Dear Friends:
     Linda is asking for help with giving Depo-provera early postpartum.
    For one thing, giving a medication against the manufacturer's
recommendation opens a practitioner to liability!
    For another thing, there is a study used to justify early post-partum use
of Depo. This study found no difference in breastfeeding rates in the control
versus experimental group. This study found a low breastfeeding rate in BOTH
groups, and used the conclusion to support early use of depo.
    What about the paternalistic attitude that the practitioner must take
responsibility for a woman's fertility?
    The Shabaan study is used to support early use of Depo. However in that
study, early postpartum was defined as 8 weeks postpartum. And the sample was
rural Egyptian women who had no access to breastmilk substitutes and were
mandated by the Koran to breastfeed for 2 years. This hardly justifies giving
Depo-provera before hospital discharge!
    I suggest examining the study the physician in question is quoting, and
bringing up the liability question as well. I am not aware of any studies
showing that early use (2-3 days post-partum) of progestin-only contraception
promotes extended breastfeeding duration.
    warmly,
Nikki Lee RN, MS, Mother of 2, IBCLC, CIMI, CCE, craniosacral therapy
Adjunct faculty, Union Institute and University, Maternal and Child Health:
Lactation Consulting
Supporting the WHO Code and the Mother Friendly Childbirth Initiative

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