?  If there are other questions I forgot to ask,
please feel free to supply answers anyway.