New contraception guidelines could undermine breastfeeding mothers

New Rochelle, NY, May 28 – New CDC birth control guidelines could undermine mothers who want to breastfeed.

The new guidelines advise that the benefits of immediate progesterone contraception outweigh the risks, and that by 4 weeks, there is no risk. Previously, progesterone birth control was not recommended for nursing mothers until at least 6 weeks after birth, and combined hormonal methods were not recommended for 6 months. In the new guidelines, combined pills are rated as “generally acceptable” from 4 weeks.

“The new guidelines ignore basic facts about how breastfeeding works,” says Dr. Jerry Calnen, president of the Academy of Breastfeeding Medicine. “Mothers start making milk due to the natural fall in progesterone after birth. An injection of artificial progesterone could completely derail this process.”

Clinically, breastfeeding support providers report a negative impact on breastfeeding when these methods are introduced too early, and one preliminary study found dramatically lower breastfeeding rates at 6 months among mothers who underwent early insertion of progesterone-containing IUDs, compared with 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 necessary reduce unplanned pregnancies. However, the most commonly used early method, DepoProvera, prevents pregnancy for only 12 weeks. “If a doctor feels a mother is so unreliable that she needs a birth control shot in the delivery room, how likely is it that she will get her next dose 12 weeks later?” Calnen asks. “There is no evidence that immediate postpartum injections delay the next pregnancy beyond the first 3 months.”

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 the know that there is a potential risk.”

The 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.”