Given available evidence ACOG recommends that women who are considering immediate postpartum hormonal LARC should be counseled about the theoretical risk of reduced duration of breastfeeding, but that the preponderance of the evidence has not shown a negative effect on actual breastfeeding outcomes.
Systematic review findings show that progestin-only contraceptives do not appear to adversely affect a person’s ability to successfully initiate and continue breastfeeding or an infant’s growth and development.
There are theoretical concerns that exogenous progesterone could prevent lactogenesis, but observational studies of progestin-only contraceptives suggest no effect on successful initiation and continuation of breastfeeding or on infant growth and development.
The copper IUD lacks hormones, which avoids any theoretical effect on breastfeeding, and is classified as CDC MEC Category 1 (no restriction on use) for women who are breastfeeding
ACOG recommends a shared medical decision making approach to contraceptive counselling.
- Obstetric care providers should discuss the limitations and concerns associated with the use of hormonal LARC within the context of each women’s desire to breastfeed and her risk of unplanned pregnancy so that she can make an autonomous and informed decision.