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Expert Q&A

	By Melissa Clark Vickers International Board Certified Lactation Consultant Moms & Babies Huntingdon, Tenn.

My doctor suggested that I take a Depo Provera shot before I left the hospital after giving birth. I declined, wanting to research it further. What is the real truth about Depo Provera while breastfeeding? Is it safe?

This is not an uncommon practice -- giving new moms the Depo Provera shot before they leave the hospital. It is convenient, but may not be the best thing for a breastfeeding mom to do. There are two issues at hand concerning the safety of Depo Provera for the breastfeeding infant: 1) will it harm the infant by whatever the infant ingests through his mom's milk; and 2) will it affect mom's milk supply.

Depo Provera is a synthetic progestin compound that is usually administered by injection for long-term contraception. (It is also given orally for some conditions.) The World Health Organization (WHO) has done extensive research on the effects of progestin-only contraceptives on breastfeeding infants and has found no adverse effects on the overall development or growth rate. According to Thomas Hale, PhD, in his Medications and Mothers' Milk 2000 (p. 416), the WHO ""suggested there is no apparent reason to deny lactating women the use of progestin-only contraceptives, preferably after 6 weeks postpartum."" The package insert for the drug states that this drug should not be administered before 6 weeks postpartum.

Dr. Hale also mentions studies that suggest that male infants exposed to early postnatal progestins have ""higher feminine scores,"" as well as studies that refute this finding. He adds that further research is necessary to fully study this possible side effect of these drugs.

On the issue of milk supply, Dr. Hale says: ""It is reported, but unsubstantiated, that some women may experience a decline in milk volume following injection, particularly early postpartum (24-48 hours). At present there is no published data to support this, nor is the relative incidence of this untoward effect known. Therefore, in some instances, it might be advisable to recommend treatment with oral progestational-only contraceptives, so that women who experience reduced milk supply could easily withdraw from the medication without significant loss of breastmilk supply.""

The problem with the Depo Provera shot is that because it is a one-time long-term shot, IF there is a problem, there is no way to ""undo"" the shot.

In another reference by Dr. Hale, Clinical Therapy in Breastfeeding Patients (1999), he states: "" Some suggest that it may suppress breastmilk production in some patients. Should not be administered prior to 6-8 weeks, and then only after challenged with an oral progestin-only preparation."" (p. 51).

So what's the bottom line? There are no absolutes here, but it is probably the better part of wisdom for breastfeeding mothers to wait until lactation is well established (at least 6 weeks) before introducing these progestin-only contraceptives, and then try a month of oral contraceptives before having the shot of Depo Provera.

Another option for breastfeeding moms with young infants is the LAM method.LAM (Lactational Amenorrhea Method) can be up to 98 percent effective for the first 6 months, as long as the following are true:

• Your menses have not returned (no vaginal bleeding after the 56th day after birth), AND
• You are not supplementing regularly nor going longer than 4 hours between feedings during the day or longer than 6 hours between feedings at night, AND
• Your baby is younger than 6 months old.

As soon as any of these changes, your risk of becoming pregnancy increases. Moms should discuss the pros and cons of the various options with their doctors.

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