Is it okay to take the birth control pill while breastfeeding?

Yes, depending on which type of oral contraceptive it is. There are two areas of concern about taking birth control pills while breastfeeding:

• effects on milk production
• the possible effect of hormones on the baby.

Some oral contraceptives contain both estrogen and progestin, others progestin only. Estrogen- containing birth control pills are not considered compatible with breastfeeding since estrogens suppress milk production. The progestin-only pill (called the mini pill), has not been reported to affect milk production.

A small amount of the synthetic hormones in these contraceptives does enter the milk, but there is no evidence that this is a danger to the baby. Follow-up studies have revealed no long-term problems in babies and children who continue to breastfeed while their mothers use hormonal contraceptives, with or without estrogen. Some physicians, however, do question the use of hormonal contraception in lactating mothers because of possible unknown effects on their children’s long-term sexual or reproductive development.

Because of concerns about estrogen-containing contraceptives affecting the milk supply, most doctors and mothers prefer progestin-only oral contraceptives or progestin-only implants (for example, Norplant ) during lactation. However, the progestin-only pill is slightly less effective in suppressing ovulation than the combined estrogen/progestin pill, so it has to be taken absolutely as prescribed. You cannot occasionally “miss a pill” and still expect to be protected against pregnancy.

Doctors recommend that you delay the use of oral contraceptives until at least six weeks postpartum. There are two reasons for this: your milk supply and breastfeeding pattern should be well established by that time, and an older baby is better able to metabolize any hormones that may appear in the milk. If you do decide to use the combined estrogen/progestin pill, you should wait until six months postpartum, when other foods in baby’s diet can make up for any drop in your milk supply.

Different brands of oral contraceptive affect different women in different ways. One kind may affect a particular woman’s milk supply, while another may not. Prescriptions for oral contraceptives should be individualized, based on how your body reacts.

If your milk supply is affected by taking the pill (or if you don’t even want to test this out), consider other forms of contraception. Breastfeeding itself, if practiced according to the “rules of the game,” is nearly as effective as oral contraceptives, at least for the first six months. See “Breastfeeding and Child Spacing” for more information.