Anticipating a Challenge

[Turkish Kate]

I'm posting now because I'm anticipating some breastfeeding challenges really soon. DS is seven weeks and it's time for me to start taking birth control pills again. DH has been more than patient. The problem is that we cannot get progesterone-only pills here, so we picked up the pills with the least amount of estrogen (0.02 mg). I'm concerned about my milk supply decreasing and hoping that someone here can give me some good news. I'm already pumping 2x/day, drinking mother's milk tea, and taking 1220 mg of Fenugreek 3x/day.

We are hoping to make a trip to the US this summer and I will try to get an appt with a sympathetic doc if we do. Is it possible to get a year's worth of BCPs at a time, if we do?

[Amris]

Why don't you get the Mirena IUD? It lasts 5 years and you don't need to worry then about getting pills or whatnot, plus the amount of hormone is less and is more mild. And if you decide you want to concieve, just have the doc remove it. Getting it removed should be doable by any doc in any country.

[Turkish Kate]

Thanks, but I have a fear (perhaps irrational) of IUDs. I have vivid memories of the Dalkon shield scares way-back-when. I don't think that Mirena is available here, if it is my doctor didn't mention it.

In any case, I'm interested in how to protect my milk supply with current (limited) choice.

[quirkylayne]

This is quite the predicament. I would think that you could get a years supply when you come to the US, in your situation. Could be $$$. I hope you find a good doc to work with. I'm sorry I don't have much advice as far as the supply - maybe add oatmeal and/or granola. I guess there are no alternatives for birth control? Condoms?

[kathteach]

Would it be possible to get the pills you want from an online pharmacy? Good luck Kate, I am sorry you are in this situation.

[lolar2]

What about Depo-Provera, can you get that?

[mamaverdi]

No no no DepoProvera. Not a good idea for someone who might have supply concerns. (You can't reverse it.)

What about barrier methods? Or charting?

[Turkish Kate]

I didn't really want to get into a debate on contraception, but I'll cover all the bases quickly. No Depo or implants for same reason MamaVerdi said and I don't know about availability here. I'm allergic to spermicide and get very irritated using condoms (? pre-latex allergy, I'm also allergic to powdered gloves). NFP would be interesting, but you try telling a Turk "no sex" for xx number of days per month, and then there's still a high failure rate--especially for lazy people like me. Online pharm won't work as drugs are regulated by customs and subject to seizure. For the time being, I can only get combination pills, but will find a sympathetic dr when I get back to the US. The unfortunate thing is that OCs are ridiculously cheap here--from about $2 to $5 per pack--and available OTC.

What I really need are suggestions on how to keep up my supply and any success stories from those who have been able to bf while taking combination OCs.

[mikes_becky]

I understand what you're saying, Kate. I'm afraid for getting blasted for suggesting this, but there is a prescription drug that stimulates milk production by acting as a dopamine antagonist-- it's called Domperidone, I believe. I wouldn't overly recommend it but it's one option, if you can get it and if your doctor approves-- and also, IF you run into production problems at all.

I suppose that as a Muslim, beer is out for you (no problems there-- I'm a Mormon, same issue), but I believe the milk-stimulating effect of beer has something to do with the hops used to make it. You could try nonalcoholic beer if that's an option for you, or use it in cooking (beer-cheese soup... mmmmm) where the alcohol cooks off, and see if that turns you into a big ole milk factory, as several of my friends have claimed it will.

You may well be able to find a doctor in the US who could prescribe you a year's worth of Micronor (aka Errin and Jolivette-- the generic versions which are much cheaper). What part of the US will you be coming to? I live in the DC area and have some knowledge of the OBs around here.

I'm sorry not to be more helpful-- that's definitely an issue you're facing, but hopefully it will all work out just fine. Try prayer, too

-Rebecca

[timneh_mom]

Kate - I would imagine a doctor would give you a year's worth of micronor! I used to see a doctor who would give me my entire year's worth of OC's as samples... all at once! (He was cool that way though!) Also, some people who will be travelling or living in another state for the majority of the year (think - people who move from Michigan to Florida in the winter) sometimes get their meds filled for the time they will be away so they don't have to worry about them. I am guessing you won't have a problem finding someone to work with you! Do you have family here whose doc will see you when you come visit?

I do have one friend who could not tolerate the mini pill so she went back on the regular pill, and I'm not sure though if she had supply trouble, because her daughter was close to a year old when she switched.

Depo has messed up LOTS of moms!! I would never take it either... at least with a pill, I can stop it right away if it's not agreeing with me...

[crunchy~mamax3]

I don't know if this is a help - but I was on the Nuvaring after my yDD was born, I believe she was about 8 weeks old when I started it. It is a combination but I am not sure how it measures up the pill - but I can say I had no supply issues whatsoever while using it. I have heard that it is similar to the pill but I can't say for sure.

My friend also used bc pills and didn't notice a drop in supply either. She started around 12 weeks pp. I think it is safer to take the combos once breastfeeding is well established and if you are going to be nursing round the clock.

[ccohenou]

Kate, I wonder if you would be comfortable relying on lactational amenorrhea (if you meet the criteria) until you are able to get progestin-only contraceptives? It doesn't require abstinence, and efficacy is similar to the minipill.
Here's some background on LAM and evidence as to its effectiveness
http://www.llli.org/ba/Aug93.html

I'm not aware of any info on mitigating the effects of combination pills on milk supply, but if I come across it, I'll share. this was not 100% encouraging, but said that the milk supply effects were considered "moderate."

[Turkish Kate]

I do *technically* meet the criteria for LAM, but DS sleeps through the night most nights, 6-7 hours at a stretch and I'm not willing to take that risk.

The Cochrane review that I read on combo pills said an average drop of something like 41%. I wonder if that's considered moderate? Hmmm . . . . Well, I've had an oversupply all along (same with DD oh so many years ago) so maybe with what I"ve done already we'll be okay. I'll start taking the pills this weekend (8 weeks pp) so guess I'll find out then.

[mamaverdi]

FWIW, there is a list of natural spermicides somewhere on MDC. Search that and you could find something for a diaphragm. Honey I think was mentioned.

Good luck. Domperidone could work...so could fennel or fenugreek. I don't know necessarily how it may interact with the bcp though.

[Turkish Kate]

I can see honey having other benefits as well.

[quirkylayne]

Good luck!
If you don't mind checking back to let us know - it would be good info if it comes up in coversations with other moms.

[RootSnort]

Originally Posted by mikes_becky

there is a prescription drug that stimulates milk production by acting as a dopamine antagonist-- it's called Domperidone...

I suppose that as a Muslim, beer is out for you (no problems there-- I'm a Mormon, same issue), but I believe the milk-stimulating effect of beer has something to do with the hops used to make it.
-Rebecca

I agree with the above, Domeperidone if you can get it. If you can't get Domeperidone, there's a similar drug we use in the US called Reglan (metoclopramide) for nausea and slow-gastric emptying, but it helps the milk supply in the same way.

Not only do the hops in beer help milk, but I've also heard the Brewer's Yeast contributes to the process as well. Both should be available as herbal supplements.

Other good herbal supplements to help increase milk production are Blessed Thistle and Fenugreek.

I'm also told that mroe frequent nursing and pumping can do a lot to help with supply. I lost 8 ounces a day when I got my monthly cycles back, so I can certainly understand what you are saying, and I wish you good luck!

[mamaverdi]

Originally Posted by Turkish Kate

I can see honey having other benefits as well.

and


Reaglan can be tough on people who have a history of depression and who have a history of not liking the US president Reagan due to name-association-phobia. (In case either of those are issues for you.)

[Khourtniey]

Not liking Reagan should not matter because its actually Reglan (Metoclopramide)

[Turkish Kate]

Originally Posted by mamaverdi

and
Reaglan can be tough on people who have a history of depression and who have a history of not liking the US president Reagan due to name-association-phobia. (In case either of those are issues for you.)

How did you know that I nearly worship JC--the "other" JC.























Jimmy Carter--the great peacemaker!