Breastfeeding & Contraception

Breastfeeding is as good as combined contraceptive pills (about 2% failure rate) if all the following conditions apply (no exceptions):

1. the baby is younger than 6 months

2. the mother has not yet had a normal menstrual period

3. the baby is exclusively breastfeeding (or near exclusively)

4. there is no prolonged period (greater than 6 hours?) when the baby does not nurse

For those of little faith, breastfeeding can be combined with other contraceptive methods. However, the "other methods" do not have to be the pill. the pill is often used because it is easy for the physician and too often the needs of the couple are not taken into account or even discussed breastfeeding is hardly ever a consideration in the equation
contraception is an intimate issue, and has complex and multiple facets including: the question of when to return to sexual relations, and what that might entail religious understanding, sacrifice, compromise a father might not want to use a condom a mother might not want to have an iud inserted, or have to take the pill it takes longer for a man to become a father than for a woman to become a mother.

Options:

• abstinence
• sexual activity other than intercourse
• natural planning methods
• non artificial methods (coitus interruptus)
• barrier methods
• IUD
• progestin only pills
• medroxyprogesterone injections (DepoProvera)
• combined pills

When to start contraception?
Conception before about 4 weeks postpartum must be extremely uncommon there is virtually no risk of ovulation in the fully breastfeeding woman up to about 6 weeks

If there is no option to the pill: wait at least 6 weeks postpartum
use progestin only pills, which have not been shown to decrease milk supply combined pills should not be used until at least the baby is feeding other foods (not usually earlier than 4 months of age) so that a decrease in the milk supply can be compensated by an intake in food.

CAVEAT!! Babies respond to milk flow, not the "amount of milk in the breast". Thus, they may not breastfeed well, even if the decrease in supply is relatively minor.

Medroxyprogesterone (DepoProvera)?

In theory should not cause problems Hartmann has theorized that the sensitization of alveolar cells to the stimulating effect of prolactin happens in response to a fall in progesterone levels this might have great significance in situations where the injection is given on hospital discharge there have been anecdotal reports of women's milk supply decreasing with progesterone and/or medroxyprogesterone injections
the manufacturer recommends waiting six weeks postpartum before giving the injection.

Suggestion:

If the mother is to be given medroxyprogesterone injections:

1. do not give injection on discharge from hospital

2. start progestin only pill at 6 weeks if there is no obvious decrease in milk supply after first cycle, give medroxyprogesterone
if there is, stop progestin only pill immediately and do not give medroxyprogesterone