Depo Provera used in Post Partum Units

[Selittle]

Hi, my name is Sarah and I currently am a junior nursing student at the University at Buffalo in New York. Just this spring I began a clinical rotation in a woman's health clinic and a mother baby unit at a local suburban hospital. For an assignment, we were asked to post a question that resulted from being in our clinical sites. When I worked in the woman's health clinic, I was administering many forms of birth control. One of the most popular types of birth control was Depo- Provera (medroxyprogesterone acetate) because of the convenience with not having to take a pill everyday. During my health teaching on this topic, one of the side affects that was most important to mention was the risk for depression. Those prone to depression should not take Depo-Provera because this can make the depression worse. The interesting thing about this was while working on the post partum unit at the hospital, I saw the administration of Depo Provera to many woman post partum to prevent pregnancy. It is well known that post partum depression is a prevalent form of depression in women who have just had children and can have devastating affects. The question that I have is if Depo- Provera is seen to cause or worsen depression is it possible that giving it to women post partum can make the onset of post partum depression more prevalent and more severe? In the hospital I saw first hand early signs and symptoms of post partum depression and it is something that should be taken seriously. If Depo was seen to complicate this issue, I personally would not want a loved one of mine to take this risk if other methods were available.

Any comments are appreciated,

Thank you,

Sarah

[SmilingBluEyes]

We do not use Depo Provera in PP at all. Birth control is discussed/taught yes, but the moms are urged to abstain from lady partsl intercourse (for lady partsl deliveries), or use barrier methods the first 6 weeks pp, then discuss the preferred method for birth control at that time with their HCP.

Our main reason is not the issue of PP depression, however, but most of our moms breastfeed and we do not want hormonal birth control interfering with milk production (which it can in early breastfeeding).

Anecdotally, I used Depo years back and never would again. it DID increase my depression symptoms, very appreciably. I can't say I would recommend it's use to anyone personally.

[sbic56, BSN, RN]

Same practice here as far as depo use postpartum in regards to avoiding it while breastfeeding, though sometimes is given once BF well established. Those who wish to receive it who aren't breastfeeding do get it, but I agree anyone should be cautious as the psychological side effects can be nasty. Then again, an unplanned pregancy could be devastating, too!

[Jolie, BSN]

Such an interesting topic! I will save the insert from my next dose of Depo and read it carefully to see what (if any) precautions it lists regarding PP depression.

On the unit where I worked, we gave it prior to DC for bottle-feeding moms who requested it. Breastfeeding moms who wished to use Depo (myself included) were given the first dose at the 6 weeks check-up, provided milk supply was well established. It is my understanding that Depo will not inhibit milk supply once it is well-established, and that was also my experience. I have used it with good results since my 7 year old was born. I did not experience any post-paartum depression, just some mild "blues", which was likely due to exhaustion, and resolved quickly once our family established a routine.

On a related note, it seems that there are still some OB providers who are sadly lacking in knowledge regarding PP depression. My friend, an experienced OB nurse and mother of 6, had a significant bout of PP depression following the birth of her youngest baby. She recognized that "something" was wrong, but couldn't put into words just what it was. She called her OB and asked if she might be experiencing PP depression, and was told, "I don't know. Let me know what you find out." Fortunately, she had it together enough to seek out another opinion and was properly treated. It scares me to think what could have happened if she had not been so motivated and knowledgable herself!