Breastfeeding and BCP Question

NICU_Nurse, BSN, RN · Nov 23, 2003

According to the Medela site (http://www.medela.com/NewFiles/contraception.html):

"Progesterone-only birth control pills can also be used during breastfeeding, though some of the medicine may get to the baby through the milk. Most researchers recommend waiting 6 weeks before these pills are started, because early milk production depends on low progesterone levels. Once milk supply is well established, these pills do not seem to affect the amount of milk made or the baby's health and growth. However, different women react to drugs in different ways. If you notice a decrease in your milk supply after starting birth control pills, talk to your doctor or midwife about alternatives. Combination pills (estrogen and progesterone together) should not be used in mothers breastfeeding young babies, because they can reduce the amount of milk made, and change the amount of protein in the milk."

mitchsmom · Nov 23, 2003

you said "I am breastfeeding my baby who will be 1 year old on Wednesday. I had been taking the minipill but with not breastfeeding as much anymore and also fear of getting pregnant during nursing school which I CANNOT afford to do, I called my OB's office and talked to a nurse about getting on the regular BCP's. I asked her if I could take the regular pills and still breastfeed occasionally (once a day, sometimes twice). She said no, I need to just wean the baby completely and get on the regular pill, because the pill would dry up my milk. This is my least favorite nurse there, she is not supportive at all and the other nurses up there are great. I was wondering, are the hormones in the BCP's dangerous to a 1-year old or is it just the possibility of it drying up my milk (which hasn't been the case for me). "

The Pill isn't so much a risk to your baby as a problem during breastfeeding supply-wise. The estrogen in combined pills is contradictory to your body producing milk. If you want to get on the combined pill no matter what, you could always try it and see if you still have any supply, you certainly do not have to wean first. If you really feel this is your only option right now, you could always try it. If it doesn't go like you want you can discontinue. Or, you could stick with the mini pill until you two are ready to wean, or consider another method.

Here's info on hormonal birth control methods while breastfeeding

Here's info on bf and birth control in general

One more on bf and birth control in general The only thing I disagree with is in this last link it is written "(referring to progestin-only methods like mini pill, norplant, depo provera) All of these methods can be very effective, and may even increase milk volume." These methods are generally ok with breastfeeding but I have not seen any evidence that it increases anyones milk volume, to the contrary I have seen collegues report patients who had supply problems even with mini-pills. This is why most lactation pros will suggest a trial with mini pills before starting depo, since depo is in your system to stay for so long after you get it - with the pills you can always discontinue.

I am in sort of the same situation as you - nusing my 18 month old and done having kids after three boys... I am using a FAM/diaphragm combo (FAM) (I can't/don't take hormonal methods due to other health issues)

Gotta run, hope that helps!

Oh yeah, here's a big page of breastfeeding links with a whole section on Fertility, Sexuality, and Contraception:

http://www.geocities.com/breastfeedinglinks/

Best wishes :)

L&D_RN_OH · Nov 23, 2003

Are you just not willing to take your chances with the mini pill? If it has worked for you so far, why change? I too, am on the mini pill and nursing my 11 mo old. I have noticed a decrease in supply in the beginning. BUT, I have had supply issues with all my kids, so the combo pill just wasn't an option for me.

If you're really intent on using the combo pill, I agree with trying it out, and see how it effects supply. If you're only nursing 1-2 times a day now, it might not cause a huge change.

Good luck.

TonyafutureRN · Nov 23, 2003

Thanks guys. I am starting the combo pills and I'm going to just wait and see about the bf'ing thing. If it does dry up my milk, it's not too big a loss since my baby is turning one and doesn't need the milk anymore, it's mostly just a bonding/comfort thing right now. But I don't think we're really quite ready to give it up yet. Thank you to everyone who posted to me. You were very helpful. Tonya

mitchsmom · Nov 24, 2003

I am glad to see you came to a decision that works for you.

Also, although solid foods are now becoming the primary source of nutrition for your 12 month old, all the good things that the baby got before are still there. As a matter of fact, those healthy parts of the milk actually concentrate more as you nurse less frequently. Pretty cool, huh? And some things such as the reduction of breast cancer risk for you are highly dose related - meaning the longer you go, the better the protection. The AAP recommends to nurse for at *least* a year so you are doing great!! Smiles & enjoy :)

BETSRN · Nov 26, 2003

Usually hormonal birth control pills do decrease milk supply. I'm not too sure about how much would get into the milk: very small amounts are usually all that passes with most meds. However, please get a copy of the book DRUGS IN PREGNANCY AND LACTATION by Briggs or MEDICATIONS AND MOTHER'S MILK by Thomas Hale. Both of those are resources that we ahve on our unit and they are very comprehensive.

mitchsmom · Nov 26, 2003

Hale is mostly concerned with supply rather than transfer to breastmilk:

"Oral contraceptives, particularly those containing estrogens, tend to reduce lactose production, hence reducing volume of milk produced. Quality (fat content) may similarly be reduced, although one recent study of the fat, energy, protein, and lactose concentration of milk of mothers using oral contraceptives showed no effect of contraceptives. The earlier oral contraceptives are started, the greater the negative effect on lactation. Suppression of breastmilk production with estrogen-progestin contraceptives is well known, is more prevalent early postpartum, and is common. Although it was previously believed that waiting for 6 wks would preclude breastfeeding problems, this is apparently not accurate. Numerous examples of supply problems have occurred months postpartum in some patients. Suggest that the mother establish a good flow (60-90 days) prior to beginning oral contraceptives. If necessary, use only LOW DOSE combination oral contraceptives with 35-50 mcg of estrogen or better, progestin-only mini pills. Suggest alternatives such as progestin only oral contraceptives (rather than Depo Provera) so that if a supply problem occurs, the patient can easily withdraw from the medication. Use Depo Provera in those patients who have used it previously and have not experienced breastmilk supply problems, or in those who have used progestin-only mini pills without problems. Attempt to wait 6 wks postpartum prior to using Depo-Provera.

The progestins and estrogens present in breastmilk are quite low, and numerous studies confirm that they have minimal or no effect on sexual development in infants.

Lactation Risk Category: 3

Adult concerns: Reduced milk production, particularly with estrogen containing preparations, but also rarely with progestin only products.

Pediatric Concerns: None reported via milk. May suppress lactation, reducing weight gain of infant.

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By the way, if you ever have a drug question that is NOT addressed in Medications and Mothers Milk, Dr. Hale has a website with a bulletin board available to professionals for this purpose:

http://neonatal.ama.ttuhsc.edu/cgi-bin/discus/discus.cgi?pg=topics&access=guest

TonyafutureRN · Nov 26, 2003

Thank you all. Your advice has been incredibly helpful. As far as Depo, I will never have another one of those shots as it caused me to gain a LOT of weight the first 2 months after I took it. And that's the last thing I need. Plus it made me bleed for 2 weeks straight, then I didn't get another period for 9 months. A friend didn't get her period back for 2 years,and then it was very irregular which it had never been before. She had a lot of trouble getting pregnant, which she attributes to the shot, after a successful IUI which yielded her daughter, her periods went back to normal after pregnancy and she had no trouble conceiving again, thank God. Thanks again to everyone who posted. Tonya