“The new guidelines ignore basic facts about how breastfeeding works,” says Dr. Gerald Calnen, President of the Academy of Breastfeeding Medicine (ABM). “Mothers start making milk due to the natural fall in progesterone after birth. An injection of artificial progesterone could completely derail this process.”
The CDC report, “U.S. Medical Eligibility Criteria for Contraceptive Use, 2010,” released in the May 28 issue of Morbidity & Mortality Weekly Report (MMWR), contains important changes in what constitutes acceptable contraceptive use by breastfeeding women. The criteria advise that by 1 month postpartum the benefits of progesterone contraception (in the form of progestin-only pills, depot medroxyprogesterone acetate (DPMA) injection, or implants), as well as the use of combined (progestin-estrogen) oral contraceptives outweigh the risk of reducing breastfeeding rates. Previously, progesterone birth control was not recommended for nursing mothers until at least 6 weeks after giving birth, and combined hormonal methods were not recommended before 6 months.
Based on clinical experience, breastfeeding support providers report a negative impact on breastfeeding when contraceptive methods are introduced too early. One preliminary study demonstrated dramatically lower breastfeeding rates at 6 months among mothers who underwent early insertion of progesterone-containing IUDs, compared with breastfeeding rates of mothers who underwent insertion at 6-8 weeks postpartum.
“The data are limited,” says Calnen, “but for now, the state of the science suggests that early progesterone exposure undermines breastfeeding.”
Family planning specialists argue that early hormonal birth control is needed to reduce unplanned pregnancies. However, the most commonly used early contraceptive method, a DPMA injection, prevents pregnancy for only 12 weeks at a time. “There is no evidence that immediate postpartum injections delay the next pregnancy beyond the first 3 months,” says Calnen.
Dr. Miriam Labbok, Director of the Carolina Global Breastfeeding Institute and an expert on the interface between breastfeeding and fertility, notes, “The mother should have the final decision on her birth control method, with full information. Unfortunately, these methods are often given to women with little counseling. Women deserve to know that there is a potential risk.”
ABM wrote to CDC Director Thomas Frieden in January urging reconsideration of the guidelines. In his reply, Dr. Frieden described the new recommendations as “the best interpretation of the existing evidence.”
Calnen is less confident. “Physicians and mothers should proceed with caution,” he says. “There are plenty of birth control methods that are proven to be safe for breastfeeding. Early progesterone is not one of them.”
The Academy of Breastfeeding Medicine is a global organization of physicians dedicated to the promotion, protection and support of breastfeeding and human lactation through education, research, and advocacy. An independent, self-sustaining, international physician organization and the only organization of its kind, ABM ‘s mission is to unite members of various medical specialties through physician education, expansion of knowledge in breastfeeding science and human lactation, facilitation of optimal breastfeeding practices, and encouragement of the exchange of information among organizations. It promotes the development and dissemination of clinical practice guidelines. The Academy has prepared clinical protocols for the care of breastfeeding mothers and infants that are available on the Agency for Healthcare Research and Quality’s (AHRQ) National Guideline Clearinghouse website.
Breastfeeding Medicine is the official journal of the Academy of Breastfeeding Medicine. It is an authoritative, peer-reviewed, multidisciplinary journal published bi-monthly. The Journal publishes original scientific papers, reviews, and case studies on a broad spectrum of topics in lactation medicine. It presents evidence-based research advances and explores the immediate and long-term outcomes of breastfeeding, including the epidemiologic, physiologic, and psychological benefits of breastfeeding.
Contact: Karla Shepard Rubinger, Executive Director, Academy of Breastfeeding Medicine, (914) 740-2100, ext. 2153, firstname.lastname@example.org