Bitter, Not So Sweet End to Newark/Nestle Campaign

After 6 months of intense volunteer efforts, this is our final e-mail update as we are closing the "Stop Newark Nestle Now" petition tomorrow, Friday, Aug. 31st.

The "Nestle Education Program" conducted it's first class on July 11th at the Newark Now – Family Success Center located at Newark Beth Israel Medical Center.  So, it appears that we stalled but were unsuccessful at stopping the Nestle sponsored "pilot" program to target childhood obesity. 

But we do know that we have been successful at educating many and raising awareness of the formula industry's marketing schemes disguised as "good will" donations. We would like to add that exposing the true agendas of the many parties involved was both a blessing and a curse. A blessing because we are now better informed about the politics surrounding the food industries as well as the the "big picture" regarding our uphill battle to secure breastfeeding.  A curse because the truth was a bitter pill to swallow, one that will leave a bad taste in our mouths for a very long time.

Even though, all International breastfeeding organizations and 2400 individuals signed the petition from over 50 countries sadly, there was not enough US support, on any level, to influence Mayor Booker to change his decision to partner with Nestle.  

In February, when we requested help from United States Breastfeeding Committee , we were told, "We do not typically take positions on individual situations of this nature, but we do encourage individual advocates to take action according to their personal conscience and interests." To us, this response was not acceptable as we are just two lactation consultants with private practices! (Renee lives in Canada) How could we be expected to lobby this issue on our own?  Most importantly, Nestle's plan to promote this program across the US is a huge threat to public health in the states and worldwide, not an "individual situation".  

It took much effort and tenacity to hold the USBC accountable to their own mission statement "to improve the Nation’s health by working collaboratively to protect, promote, and support breastfeeding."  Also their objective, “ to advance breastfeeding on our Nation’s agenda through Collaboration, Leadership, and Advocacy.” Goal B of their current Strategic Plan is to: “Reduce marketing that undermines optimal breastfeeding,” with the sub-objective to “Counteract the negative impact of product marketing.”  

USBC did offer and follow through with notifying their state coalitions regarding the campaign but refused to sign the petition as a group, post it to their website, write a press release, or consider speaking to the NJ Health Commissioner Mary O'Dowd, as we requested. Commissioner O'Dowd viewed this Nestle sponsorship as only a "donation". Communication from the USBC might have been more effective in convincing her otherwise. Especially with regards to this program being in conflict with the WHO Code, endorsed by the US Government and the Surgeon General's Call to Action to Support Breastfeeding.

Finally this month, the USBC did report that they have arranged a meeting with Mayor Booker at the end of the month. They have also promised to write a "position paper for cities, counties and states describing how such partnerships are undesirable" which is supposed to be placed on their web site soon. Otherwise, we are not privy to any information regarding their "behind the scene" advocacy in this matter. 

Even after being properly informed, Surgeon General Regina Benjamin, First Lady Michelle Obama, American Academy of Pediatrics, National Initiative for Children's Healthcare Quality, Center for Disease Control, International Lactation Consultant Association, La Leche League Intl, NJ Governor Chris Christie, NJ Health Commissioner Mary O'Dowd, numerous Newark Public Health Officials, Newark town counsel members, clergy or local media (just to name a few) felt no obligated to get involved, intervene or speak out publicly about what is going on.  As with the multitude of agencies, organizations, programs and professionals designed and funded to combat childhood obesity, promote and protect the health and well-being of women and children in the US - we were met with silence, secrecy, lack of transparency, complacency or "we don't get involved, the Mayor can do as he pleases."  And what makes it even worse, we were to discover that many of the above, are themselves, funded by the formula, baby food and junk food industries.  

As all national organizations from countries around the world, ramp up their interest in promoting and supporting breastfeeding, there is still silence or lack of action, (in many countries) on the issue of protecting women from the commercial pressures to artificially feed their babies and the safety of those babies who depend on formula to live - the US is not alone in this.

It is our belief that if all national breastfeeding organizations are not actively involved with putting the WHO Code into serious practice, breastfeeding will continue to be another casualty this world cannot afford. More and more babies will continue to be put in serious health risk as the dependance on artificial baby milks increase as breastfeeding decreases. 

Furthermore, as long as the US government allows politicians to make decisions about health care, industry will come first. As long as the formula industry is permitted to "buy" their way around proper manufacturing/regulation/ marketing of their products- they are literally "untouchable". By this we mean, unaccountable to those who dare question their methods and those who become dependent on their products.  History has shown that when dealing with formula companies that place profit above all else, babies are at risk- no matter how they are fed.

This was a petition to stop the Mayor of Newark from allowing Nestle to exploit his city's poorest, most vulnerable citizens. The method was to declare Nestle's seemingly harmless program, a cleverly crafted scheme to further their agenda of greed and market domination.

But it didn't stop there. This became a global outcry to "WAKE UP and ACT to PROTECT breastfeeding and all babies from further harm!  Unfortunately, no matter how hard we tried, those in the decision-making seats whom we bestowed our confidence and loyalty, simply chose to ignore our pleas.

We would like to thank you for your support over the last six months. The international support was overwhelming. Advice from our colleagues at BMA (Baby Milk Action), IBFAN (International Baby Food Action Network) and WABA (World Alliance for Breastfeeding Action) including their open letters to Mayor Booker and posting on their websites was invaluable.  Special thanks to Peggy O'Mara from Mothering.com, Elizabeth Ben-Ishal of Public Citizen, Bonnie Rochman from Time.com, Motherwear.com, Valerie McClain, Jodine Chase, as well as all US BF coalitions, BF advocacy websites and individual bloggers who posted and shared this petition. Lastly, your personal letters helped by adding that "human touch" which got us through many long hours, allowing us to take this as far as we possibly could.

We may not have been able to stop this but maybe our efforts will stall or even prevent Nestle from doing this "in other cities and states". This petition may be over but our commitment to protecting mothers and babies must never end.

Best wishes,
Maria Parlapiano RN IBCLC
Renee Hefti-Graham RN, LC

Newark/Nestlé Partnership: There's Nothing Sweet About It!!

For decades, Nestlé Corporation has hidden behind a vale of creamy, luscious chocolate. Perceived by Americans as harmless, Nestlé has its sticky fingers in almost everything from bottled water to dog food. In the US, Nestlé owns Gerber and Beechnut brands. Now, with their recent purchase of Pfizer’s Infant Nutrition Division, they rain supreme as the largest purveyor of infant formula and baby food in the world.

http://online.wsj.com/article/SB10001424052702303592404577361070078138812.html

On February 11th, Mayor Cory Booker of Newark, NJ accepted a $100,000.00 check from Marilyn Knox, CEO, of Nestlé Nutrition USA, as a “benevolent” offer to partner with him to fight his city’s childhood obesity problem.

http://newarknj.patch.com/articles/new-pilot-program-will-target-childhood-obesity-in-newark

As a maternal/child health specialist, nurse, and lactation consultant, red flags (or should I say candy wrappers) flew up all over the place when I heard this! Not Nestlé! One of the largest contributors to worldwide obesity is sponsoring a nutrition program targeted at reducing childhood obesity? Surely, Mayor Booker is ill-informed, I thought. Obviously, no one told him about Nestlé’s appalling reputation or the studies that show formula, bottle feeding and early introduction of solid foods actually increase childhood obesity!

http://healthland.time.com/2012/04/27/can-a-formula-company-really-promote-breast-feeding-and-fight-child-obesity/

As a matter of fact, it was clear to me that Mayor Booker and these poor Newark families (25% below the poverty level) were just being used as a "front" for the largest coup in US formula industry history.
So, after failed attempts to meet with Mayor Booker, I created the petition, “Stop Newark /Nestlé Now!" on February 16, in an attempt to stop this hypocritical partnership.
Petition link:
http://www.change.org/petitions/mayor-cory-booker-newark-new-jersey-usa-stop-the-hypocritical-newarknestle-campaign-to-target-childhood- obesity?share_id=HDVyjOmNmk&

The following information is to inform, educate and compel into action those who care deeply about the oppression of mothers and the future of children all over the world.

Let’s start with this statement from Dr JP Dadhich, National Coordinator, Breastfeeding Promotion Network of India, “Breastfeeding plays a key role not only in infancy but also in shaping the future of the child. Exposure to infant formula during this vital period may in fact increase chances of obesity later in childhood. The risk increases as the beneficial effects of breastmilk that prevent obesity are replaced with the detrimental effects of infant formula.”
http://www.bpni.org/Article/Does-Formula-Feeding-contribute-to-childhood-obesity.pdf

I, and those who support this petition, believe that Nestlé sponsorship of this anti-obesity campaign is just the latest Nestlé marketing tactic to divert attention from these very chilling facts:

1. Nestlé has a well-deserved, notorious reputation for aggressive and unethical marketing placing them among the top four
most boycotted companies on the planet!

2. Gerber formula is milk from a cow, laden with addictive high fructose corn syrup, sucrose, oils and chemical additives,
which are directly linked to obesity in infants. Formula-fed infants ingest 30,000 more calories/year than their breastfed
counter parts. http://analyticalarmadillo.blogspot.com/2010/07/bottle-feeders-please-stop-twisting-it.html

3. Nestle’s baby foods are processed and packaged with cost in mind, not quality.

4. Nestlé spends $4 million each year lobbying against regulation and taxation of unhealthy food.
http://www.opensecrets.org/lobby/clientsum.php?id=D000042332&year=2011
This manipulation enables them to continue manufacturing and marketing junk and confectionary foods that have resulted in
increasing world obesity rates.

5. Formula feeding is linked to diabetes as well as many other diseases resulting in increased health care costs, energy
usage,production, transport, pollution and waste. Furthermore, it costs about $200 a month to formula feed one baby. That is
14% of the per capita income of the average Newark families. Some parents will over dilute the formula or substitute other
fluids, such as coffee creamers, which leads to even further illness, poor development and death.

6. The Surgeon General's 2011 Call to Action For Breastfeeding Report called for "all women to exclusively breastfeed their
babies for the first 6 months" and states “full-term infants have a 32% excess risk of childhood obesity associated with not
breastfeeding.” Action 6 (from her report) states: "ensure that the marketing of infant formula is conducted in a way that
minimizes its negative impact on exclusive breastfeeding".
http://www.doh.state.fl.us/chdManatee/Pdf/Surgeon_General's_Call_to_Action_to_Support_Breastfeeding.pdf
*Note: We have had NO REPLIES to our pleas for help from the Surgeon General.

7. The First Lady, Michelle Obama breastfed her 2 daughters and is a staunch supporter of breastfeeding. Her campaign, "Let's
Move" to target childhood obesity is being corrupted by Nestlé and Mayor Booker. (We have as yet had no replies to our please
for help from the First Lady.)

8. The Mayor is violating NJ Conflict of Interest Laws, the City ofNewark- Children's Bill of Rights and the International Code
of Marketing of Breastmilk Substitutes. Furthermore, the Mayor isviolating the Code of Ethics he signed when he entered the
"World Mayor" competition.

9. Nestlé is setting themselves up as "The expert nutrition educators" in the US and throughout the world. In the US, they
have already partnered with the AAP, http://www.aap.org, USDA http://www.usda.gov, The Governor Of Michigan has given Nestlé
the go-ahead to "educate" in medical schools, hospitals and communities.
http://www.nestle.com/Media/NewsAndFeatures/Pages/Gerber-programme-child-obesity.
Also Nestlé is has posted jobs dedicated to converting Federal WIC programs to their Gerber brand formula.
http://www.indeed.com/jobs?q=Gerber+Nutrition+Products&l=Newark%2C+NJ

Nestle’ has sales of $30 billion a year in North America alone. “Peter Brabeck-Letmath, head of Nestlé S.A. - said "companies should only pursue charitable endeavors with an underlying intention of making money for investors.” Source: Boston Herald “Nestlé chief rejects the need to 'give back' to communities”, 9 March 2005.
Then the question is, how is Nestlé benefiting its investors by linking its name to this initiative?

Well, let’s see. When I questioned Mayor Booker (on his radio show, Newark Today) about this partnership with Nestlé he responded, "There are no strings attached" but Nestlé's true agenda is quite apparent. When the Mayor was filmed accepting Nestlé's check of $100,000.00, he was standing in front of a background covered with Nestlé/Gerber logos and the Nestlé's press release had pop-up ads for formula, coupons, rebates, Baby Club etc.(direct violation Action 6: Surgeon General’s Report)
Obvious benefit to Nestlé, right? (Note the Gerber logo to the left of Booker’s head in the photo above.)

http://www.mediajunkey.com/2012/02/15/nestle-ceo-marilyn-knox-speaks-about-innovative-lets-move-newark-program/

The Newark/Nestlé partnership to reduce childhood obesity is a "New Pilot Program". Nestlé strategically plans to take to other US cities and states. Nestlé's Infant Nutrition President and CEO Marilyn Knox, stated on a YouTube channel press release, "we want to recognize Mayor Booker specifically for not only what he is doing here, but the example of taking Newark and turning it into actually an example, a role model to replicate in other places ..." So, New Jersey will carry the legacy of being the first state that’s opened the castle gates for the wooden Trojan horse!

Nestlé’s plan is to provide their own “nutritionists” to "educate" about breastfeeding and nutrition (push Nestlé products). Slated to start this month, they plan to set up peer counselor programs (using the clients to market Nestlé products), hand out gifts and samples “luring” the mothers in and making them dependant on Nestlé products, at all 15 of the Family Success Centers in Newark.

In the posted job description for the "Nestlé-Newark Now Family Nutritionist" there was no mention, at all, of breastfeeding. Nestlé spokesperson has said their “nutritionists” will be promoting and supporting breastfeeding (which is cheaper and healthier), but trust me, in reality, formula feeding will be the focal point of instruction. Nestlé “nutritionists” will say they are endorsing the use of home-made, whole, fresh foods for babies which are less expensive and more nourishing but in fact, they will promote Nestlé prepackaged, processed baby foods, first and foremost.

How do I know this? That’s easy. Nestlé is a known violator of the WHO Code of Marketing Breastmilk Substitutes. They do what they want and “thumb their nose” at anyone who dares to confront them.
http://info.babymilkaction.org/pressrelease/pressrelease19apr12

New York Mayor Bloomberg announced, April 19, 2012 (NY Post) that he has launched the WHO / UNICEF Baby Friendly Hospital Initiative, a program to support and encourage women to breastfeed. Mayor Bloomberg states, "There is a 22% reduced risk for childhood obesity when women breastfeed for 6 months".
http://www.nypost.com/p/news/local/mike_do_what_breast_for_baby_5x37cU1trizbh1T3qXtB6O#ixzz1saJuKfXU
Yet, just across the Hudson River, in Newark, the opposite is set to occur – less breastfeeding, higher rates of obesity in the hands of Nestlé.

Initially, Mayor Booker was given materials about the importance of breastfeeding (to help prevent obesity, other health issues, health care costs etc.) and information about Nestlé’s true motive for partnering. The Mayor was offered creative alternatives that could help women successfully breastfeed and thereby decrease childhood obesity and other health issues. The Mayor has received every signature and every comment on the petition and many letters but he has shown no sign of cancelling his partnership with Nestlé. He has not responded to any correspondence and has refused all requests for meetings.

As of today, more than 2000 people have signed from more than 50 countries and hundreds of people have left negative comments about Nestlé on the petition site. All International Organizations, under WHO and UNICEF's direction to protect breastfeeding from commercial pressures to artificially feed babiesincluding IBFAN (International Baby Food Action Network), WABA, (World Alliance for Breastfeeding Action), BMA (Baby Milk Action, UK) and IBFAN Switzerlandhave signed and written letters asking the Mayor to cancel his partnership. There has been worldwide outcry for Newark to stop this partnership but, unfortunately, it has fallen on deaf ears.

Some excuse the Mayor by saying Newark is desperate for money. Poor, desperate cities are easy prey for a pariah like Nestlé. But should desperation for money trump common sense and good judgment? As citizens, we expect due diligence and responsible decision making from public officials. We expect our children’s best interest to be placed above all else and our voices to be heard, not ignored.

Mayor Booker posted on his Facebook page, "a child being born right now, today, is depending on us to liberate their potential, and ensure that they enjoy America as truly a land of equal opportunity."

In response to that statement, I challenge Mayor Booker: How can that "child being born today" depend on someone who blatantly disregards this plea on their behalf? Haven’t we learned that it is more difficult to liberate a child’s potential when their nutritional/emotional start in life is substandard or damaged?

How can children who have been placed at such a disadvantage, grow to enjoy America, as truly a land of equal opportunity?
They can’t.

Posted as a guest blog on mothering.com 5/4/12

That First Week: Basic Answers to Common Questions

My friends, Joe and  Sam (short for Samantha)  just had their first baby,

 Benjamin.  So, of course, I've been "all over that", ya know, seeing them 

before hand and the morning after he was born, on their way home from the 

hospital and through texting/facebook as well.  

Like most new parents, they had concerns and questions which I am used to.   So I thought I would share our dialogs which contain useful information but 

most importantly reflect the process and progress.  I cannot 

emphasize enough how important on-going support is to the breastfeeding 

family.   And if this is done well and in a timely fashion, the result: less fear and anxiety, lots of milk and a happy, content baby.  

For you veteran - lactivists:   I am sure this dialog will trigger some mammaries, oops!... I mean memories of those very first days. 

Sam: I honestly have an amazing husband....The last two nights have been 

really long and hard for me because I just couldn't figure out what Benjamin wanted...Today joe kept telling me to nap and relax, which I did and it has made a WORLD of difference 

tonight. Thank you wonderful husband/awesome daddy!

Maria's reply: First of all props to Joe!  Second, It's simple - Ben just wants you. Think about it: he was wrapped inside the warmth, security and comfort of your body for 9 months. You're still his home -he's just on the 

outside now. And so your breasts have taken over where the placenta left off nourishing and growing his body - it's basic biology,.....we often forget that we are mammals.

Sam:  Ben spit up once yesterday and twice this morning....not a lot.    Should we burp him? He does get the hiccups.

Maria: Spit up: just means he ate more than he had room for. Maria-ism: " it's a 
laundry problem, not a medical one." the valve at the top of his stomach 
(esophageal) is very loose and floppy -which allows a baby to regulate his 
stomach contents by spitting up excess milk. Quite ingenious really. It helps 
not to force feed - he does not have to nurse on both sides - don't wake him up 
to feed him and don't lay him on his back right after he feeds etc. You will 
notice it happens more when your breasts are extra full...he will adjust your 
supply over the next 6-8 wks
Hiccups are a "space" issue. Their abdominal organs are all squished in a 
very small space right now. When they eat and their stomach is full- it presses 
up against their diaphragm ( which lies above the stomach) causing it to go into 
spasm. As their body gets longer and wider- their organs will drop lower 
allowing more room and thus the hiccups go away - basically they outgrow them. 
You don't need to do anything -remember in utero he drank about a quart of 
amniotic fluid a day and had the hiccups often without any problems.

Sam: my boobs still seem a little hard after Ben eats. Can I pump and save 
it for night time so Joe can do a feeding?

Maria:Yes it's fine to pump if nec-on mild to mod setting w/ good massage during -do one 
breast at a time -for only 15 min - more is not better . As far as 2 nite is 
concerned : your breasts will not allow u to sleep more than 2 maybe 3 hrs. Your 
prolactin levels are highest @ nite to accommodate the freq nite nursing in the 
beginning. So u will have to get up and pump - Joe will be stuck with a fussy 
baby fed or not, who wants his mommy and u will end up nursing anyway. Like I 
have said before: u need to learn how to lay down and nurse - this is the most 
effective tool to make your nites the best they can be /. I am happy to teach u 
how.  Also, if your breasts r very warm u can use some cool compresses in b/w feeds just wet 
two disposable diapers and place them in freezer tuck in bra until they reach body 
temp then refreeze reuse I 'd rather not use bottles just yet if Joe feeds him I'd rather him use the 
syringes - I show him how - you are doing so well ! I just don't want to screw 
anything up.

Sam: I tried to pump and it didnt work so I'll stick to feedings. As far as laying 
down to feed, I can't get myself up bc of my surgery. So eventually I will 

take u up on laying down feeding lessons.

Maria: You just need to roll onto your side and stay there all night -honestly, you can 
do everything from there. I fear if u don't soon -u will crash and burn, sweetie

Sam: I crashed and burned this morning-tears and crying. But then took a two hour 
nap. Much better. I'm going to nap after lunch.
Maria: Normal hormonal stuff -this should pass quickly. Yes, your best time to sleep will 
be 7am-12 noon for the next 3weeks -that's when the babies sleep the most. So no 
waking him up, no phone calls, txt, visitors or appointments -this is your 
sacred time!!! Take advantage of it - u will feel much better if u do. 

Maria: It's annoying that I have an answer for everything, isn't it? Lol
Sam: Actually no....u r amazing. I'm sorry I have so many questions. 
Maria: Never apologize for asking questions ( I love playing stump the lactation 
consultant-lol) but honestly-most people do not know this information -it is my 
business to know it and share it 

Sam: We go to the Peditrican today :-)
Maria: Good -LMK how u do. Waiting on the slings-hopefully coming today

Sam: Sir Benjamin is now 6lbs 13 oz and grew a half of an inch!!!! Doctor said good 
job for ur breastfeeding instructions!!
Maria: Great job, people! That's 7 oz in 2 days! You should be so proud of yourselves 
-I know am!
Sam:  -) yay!!!   Instead of a peanut, he's a chestnut!

The "Corporate" Mindset - Are Women Thinking More Like Men?

Since Breastfeeding is not about control or perfectionism ( nor should it be) it

does not fit the "model" women have now become accustomed to.  Which I believe

is the corporate model set up by men. You know, constant micro-managing,

competition, over-evaluating, where A&B equal C,  more is better,  if it's free -how good could it be? and there is an agenda -always an agenda!   

Correct me if I'm wrong, but in order to effectively compete with men in the business world

-women have had to think like men.  This "corporate thinking" does not bode well

for breastfeeding and mothering in general.  But it works beautifully for the infant marketing industry!

In my practice demographic - mostly high socio-economic, two-income families,  control and
perfectionism runs long and deep.  This, of course, only sets one up for anxiety
and depression.   If one can't control it then it's too stressful and if it's not perfect immediately, it's deemed a waste of time-  Exhausted/ fearful/disillusioned/ disappointed and desperate -one reaches for anything that brings them back to their "comfort zone" of control.  In this case: bottle-feeding and/
or pumping.  And guess who's ready to swoop down when this happens?  We all know who those players are.

This pervasive mindset of control and perfectionism has set the stage for the most effective marketing strategy I believe history has ever seen - newborn product sales especially the infant feeding industry.

What can you do?  Put the "corporate" mindset aside (that's fine for work) and tap into the feminine/maternal side of you....it's in there somewhere!  Don't fall for the capitalism, commercialism and undermining marketing, that is stealing you from your child.  Money does not equal love.  Success in business does not equal success in parenting.  Embrace and celebrate what makes us different as women.  The tenderness, patience and fortitude to do what's right by your child comes from your heart, not your head.....or wallet.

Alcohol, Holidays & Breastfeeding

I get many calls this time of year re: alcohol intake and breastfeeding.
Even though it is fine to "partake", I think it helps to remind ourselves that too much alcohol can impair one's ability to respond and safely parent as baby needs -- no matter how baby is fed.

So it is not as much the amount of alcohol present in your milk ( its too unstable to stay there very long) but the level of impairment you experience.  Most of alcohol-related consequences are not breastfeeding issues, per se. but impairment ones.
So be smart and responsible: pay attention to how much you've had and your body's reaction to it - eat and drink lots of water.
If you get intoxicated:  do not drive, have someone else care for your baby, do not co-sleep or nurse until you are sober.  Only pump if you need to and discard that milk (until you are sober)

Please do not waste your money on alcohol test strips as they are not at all accurate or necessary.

For further info: This article from Thomas Hale's Infant Risk Center site can be helpful, whether breastmilk is direct from the source or expressed):
http://www.infantrisk.com/content/alcohol-and-breastfeeding.

Enjoy and be safe

Wean Me Gently

I know I look so big to you,

Maybe I seem too big for the needs I have.

But no matter how big we get,

We still have needs that are important to us.

I know that our relationship is growing and changing,

But I still need you. I need your warmth and closeness,

Especially at the end of the day

When we snuggle up in bed.

Please don't get too busy for us to nurse.

I know you think I can be patient,

Or find something to take the place of a nursing;

A book, a glass of something,

But nothing can take your place when I need you.

Sometimes just cuddling with you,

Having you near me is enough.

I guess I am growing and becoming independent,

But please be there.

This bond we have is so strong and so important to me,

Please don't break it abruptly.

Wean me gently,

Because I am your mother,

And my heart is tender.

by Cathy Cardall

Happy Holidays & Healthy New Year !

Hormonal Contraceptives & Breastfeeding

I receive many calls regarding low milk supply, a sudden drop in milk supply or a baby's poor weight gain or sudden drop or standstill in weight.  One of my first questions is : "Are you taking any birth control pills?"  Many times the answer is "Yes".   Since many doctors are prescribing without warnings or just ill-advised, here is the "skinny" on Hormonal Contraceptives and their impact on breastfeeding.  So you are able to make an informed choice yourself regarding what type of birth control method to use.

In NeoReviews, the official journal of the AAP, Thomas Hale, PhD states in his article Pharmacology Review: Drug Therapy and Breastfeeding (2005;6;e233-e240)

"Birth control products probably produce more complications than any other medication used by breastfeeding mothers.  Estrogen-containing birth control products have been found to reduce human milk synthesis significantly in some mothers.  Therefore, progestin-only products are greatly preferred in this population.  However, even progestin-only products may reduce milk synthesis in some mothers, and great cautions should be used following their initial use.  All mothers should be advised that these hormonal products may reduce milk synthesis, and they should discontinue their use immediately if they note a decrease in milk production.  The use of medroxyprogesterone (Depo injection) early postpartum should be avoided until milk production has been established.  Some mothers anecdotally report complete shutdown of milk production following its use."

The Drugs and Lactation Database (LactMed) HYPERLINK "http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT"  states that "nonhormonal (contraceptive) methods are preferred during breastfeeding".  The hormonal contraceptive choices in question are progestin-only oral contraceptives,
Depo Medroxyprogesterone (DMPA) injection, Mirena IUD, and Implanon/Norplant implant.
Estrogen-containing contracrptives continue to be contraindicated for breatfeeding mothers.

Progestin-only oral contraceptives (Micronor, Camila, Errin, Jolivette, Nora-BE, Nor-OD)
Although touted as the preferred oral contraceptive for breastfeeding mothers, in the 2010 edition of Medications and Mothers' Milk, Thomas Hale states that "recent reports claim that Micronor can be assocoiated with decreased milk production".  Also these drugs "may reduce lactose content and reduce overall milk volume and nitrogen/protein content, resulting in lower infant weight gain"  Milk levels increase for most of these women when this contraceptive is stopped.

Depo Medroxyprogesterone (DMPA)
Common injection given to clinic moms in the hospital during their postpartum stay.  Hales rates this as an L4 or Possibly Hazardous if given within 3 days of birth.  LacMed states that "Administration sooner than 3 days postpartum could inhibit lactogenesis and interfere with the establishmnet of lactation."
If if this injection is given later, it can be a problem for women sensitive to progestin since it cannot be removed or stopped.

Mirena IUD
Even though, Mirena produces the lowest plasma levels of progestin thus becoming more popular, it is not without concern.  Hale does note that "some caution is recommended as I've received three accounts of milk suppression following insertion of Mirena IUDs"

Implanon/Norplant implant
This involves placing six match-size, flexible capsules under the skin of a woman's upper arm.  These release a low dose of synthetic progestin continuously for up to five years. I recently saw a client who experienced a decrease in milk supply after receiving this contraceptive - which again is difficult to remove.

Seasonale
This is an extended-cycle oral contraceptive  but due to it's estrogen content , caution is recommended in breastfeeing mothers due to potential reduced milk supply.

Plan B, Levonelle or NorLevo
This is a post-coital emergency contraception.   The mother should not breastfeed for the first 8 hrs, or at the most 24 hrs to reduce the estimated dose to the infant via breastmilk.


So am not advocating no birth control but there are enough "red flags" to use them with great caution.
Milk supply and infant weight gain needs to be carefully monitored.  It is difficult to sit with a mother who is suddenly struggling with her milk supply and suspecting that her birth control method prescribed by her doctor may be responsible.  It has high-emotional, physical and economic consequences for the mother and baby that should not be ignored or placated.