Introduction The American College of Obstetricians and Gynecologists (ACOG) recommends against the use of combined oral contraceptives (OCs) as first-line contraceptives for breastfeeding women because of the thought that estrogen may inhibit milk production. As a result, progestin-only OCs are recommended as first-line contraceptives instead. Combined OCs have several advantages over progestin-only OCs and evidence documenting a negative impact on breastfeeding by combined OCs is scanty. A recent Cochrane collaboration review concludes that evidence is insufficient to make conclusions about the impact of combined hormonal contraception on breastfeeding. Despite expert recommendations, we suspected that providers do routinely prescribe combined OCs to breastfeeding women.
Purpose The purpose of this study was to evaluate which OCs are prescribed for postpartum breastfeeding women by New Mexico Obstetrician-Gynecologists (OB-GYNs) and Certified Nurse Midwives (CNM).
Methods A 19-item survey was designed to assess postpartum OC prescribing practices. The survey was mailed to 191 OB-GYNs and 114 CNMs in the state of New Mexico.
Results 137 questionnaires were completed for a response rate of 46%. A second mailing has gone out and we anticipate a final response rate of over 55%. Preliminary results show that 53% of OB-GYNs and 16% of CNMs have ever prescribed combined OCs to breastfeeding women within the first 6 weeks postpartum, but only 33% and 7% respectively encourage their use during this time period.
Conclusions A sizable minority of providers prescribe combined OCs to postpartum breastfeeding women. A clinical trial to determine advantages and disadvantages of combined OCs for breastfeeding women is urgently needed to assist providers and patients in making decisions about postpartum contraception.