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Reprinted from Issue 2 • 2007
Depo and the God-Doctors
Some years ago, my sister declared that the “god-doctor days” were over. She insisted that women are now informed enough to make their own choices and that doctors can no longer expect them to blindly follow the advice they are given. In many instances, that’s true. But Depo-Provera (medroxyprogesterone injection) seems to be a glaring throw-back to the god-doctor days.
When Depo came through the door, the principle of autonomy went out the window. “The shot” is hastily pushed onto—or, literally, into—bleary-eyed postpartum women who are given little or no time to comprehend the selected and often biased information they are told. Where is respect for the woman’s chance to consider her options or to choose among alternative contraceptives? Where is respect for her possible moral values or religious beliefs? Where is respect for her? Have you noticed a disproportionate number of clinic patients—breastfeeding and non-breastfeeding alike—being given Depo-Provera? Doctors brashly proclaim that these women “won’t be back for [their] six-weeks checkups,” so they have Depo given quickly before the new mothers head out the door. The presumption is that clinic clients are too stupid or unwilling to return for health care. How often do we hear doctors say of a clinic patient, “I
don’t want to see her back here in three months and pregnant again.” I always think “Really? You don’t
want to see her pregnant? Well, Doc, getting Depo—today or six weeks from today—will, at most, delay pregnancy for just a few months. You and the other god-doctors may not want to see any more of ‘those people’ on the planet. But doing away with what you might view as the dregs of society is just a tad beyond your scope of practice.”
Why the rush to give Depo at two days postpartum? Multiple studies have shown that bottle-feeding mothers do not conceive for at least 45 days after delivery, while mothers who are exclusively breastfeeding are unlikely to conceive for even longer. Does the doctor warn her that any of the shot’s side effects—including reduced milk supply—will last at least 3 months and possibly longer? The manufacturer’s instructions recommend that breastfeeding mothers who opt to use Depo “have their first injection during or after their sixth postpartum week.” MedlinePlus offers an even more strongly-worded recommendation: “You may use medroxyprogesterone injection while you are breastfeeding as long as your baby is 6 weeks old when you receive your first injection.” The studies don’t show an irrefutable relationship, but I have heard an abundance of anecdotal evidence that milk supply decreases after Depo is given. Could the hasty administration be justified in court if an adverse event occurred? It wouldn’t be hard to find several expert witnesses for the reduced milk supply problem.
• No known benefits for getting Depo at two days post partum.
• Possible harm for the mother and her child—harm that is typically ignored or glossed over, with the
woman’s milk supply rarely if ever mentioned.
• Little or no education on possible contraceptive alternatives.
• Blatant discrimination and lack of respect for the woman.
• And an ego big enough for a doctor to still act like a god-doctor long after those days have passed.
2007 WMC Worldwide. All rights reserved.
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