Many moons ago The Pump Station and Nurtury asked me to teach a class and write a blog entry about contraception while breastfeeding
Here’s my blog entry for them, for you:
As an OBGYN, I was well aware of the intense post partum changes that I should expect from my own body. The biggest challenge of all, and one that my medical experience didn’t prepare me for, was the sometimes painful, emotionally turbulent, and occasionally wonderful experience of breastfeeding. Happily, I was going to the breastfeeding support groups at the Pump Station. They provided me with a wonderful blend of camaraderie and information. Much of that information was new to me, but I soon came to realize that there was at least one area about which my group-mates often had questions in which I was well versed. At almost every class, someone would ask about contraception choices – what was the best to use while breastfeeding? What was safe? Knowing I was an OBGYN, our group leader would defer these questions to me.
There are certainly many possible choices, but the most controversial seems to be the questions surrounding progesterone. The lactation consultant would inextricably tell women that it would decrease milk supply, citing expert opinion and legitimate sources. The medical literature I was familiar with told me that progesterone would have no effect at all on breast feeding.
So which one was it? Are progesterone methods of contraception friend or foe to the breastfeeding woman?
I did a thorough medical search and found a ton of information (some helpful, some useless). I am clearly not the only person trying to answer this question.
Before I go through this information, let me get you up to speed with progesterone contraception.
Progesterone forms of contraception:
There are many different types of progesterone used for contraception – names like norethindrone, levonorgestrel, norgestimate. They vary slightly depending on the delivery method (swallowed, injected, etc), but are sometimes lumped together for ease of analysis.
What do the studies show?
I don’t want to bore you with the extraneous details (I bored myself reviewing some of this information) … but here’s the gist:
Lactation is made possible, in part, because of a sudden drop in maternal progesterone levels the first few days post partum. Addition of a progesterone at this time may, theoretically, halt this natural process.
Current evidence to support either argument is weak. The studies are not uniform. The outcomes are not consistent.
I don’t blame you. I haven’t given you an answer because there is no straightforward answer.
I believe that large studies show us, overall, that progesterone only contraceptives CAN be a good option. They are unlikely to have a detrimental effect on breast feeding or infant outcomes. This is the information your OBGYN will site. I know I have.
BUT, and I urge to remember this, some women may be sensitive to progesterone. Lactation consultants see this sensitivity consistently and with more frequency than the literature suggests. Although the data is unpublished and at this point anecdotal, I believe it is enough to question progesterone only methods. Breast feeding is hard enough as it is … your choice of contraception should not make it harder.
I suggest you proceed with caution:
Get educated on all forms of contraception. Come to my class, Sex and Contraception for the Post Partum Woman to learn more!
Also seen here: http://pumpstationblog.blogspot.com/2014/07/breastfeeding-and-contraception.html
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Nov 3, 2014
Original post published:
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