Julie Taylor wrote:
"This is a long shot I know but I have been looking at the archives about debates about giving Depo 
provera in the early post partum period. I have had many (low income ,clinic) patients come to us 
with a sudden and drastic decline in their milk supply after being given Depo prior to discharge by residents.Most of these patients 
speak only Spanish and have no idea what is given to them! I had a somewhat heated discussion with 
the attending physician who told me that Depo actually increased milk supply and that I didn't know 
what I was talking about! I have been searching feverishly for data to support my argument but have
found only articles by the Academy of Breastfeeding Medicine (wonderful but not enough). Did Dr Newman
publish any research about this subject? I cannot find it if he did.  I know that lactogenisis occours
due to the drop in progesterone caused by delivery of the placenta. Obviously giving progesterone 
is going to cause failure of breastfeeding. I saw a letter written in 2003 by Patti Gardner and I
telephoned her to ask for the references used by Dr Margaret Neville of the University of Colorado 
( she does not appear on their website, I assume that she no longer works there) Patti was not in 
her office and I left a message. Does anyone have any supporting references for this? I would love 
to wipe that smug smirk off that attendings face!"

Julie,
This has been going on for a very long time and got me in a lot of trouble in hospital. Depo is often the drug of choice for the physicians of 
poor women, who believe that these moms will have unprotected sex before 6 weeks and get pregnant again. You notice that I did not say, 
it is the drug of choice for the women, b/c the women often have no informed consent whatsoever. It is definitely my experience that poor 
women in the US are treated very differently from privately insured women when it comes to birth control. They are given less information, fewer 
choices and treated with less regard for their ability to make choices. They are also treated as if their choices may be unacceptable to others,
as if that ought to matter to them! I have seen women lied to and truly pushed into having depo within 48 hours of birth. I saw mothers told they
COULD NOT BE DISCHARGED until they got the shot!!! Coercion was blatant and everyone got away with it. Physicians clearly did not want 
mothers to know that there were any feeding risks associated with depo. Package inserts were intentionally removed from the product and kept
in a closet and NOT given to the mothers so that they had no ability whatsoever to make a decision. I was literally told by a physician that he 
was in a better position to choose a mother's form of BC than she was and that it was his place to do so!

Many of the moms who got depo had serious feeding problems and most of them absolutely hated the side effects. Many of the moms did not 
take the shot again, so at 3 mos, when they actually were much more at risk for pregnancy, they were often without BC of any kind, including 
exclusive breastfeeding. Docs told us straight out that they did not trust these moms to come in for their 6 week pp check-ups, which was why
they insisted on depo in hospital. When we asked if this wasn't up to the mother, we were told that the mothers were in economic situations that
made it important for them to avoid pregnancy. The rights of women to their own reproductive health in the US are shaky at best, but for poor 
women, they are atrocious!

I think that there may be the doctor or two who would be swayed by facts, but I think this is a class issue and that personal biases outweigh 
science most every time. After all, the science supports uninterrupted birth and exclusive breastfeeding, but you don't see American docs 
jumping on those bandwagons in droves either. 

Jennifer Tow, IBCLC, CT, USA 
Intuitive Parenting Network LLC


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