Contraception and Milk Supply

Today for #milkmonday we are highlighting a manuscript that was just published and brings to light an extremely important issue: can the type of contraception you use impact your milk supply? The answer we get from existing research is no, that for the average healthy mother who delivers a healthy, term infant, contraception does not impact milk supply. However, we see anecdotally that certain types of hormonal contraception can impact milk supply. So why is there a discrepancy, and what is the answer?

Depending on who is conducting the research and who is reading the study, what is considered clinically significant can vary.

We do this thing in research where we analyze the data with statistics to determine whether something we are witnessing is statistically significant. These statistics tell us whether the outcome we are seeing is happening by chance. Scientists and health professionals alike can use these numbers to inform a very black and white answer to something that may be much more complicated. As the authors of this manuscript put it:

For a woman who strongly desires to breastfeed, even a very small risk of iatrogenic lactation failure may be clinically relevant.

Bryant AG, Lyerly AD, DeVane-Johnson S, Kistler CE, and Steube AM. Hormonal contraception, breastfeeding and bedside advocacy: the case for patient-centered care. Contraception. 2019;99:73-76

You see, the studies that have been conducted may have observed a milk supply decrease some women, just not enough women to sway the statistics to be “significant”. As the article summarized nicely, someone with a public health interest in family planning may use this evidence to support placement of hormone-containing contraception. A lactation counselor, conversely, may use this evidence to support waiting to use hormone-containing contraception or advocacy for a non-hormonal contraceptive.

We then tie in the social injustices that surround reproductive health and breastfeeding, and the picture begins to get more complicated. It is unfortunate, but true, that poor women having children has a very different connotation than rich women having children. The same can be said for minority populations and women of color.

Health care providers have been shown to alter their counseling based on a patient’s race/ethnicity and perceived socioeconomic status.

Bryant AG, Lyerly AD, DeVane-Johnson S, Kistler CE, and Steube AM. Hormonal contraception, breastfeeding and bedside advocacy: the case for patient-centered care. Contraception. 2019;99:73-76

We know as health care providers, that counseling in a culturally competent and humble manner can help improve patient outcomes. However, when counseling shifts based on assumptions made off of race, ethnicity, or socioeconomic status, we are risk of widening the health disparities that exist.

The article closes by providing questions that can be used when counseling on breastfeeding and hormonal contraception, and it focuses on one thing: determining the desires of the patient through open-ended questions and providing recommendations based on PATIENT desires.

Health care provider recommendations should not be based on assumptions tied to race, ethnicity, socioeconomic status, sexuality, age, or any other factors. Recommendations should be evidence-based and tailored to the desires of the patients we are serving.

A 15-year old new mother who depends on WIC and SNAP benefits to provide for her new child should be given the same chance to breastfeed successfully as the 29-year old new mother who is financially independent. This includes avoiding hormonal contraception if the mother so chooses.