Contraceptive implant soon after delivery does not impact breastfeeding success
Key takeaways:
- Women who received a contraceptive implant 30 minutes, 72 hours or 6 weeks after delivery all achieved breastfeeding success.
- Breastfeeding duration and exclusivity were similar for all groups.
Women at risk for low milk supply who received an etonogestrel implant as soon as 30 minutes after delivery reported similar breastfeeding success as women who received the contraceptive implant 6 weeks postpartum, researchers reported.
“In postpartum people with risk factors for low milk supply, it is unclear if the specific timing of immediate postpartum implant initiation may affect breastfeeding success,” Erika E. Levi, MD, MPH, of the division of family planning and preventive health in the department of obstetrics and gynecology at NewYork-Presbyterian/Columbia University Irving Medical Center, and colleagues wrote. “In creating systems and policies to increase access to postpartum implants, placing an implant within 30 minutes of delivery may be the most efficient and logistically preferable option for many hospital settings.”
Levi and colleagues conducted a three-armed randomized noninferiority trial with 155 postpartum women (mean age, 28 years) who planned to breastfeed and had known risk factors for low milk supply, such as premature delivery, obesity or polycystic ovary syndrome. Researchers randomly assigned women to an etonogestrel implant within 30 minutes of delivery (n = 51), 24 to 72 hours postpartum (n = 52) or more than 6 weeks postpartum (n = 52).
The primary outcome was time to the second stage of lactogenesis. Secondary outcomes included duration and exclusivity of breastfeeding and contraceptive implant satisfaction throughout 6 months postpartum.
The findings were published in Contraception. In the intention-to-treat analysis, women who received the implant within 30 minutes of delivery (mean difference, 2.92 hours) or 1 to 3 days postpartum (mean difference, –0.75 hours) did not have statistically different time to the second stage of lactogenesis compared with women who received the implant more than 6 weeks postpartum. In the as-treated analysis, women who received the implant within 30 minutes of delivery (mean difference, 2.5 hours) and 1 to 3 days postpartum (mean difference, 2.49 hours) also had similar time to the second stage of lactogenesis as women who received the implant at more than 6 weeks postpartum.
Researchers observed similar breastfeeding duration, breastfeeding exclusivity and implant satisfaction among all three groups.
“Despite theoretical concerns about progestin-containing contraceptives and their potentially negative impact on breastfeeding initiation and continuation, the evidence has consistently demonstrated the progestin-containing contraceptives can be safely used by postpartum people without a measurable impact on breastfeeding success,” the researchers wrote. “Many health care workers who make up the care teams of postpartum people, including physicians, midwives, nurses and lactation consultants, continue to have concerns regarding the use of these methods in breastfeeding people. This can lead to conflicting or confusing counseling for patients who are trying to both optimize their breastfeeding success and avoid an unplanned pregnancy during the postpartum period.”
Perspective
Back to Top
Examining factors that may impede breastfeeding is an essential topic of study and important to parents around the world. With interpregnancy interval and family planning also being of critical importance in family well-being, the current investigation is a welcome addition to the body of literature in this area. Importantly, there exists a concern that the addition of exogenous progestins, like as is present in a contraceptive implant, may impede lactogenesis in the early postpartum period. Therefore, while it may be convenient and efficient to place a contraceptive implant during the early postpartum period, if early placement impedes lactogenesis, patients may wish to delay placement to establish their milk supply first.
Overall, the authors concluded that time to lactogenesis stage 2, degree of breastfeeding exclusivity and duration of breastfeeding across a 6-month period did not differ across implantation timing groups. Additionally, no major differences in implant adverse effects were observed.
These findings offer some solace to women intending to breastfeed who also want immediate contraceptive coverage during the postpartum period. Indeed, the results can be interpreted as supporting a possible reduction in multiple in-person outpatient visits — and a possible transition to telemedicine platforms — if contraception is established prior to delivery discharge. Within the current study, in fact, one-third of the women randomly assigned to receive their contraceptive implant at the 6-week postpartum visit did not attend the 6-week postpartum visit and therefore did not receive their implant.
The current findings are limited to women with at least one factor potentially impacting breastfeeding success including delivery prior to full-term gestation, prepregnancy BMI of greater than 35 kg/m2, polycystic ovary syndrome, gestational or pregestational diabetes or self-reported prior difficulty with low milk supply.
Collapse