Help breast-feeding moms choose hormonal methods
October 1, 1997
Help breast-feeding moms choose hormonal methods
What are the safest hormonal contraceptive options for breast-feeding women? Adele Palmer, a sexual health counselor with Palliser Health Authority Community Health Services in Medicine Hat, Alberta, Canada, asks this question for effective counseling with women at her clinic. She says some patients discontinue breast-feeding because they believe hormonal contraceptives will either alter their milk flow or harm the infant.
Responses are from two members of Contraceptive Technology Update’s editorial board: Allan Rosenfield, MD, dean of the School of Public Health at Columbia University in New York, and Sharon Schnare, FNP, CNM, a Seattle-based family planning clinician and consultant.
Rosenfield: Basically, for women who are breast-feeding, most would recommend a low-dose, progestin-only oral contraceptive, switching to a low-dose combination pill after four to six months of breast-feeding.
Schnare: As a midwife and nurse practitioner, I am very careful about medications, hormones, etc. in breast milk. First, contraceptive counseling and education should occur before the baby is born. I encourage mothers to consider which contraceptive methods to use after the baby is born. I also discuss contraceptive issues related to breast-feeding and postpartum physiological changes.
Too often, clinicians assume that women will not engage in sexual activity particularly intercourse until after the traditional six-week "postpartum checkup," when in fact, the majority resumes intercourse as early as two weeks postpartum or less. When contraceptive counseling is left to the six-week visit, it often means that women have had unprotected intercourse.
In my practice, I address contraception before delivery. I want to know what my patient’s breast-feeding plans are. I discuss hormonal contraception and breast-feeding before delivery. When patients plan to breast-feed, I discuss these methods and safety during breast-feeding:
Norplant. Norplant may be inserted immediately postpartum.
Depo Provera (DMPA). DMPA may be injected as soon as breast-feeding is established or before the mother leaves the birthing center or hospital. I discuss postpartum vaginal dryness and encourage the patient to consider using lubricants.
Progestin-only pills.
T380A IUD or the Progestasert IUD.
Foam and condoms. I give all pregnant patients foam and condoms to keep at home. When a new baby is brought home, many times the last thing on a couple’s mind is birth control. Having foam and condoms on hand ensures that the couple has protection when they need it.
Lactation Amenorrhea Method. This method of contraception is essential to discuss with new parents because it is effective when used correctly, and, of course, it’s hormone-free.
It is very important to inform pregnant women of all contraceptive choices, and I always discuss emergency contraception. Women may breast-feed for short or extended periods of time, so this information gives mothers broad choices should they stop breast-feeding. Prenatal education should include discussion of sexuality in the prenatal and postpartum phases.
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