Breastfeeding mothers should know about two areas of concern when taking birth control pills: Effects on milk production; and the possible effect of hormones on the baby.

Effects of oral contraceptives

Some oral contraceptives contain both estrogen and progestin, others progestin only.

Estrogen-containing birth control pills are not considered compatible with breastfeeding since estrogens suppress milk production.

The progestin-only pill (also called the mini-Pill), has not been reported to affect milk production.

Effects of hormones on your baby

A small amount of the synthetic hormones in these contraceptives does enter the milk, but there is no evidence that this is a danger to the baby.

Follow-up studies have revealed no long-term problems in babies and children who continue to breastfeed while their mothers use hormonal contraceptives, with or without estrogen.

Some physicians, however, do question the use of hormonal contraception in lactating mothers because of possible unknown effects on their children’s long-term sexual or reproductive development.

Contraception options

Because of concerns about estrogen-containing contraceptives affecting the milk supply, most doctors and mothers prefer progestin-only oral contraceptives or progestin-only implants (for example, Norplant ) during lactation.

However, the progestin-only pill is slightly less effective in suppressing ovulation than the combined estrogen/progestin pill, so it has to be taken absolutely as prescribed.

You cannot occasionally ‘miss a pill’ and still expect to be protected against pregnancy.

Doctors recommend you delay the use of oral contraceptives until at least six weeks postpartum.

There are two reasons for this: Your milk supply and breastfeeding pattern should be well-established by that time; and an older baby is better able to metabolize any hormones that may appear in the milk.

If you do decide to use the combined estrogen/progestin pill, you should wait until six months postpartum, when other foods in baby’s diet can make up for any drop in your milk supply.

Different brands of oral contraceptive affect different women in different ways. One kind may affect a particular woman’s milk supply, while another may not.

Prescriptions for oral contraceptives should be individualized, based on how your body reacts.

Alternatives

If your milk supply is affected by taking the pill (or if you don’t even want to test this out), consider other forms of contraception.

Breastfeeding itself can suppress ovulation and can be nearly as effective as oral contraceptives (98 per cent effective), at least for the first six months, if all of the below practices are closely followed:

Breastfeed frequently. In order for the level of milk-making hormones to stay high enough to suppress fertility hormones, frequent, unrestricted breastfeeding is necessary. This usually means breastfeeding at least every two to three hours during the day, or as often as your baby needs.

Nurse during the night-time. Since fertility hormones tend to be highest during the sleeping hours, it’s also important to keep the milk-making hormones that suppress ovulation high at night.

Since co-sleeping babies usually breastfeed more frequently during the night, having your nursing baby nestle right next to you is one of the most effective ways to delay fertility.

Once your baby starts sleeping through the night, the fertility hormones take over and breastfeeding is no longer likely to lead to natural child spacing.

Avoid supplemental bottles and pacifiers. To keep the milk-making hormones high enough to suppress ovulation, it’s important that all of your baby’s sucking be at the breast.

Delay introduction of solid foods. Wait until your baby is at least six months’ old to introduce solid foods, and then make them an addition to, not a substitute for, breastfeeding.

If you notice your baby is decreasing the number of nursings after you start introducing solid foods, back off a bit on the solids.

If you have any questions about the use of contraceptives while breastfeeding, or using breastfeeding as a form of birth control, contact La Leche League of Bermuda at islandgirl@northrock.bm or 236-1120. Visit us on Facebook at La Leche League of Bermuda.