About 6 weeks to 2 months postpartum, your health care provider will bring up the subject of birth control. Even though sex may be the farthest thing from your mind! Your doctor has your mental and physical health in mind when he talks to you about a birth control method. It can be devastating emotionally and physically to get pregnant again before you are ready.
There are many birth control methods that are compatible with breastfeeding and have absolutely zero risk of harming milk production. Condoms and other barrier methods are safe and effective when used appropriately. But these methods are considered “risky” to many doctors because they rely on patient compliance and errors can occur. More and more doctors, therefore, are encouraging new mothers to use an IUD for birth control.
There are some relatively new IUDs on the market, that can create problems for breastfeeding individuals. The Mirena., Skiyla, Liletta and Kyleena all contain small amounts of synthetic progesterone. Progesterone is the hormone that keeps you from lactating during pregnancy. It follows that progesterone, even a small amount, could cause a reduction in milk supply for a breastfeeding mother.
For many years health care professionals have insisted that the hormone stays local to the uterus and cannot cause milk supply problems But lactation professionals find that this is a common result with their breastfeeding clients. I would bet that there are many other clients who didn’t put 2 and 2 together and just believed that their milk ”dried up” all by itself or because they had returned to work. Since the resumption of birth control and going back to work often occur at about the same time, a mom could easily assume that being away from her baby for 8 hours per day is what caused the drop in milk production. So who knows how many mothers quit breastfeeding because of an IUD? I believe the number is much, much larger than is reported. Here’s what the United States Lactation Consultant Association has to say:
Research is underway to catalog the effects of various hormonal birth control options on lactation. Many health organizations and healthcare providers currently recommend the use of hormonal birth control without regard for the potential effects on breastfeeding and lactation or with the outright denial that any issues could result. This directly contradicts the professional experience of many in the field of human lactation.If you have experienced milk supply problems after beginning hormonal birth control method including an IUD, we urge you to report your experience!
Well, as of late 2021, we do have research to prove that these IUDs cause systemic changes in the breast. This study did not look at milk supply per se, but it did address the fact that these IUDs do indeed affect the body systemically.
It will be awhile before the research affects behavior at OB and midwife practices. Until then, I’ll continue to support my clients who come to me with milk supply concerns. I’ve included one story here:
Margie called me because her milk supply had plummeted to practically nothing. Her baby could not breastfeed, but she had been pumping since his birth so she has always known exactly how much milk she produced.
After Margie’s milk came in, she was able to pump 4 ounces every 2 hours—with a hand pump! She continued pumping regularly and always had more than her baby could eat. When her baby was 2 months old, her doctor recommended the Mirena IUD. She agreed that it sounded like a good birth control method for her. She noticed a gradual, slight dip in her milk supply within a week. She thought maybe it was because of the hand pump, so she tried a professional grade pump. Her supply continued to decrease, so she rented a hospital grade pump. There was no improvement. A mere six weeks after the IUD was inserted, her milk supply had practically vanished—down to 2 oz per day. She had the IUD removed.
Margie is now working hard, with my guidance, to increase her milk production. There is no doubt in her mind (or mine) what caused her supply to plummet. It makes me sad that anyone would have to go through what she has gone through. Especially since it was completely avoidable.
So what should you do about birth control? Talk to your doctor about options. Let her know that breastfeeding is important to you and that you want to avoid risking your milk supply. Explore all options—keeping in mind that any birth control method is largely a “back up” method if you are fully breastfeeding and your baby is under 6 months old and your periods have not returned . Avoid any birth control method that relies on hormones–including the “mini-pill.” Remember that you will be breastfeeding for a relatively short period of time in your child’s life. The hormonal IUDs and other hormonal methods may be a good choice for you when your baby is older and is not reliant on your milk for nourishment. Lastly, if you have already instituted birth control that includes hormones, and you are concerned about milk production, please report your experience and call me for help!
Note: Many breastfeeding mothers use these IUDs or the “mini-pill” with no noticeable effect on breastfeeding. Unfortunately, it’s impossible to predict how an individual mom’s milk supply will react to the introduction of progestin.
See also, “Breastfeeding and Fertility”.