CASE STUDY :
A.B. is a 26 year old mother who has been pregnant five times with five living children. She has recently delivered a new baby girl via natural spontaneous vaginal delivery. Her other children are a 5-year old boy, a 4-year girl, a 3-year old girl, and 23 month old girl. While not married, she is in a steady relationship with the father of the newborn. A.B.'s postpartum physical exam is within normal limits; however she appears to have a depressed mood. She states that she is feeling fine, but very tired. In fact she asks to be left alone for most of the morning, so that she can sleep. Her infant stays in the room with her because she is breastfeeding.
When discussing postpartum contraception, AB stated that she wanted to get her 'tubes tied'. However, for unclear reasons the procedure was not done. She was given an alternative contraception choice of a medroxyprogesterone (Depo-Provera) injection prior to discharge and then having an intrauterine device (IUD) placed within six weeks. There is some controversy that progestin-only methods of contraception may interfere with the initiation and/or production of breast milk. Exclusive breastfeeding can offer contraceptive protection.
As her nurse, would you advocate for this mom to breastfeed without additional contraceptive protection or would you advocate for the mom to take the prescribed contraceptive method realizing that it may interfere with her milk production. Why?