Are Norplant, Depo-Provera good options for nursing mothers?

PIP: Family planning providers do not agree on whether it is good clinical practice to administer Norplant or Depo-Provera to mothers shortly after delivery. Manufacturers of both contraceptives recommend that providers not prescribe them before 6 weeks postpartum for lactating mothers. The hormones enter the breast milk, but the amount is minimal, and no studies show the small amount of hormones to be harmful. Some providers point to this lack of data as a reason to prescribe them to mothers immediately after delivery because progestin-only pills do neat adversely affect breast feeding. Some providers even claim Norplant should be inserted no later than 3 weeks. On the other hand, other providers, like a physician from Chile, stress that the lack of studies does not mean it is safe, just that there have not been enough studies. The Chilean physician is investigating the effect of hormones on infant health and central nervous system development. A nurse midwife at the University Medical Center in Jacksonville, Florida, reports that no woman using Depo-Provera has complained of breast-feeding problems. More than 50% of postpartum women leave this hospital after receiving an injection of Depo-Provera and those who do not come back for their 3-month injection are those who did not receive proper prenatal counseling about its side effects. The most upsetting side effect is bleeding which becomes less stressful with adequate counseling. Depo-provera extends the normal postpartum bleeding by a month. A director of services at a family planning clinic in San Marcos, Texas, notes that proper counseling, both before insertion and before removal, is also the key to proper management of Norplant acceptors. Providers at this clinic insert it 6 weeks postpartum. Hispanic women in San Marcos are concerned about bleeding because their partners do not want to have sex with a bleeding partner. Another side effect concerning clients is weight gain.^ieng