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Breastfeeding and Contraceptives
By Sherri Hedberg, IBCLC

Birth control and breastfeeding is a big issue with mothers nowadays. Most families choose to use some type of birth control between pregnancies, and this often coincides with breastfeeding. Finding a method that works best for you and your family is a bit easier nowadays. With the availability of long term studies on the effects of certain birth control pills and breastfeeding, physicians are loosening their strong stance against their use while breastfeeding.

Below is current information about birth control and breastfeeding. This is simply information shared - it is not meant to take the place of your physician's recommendations. Please consult your physician before taking any medication while breastfeeding.

Creams, foams and barrier methods (condoms & diaphragms) are all compatible with breastfeeding. The chemicals used do not pass readily through the skin and do not cause problems with breastfeeding.

There are three types of birth control pills: the mini-pill (containing only progestin), a low-dose estrogen pill (commonly called the 7-7-7 pill), and the regular combined pill (containing both estrogen and progestin).

The mini-pill has been used by breastfeeding mothers for over two decades. It is the only birth control pill that has a long-term study available, meaning that babies who nursed while their mothers took this pill were followed into adolescence to determine any effect. None have been documented. Since this pill contains only progestin, it does not have much effect on breastfeeding. Breastfeeding mothers normally have high progesterone levels while breastfeeding (which plays a strong part in the delay of fertility). This pill simply prolongs that otherwise natural state. The mini-pill would be a good first choice for a breastfeeding mother.

Norplant and the Depo-Provera shots fall into this category because they are also progestin-only, but there is concern about these methods because of the way they are administered. Some mothers have reported a decrease in milk supply after taking either the shot or having Norplant inserted, but there are no formal studies to confirm this.

Some physicians are prescribing low-dose estrogen pills to breastfeeding mothers. Since there is estrogen in this pill, there is some concern. Estrogen has been shown to affect milk supplies in some women and one study suggests that it also changes the quality of the breast milk (though not enough to make formula a better choice). These studies were done with the regular combined pill so it is not clear if the amount of estrogen given would change these results. Still, some mothers may consider this option if they are unable to take the mini-pill due to certain side effects not related to breastfeeding.

The regular combined birth control pill is generally not recommended during breastfeeding, but there are some physicians who do prescribe it. The puzzle to using hormone birth control methods during breastfeeding is that every person is different. While one mother may not have a problem, another could have a serious problem. When I say 'problem', I am referring more to the mother's ability to produce milk and not the effect of the hormone on the nursing baby. Almost every drug taken by a nursing mother passes to some degree into the breast milk. Progestin does not appear to cause problems in an infant and many believe that a small amount of estrogen is safe . . . but there is still a need for further study.

There are some guidelines to keep in mind if you are considering taking the pill.
  1. Wait as long as you can before you begin - at the very least 6 weeks, 3-6 months better. The older your baby is and the more established your milk supply is will decrease your risk of having a milk supply problem.

  2. Take as little as you can get away with. Consider starting with the mini-pill.

  3. During the first 2 weeks of taking the pill, nurse often and pay attention to any change in your baby's nursing pattern.
If you are thinking about the Depo-provera shot or Norplant, DO NOT take until at least 6 weeks. I have worked with several mothers who received the shot before the left the hospital who have had difficulty establishing their milk supply. And remember about the lactational amenorrhea . . . if you are nursing often and not giving supplements, it is unlikely that you will be fertile during the first 6 weeks anyway. For more information about this, read my article on Breastfeeding and Fertility.

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