Hormonal Contraceptives and Breast Milk
Is Your Baby on Steriods?
You have chosen breast feeding for your baby because you want to give him or her the very best you have to offer. Science has shown that breast milk contains essential nutrients and immunities that cannot be found in infant formula. But are synthetic steroid hormones a part of your baby's nutritious menu? If you use contraceptive pills or the mini-pill, Depo-Provera or depo-subQ provera 104, implants, or a hormone treated IUD, you are feeding your baby chemicals that nature never intended.
You just had a baby and you don't want to get pregnant again any time in the immediate future. Your body has gone through the stress of childbirth and needs a rest. Your doctor may have recommended estrogen-free birth control drugs as a no-hassle method of ensuring that you will not become pregnant again. The doctor has reassured you that the birth control drugs will not reduce your milk flow. However, all birth control drugs appear in the breastmilk in measurable amounts. Are these drugs good for your baby?
Are Synthetic Sex Hormones Good for Babies?
Since all steroids pass through the breastmilk into the infant, the World Health Organization and the International Planned Parenthood Federation do not recommend hormonal contraceptives as a good choice for lactating women. Newborns have an immature liver and immature kidneys, so they are unable to clear the drug out their systems in an efficient manner. Furthermore, their bodies require natural hormones for growth and development of the brain, sex organs, and other systems. Artificial hormones may compete with these natural hormones in the body. Animal studies have shown that, even in small amounts, inappropriate hormone exposure in infants can have permanent and detrimental effects.
Dispute Among the Experts
The overall amounts of hormones that infants receive in the breastmilk in these cases is small. Studies of the development of children whose mother's used hormonal contraceptives while breastfeeding show no clear harmful effects. Many experts feel that the risk to the mother of an untimely pregnancy outweighs the risk to the infant. Furthermore, over time infants can more quickly clear the drugs out their bodies. As a compromise, many experts recommend use of hormonal contraceptives after the baby is six weeks old.
Based on the opinion of these experts, drug manufacturers promote progestin methods to obstetricians and new mothers to increase sales. However, it is important to note that the effects of infant hormone exposure may take decades to detect and may not be evident until the children reach puberty or begin childbearing themselves. The long term studies needed to answer these worrisome questions have not been done. Also, there are few studies of what happens to babies whose mothers take these drugs earlier than six weeks because such a study might be considered unethical.
Other Birth Control Options for Nursing Women
Nursing mothers may consider non-hormonal methods of birth control. Barrier methods for women, condoms for men, and natural methods have no effect on a woman's ability to breastfeed. Because breastfeeding naturally decreases fertility, barrier methods will be more effective than their typical listed failure rates. However, the spermicide (Nonoxynol-9) typically used with barrier methods may also appear in the breastmilk, and this has not been studied in humans.
Female sterilization is also a popular option, and may be suitable if performed with only local anesthetic. However, general anesthesia and separating the mother and baby for surgery and recovery can also disrupt breastfeeding. Furthermore, the decision to become permanently infertile should never be made in the wake of the emotionally and physically turbulent aftermath of a pregnancy.
Because babies should not receive unnecessary drugs, especially sex hormones, ContraceptINFO recommends that nursing mothers consider using non-spermicidal condoms or natural breastfeeding for birth control. These methods are safe and easily reversible. Some cervical barrier methods may be used without spermicide, and these may be acceptable. For example the Lea's Sheild has been shown effective without spermicide, and the FemCap uses only a small amount of spermicide.
Not for New Moms
Never Use These While Nursing
The following birth control drugs contain synthetic estrogens and will reduce your milk flow, even in low-dose formulations. Therefore, they are never recommended for nursing mothers, although some doctors may offer them to women 2-3 months after delivery.
However, keep in mind that even a estrogen-free method may interfere with lactogenesis, especially if started within the first few days after birth, before milk production is well-established.
Health and Safety Warning
There are other health reasons for new moms to avoid combination (estrogen containing) drugs. The risk of drug-related postpartum stroke, heart attack, and blood clots are highest right after delivery. Women should avoid using any method containing estrogen for at least three weeks after birth.
Specific Contraceptives and Breastfeeding
Implanon Contraceptive Implant
Based on limited data, use of Implanon is not recommended by the manufacturers before the baby is 4 weeks old. Use of Implanon before the 4th postpartum week has not been studied.
Small amounts of the drug are excreted in breast milk. During the
first months after Implanon insertion, when maternal
blood levels of the drug are highest, about 100 ng of synthetic hormone may
be ingested by the child per day based on an average daily
milk ingestion of 658 mL. Based on daily milk ingestion of 150
mL/kg, the infant dose one month after
insertion of Implanon is about 2.2% of the maternal dose.
Organon, the manufacturer of Implanon notes that
"healthcare providers should discuss both hormonal and nonhormonal contraceptive options, as steroids may not be the initial choice for these patients."
Levonorgestrel has been identified in small quantities in the breast milk of lactating
women using Mirena. In a study of 14 breastfeeding women using a Mirena
prototype during lactation, mean infant serum levels of levonorgestrel were
approximately 7% of maternal serum levels. Berlex, the manufacturers of Mirena, state that "hormonal contraceptives are not recommended as the contraceptive method of first choice during lactation."
Depo-Provera and Depo-subQ Provera 104
The drug is detectable in the milk of mothers receiving both types of Depo-Provera. Furthermore, the drug enters the baby's bloodstream at the same levels found in the mother.
Ortho MicroNor Estrogen-Free Oral Contraceptive
Small amounts of progestin pass into the breast milk, resulting in steroid levels in infant plasma of 1-6% of the levels in the maternal plasma.
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