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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

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