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medroxyprogesterone (Depo)

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  • medroxyprogesterone (Depo)

    Could you please explain why Depo is rated an L4 if used during the first 3 days postpartum? Is it because of the progesterone and the affect it could have on milk production?

    Thank You,

  • #2
    Sugarmy3:

    Absolutely. We are pretty certain, that the early (first week) use of progestins may inhibit the onset of milk production. I always suggest you use the ORAL progestin-only pill first at about 1 month. If this goes well for a month or so, then Depo-Provera is probably quite safe.

    Tom Hale Ph.D.

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    • #3
      Deo provera

      This is what I understand as well that depo can have an effect on milk supply. Then why is it that OB docs continue giving it to mothers before discharge. Where can I find evidenced based information to present to these docs?





      Originally posted by sugarmy3 View Post
      Could you please explain why Depo is rated an L4 if used during the first 3 days postpartum? Is it because of the progesterone and the affect it could have on milk production?

      Thank You,

      Comment


      • #4
        Lomanriq:

        Yes, I give it an L4 rating due to the 'possibility' that it will suppress milk production. Its transfer to the infant is probably minimal and not considered a problem.

        Tom Hale Ph.D.

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        • #5
          progestins in the first week pp

          The use of depo shots prior to discharge was a hot button when I first certified in 1996. Nearly 20 years later, we still have the same questions/issues, broadened now with things like nexplanon. I try to get mini pill usage as you suggest at a month, for a month, followed by less "stoppable" progestins if all has gone well. But we still have docs who insist on giving/injecting/placing progestins on day 2 or 3.

          It seems so basic. If lactogenesis II is triggered by the drop in progestins following loss of the placenta, WHY IS IT SO HARD TO CONVINCE DOCS THAT THIS MIGHT BE PROBLEMATIC? It doesn't even seem like a very complicated concept. I just want to say "duhhhh!"? How many more years of school would this require? I think it is partly a system issue, in that the mom's PP checkup isn't until 4-6 wks, and the providers are terrified they will show up pregnant. I'm sure some do, but not very likely if they have been helped to establish exclusive BF.

          Maybe it IS only a theoretical risk. But if the ob world would spend more time becoming well informed and truly supportive of breastfeeding (even if just for it's positive effects on WOMEN'S health), they wouldn't have to feel like THEY have to keep women from getting pregnant (women being incapable of understanding good information and then acting on it themselves, of course.)

          Can you give us some updated references that might address the initiation of supply issues?

          thanks!
          Kay McKee, IBCLC

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          • #6
            me again. I just looked at several online resources, and found the CDC-USMEC update of 7/8/2011, which says ok even immediately following delivery. But I am bothered that they only discuss "safety" for the woman and the baby, and I wonder if they would consider difficulty establishing adequate supply a "safety" issue. After all, we can "safely" feed formula if BF doesn't kick in well. ???

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            • #7
              Kay:

              In medicine, we live in a world that is increasingly "evidence based". Can you show me any published evidence that medroxyprogesterone (Depo Provera) decreases milk production? I don't think so, as I've never found it. It certainly may be true, and I believe it to some degree, but you nor I have any evidence to really support this theory.

              Until we do, it will be difficult to support our 'theory' that it suppresses milk production.

              Tom Hale Ph.D.
              InfantRisk Center

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              • #8
                very good. This is useful for me

                Comment


                • #9
                  ACOG recommends that patients are told of the theoretical risk of low supply and allowed to make an informed decision. This is stated in their position paper Optimizing Breastfeeding Support. Additionally, while the CDC says immediate postpartum Depo is okay, WHO says it is not and recommends waiting at least three weeks. I have seen many, many patients who have also been pumping good volumes and receive the shot at 4 or 6 weeks and notice an immediate decrease in the volume that they pump. One person might be a coincidence, but over 20 years I have easily have 50 women report this to me. I also found a rapid decrease in production when I got the shot at 6 weeks, and it took my body nearly a month to recover the supply.

                  My biggest concern is with those patients given the shot immediately in the hospital prior to onset of mature milk production. I constantly battle with MDs who feel no need to even inform the mother that this could potentially happen. IMHO, women with have a h/o oversupply likely have few or no issues. I see much more impact on first-time mothers and those with a history of low or borderline supplies. The research that is out there is so limited and flawed, I don't understand why MDs think it's okay to rely on it. And why they consistently disbelief the reports from LCs and mothers. I would prefer they have an established supply first and that we tell that them it potentially could be an issue, but not definitely. They should also be evaluated for other possible risks for low supply such as breast hypoplasia.

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