While many of you had good suggestions for increasing milk supply in a
working mom, I think this mom's problem is probably at least compounded by
the birth control pill.
She mentions taking Micronor in the beginning, presumably without a problem,
then being switched to Apri.  Apri is a monophasic combination
(estrogen/progesterone) birth control pill.  It sounds as if mom's supply
dropped after the switch.  In my experience, most breastfeeding women have a
noticeable drop in supply when using combination pills.  Her "period"
returning is probably her withdrawal bleed from the pill this month.  Some
docs seem to have the opinion that it's okay to use estrogen in lactating
moms "as long as the milk supply is established."  I've had several patients
come for second opinions lately who were told this and were struggling with
supply for their young babies (2,3, or 4 mos old) after being started on
combination birth control.
If mom really prefers the pill, switching back to Micronor is an option.
The progesterone-only pill (POPs) is slightly less effective than the
combination pill, especially if not taken at the same time every day, but
more effective than barrier methods.  I don't understand why the physician
had her switch if she was pumping/breastfeeding less than 8 times a day.
I've had many moms use POPs throughout lactation, and have some
non-lactating women who use it with good effectiveness.  It sounds like the
doc felt it wasn't enough protection unless the mom was also nursing enough
to have lactational amenorrhea also.

Jennifer Tieman
Family Physician
Mom to 3, and new baby #4 expected 5/31/03

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