Episode 327

On Today’s show we will be talking in more detail about  the worries that breastfeeding moms have when it comes to medications and breastfeeding safety.  At some point when breastfeeding your baby, it is likely that you will be taking some medication.   There are  times you will be told that you need to wean to take a certain medication.  Rarely is this necessary.  Most medications you take, will enter your milk, however, the amount is almost always in small amounts that are not considered harmful to your baby.  There have been times when a mom has made an appointment to rent a pump because she was told to pump and then throw away her milk, during a time when she was taking a medication.  Turns out that I was able to give her information to bring back to her doctor that showed this medication was rated safe for breastfeeding mothers.   Better still, in researching, I find that this same medication has been prescribed to babies.  The dose that the baby was getting was much higher than the very small amount that came through her breastmilk. In my humble opinion, You will need a good reason from your doctor why it is not safe for you to take this while breastfeeding, when this same medication is given to babies.

Since I am not a physician, it is not within my scope of practice to advise moms  on the safety or risk of medications, however, I have excellent resources that I use and I gladly share these resources with moms.  I encourage them to take this info to their physician and discuss it further.  Often,there are alternative medications that you can safely take, that will have the same result, so be sure to inquire about alternatives.  If you or your baby have a medical reason that would make it unsafe, your physician will be able to explain this to you in greater detail.

Why is there confusion on this subject?  Why do you hear conflicting advice?

The subject of medication and breastfeeding safety  can be very confusing.   During your pregnancy you  may have been told that you cannot take a specific medication as it is not safe for your baby growing in utero.   Now that you are breastfeeding, you find out that this same medication is safe to take while breastfeeding. You just shake your head as you just don’t know what to think  I can totally appreciate why this might be confusing to you.

Part  of  the reasons for the confusion is that how much of the drugs get to the baby when you are pregnant, is different than how the drugs get to the baby when you are breastfeeding.   The breast tissue is like a major filtering factory by the time it is done doing its job, very small  amount gets into your milk.  You do not have this same filtering factory when you are pregnant.

Perhaps breastfeeding is going well, your baby is gaining great, is very happy and healthy.  At some point though, you need to have a medical test taken. Have you ever been told you need to stop breastfeeding because you need medical testing? Or perhaps you were told that the treatment you need for a medical condition cannot be performed  until you are done breastfeeding?  As you contemplate you choices, before you make a firm decision, remember, the good news is that most medications are compatible with breastfeeding, and for those few medications that are a safety issue there are usually acceptable substitutions. You also have options for medical testing  and treatment that you might need.

There may be alternative treatment and it is up to you to inquire about this.  Perhaps when asked, you find that while your physician made it seem urgent, it actually is not and can easily wait until your baby is weaned or until your baby reaches a point where they are nursing very infrequently.  Perhaps you find out that it is not safe to have this treatment or test, however, rather than wean, you only need to interrupt breastfeeding for 3 days or 5 days and then you can go back to it.

At one point, your baby may be old enough to handle a certain medication taken at a certain dosage and for a period of time.  This is why, if you are able to delay treatment, you may be able to have the treatment and continue breastfeeding.  Things do not always stay the same.  This is news to many parents as they either have been told or just assume that once you are told a medication is not safe, that it will always mean it is not safe.  Many a breastfeeding relationship has been saved just by the parents educating themselves about medication safety while breastfeeding.

Are all medications created equal.  Definitely not.

So, yes, all medications need to stand alone and be checked for safety separately.  Every mother, her baby and her medication or medical treatment or medical testing needs to be viewed on an individual basis.  What was not okay to take at 4 months postpartum, may totally be find at 7 months postpartum when your babies liver has matured and now does a better job

You may be thinking to yourself… you make it sound  so easy.. Lori.. to get accurate information.  Well, I believe that it is.  The research and resources are at your fingertips as long as you know where to go.  I firmly believe that you need to do some of your own research so you can be a partner in your and your babies health care.  Of course, nooone is expecting you to be an expert in a short period of time.  However, you will be surprised just what you can learn on your own with just a little digging. Your physicians?  In talking to physicians, I find that often they rely on one source of information and this source may be outdated.  There is documentation and research that is done solely for the breastfeeding mom and they might not know about this.  You deserve  to have access to the most updated and well researched information.  Sometimes physicians have access to the same information and yet they like to err on the side of safety.   Because of this, you may not be told about other options.   Perhaps your physician has given you the “go ahead” and yet you are holding back out of fear…  You are not willing to do anything that might pose even the slightest risk to your baby.  I totally understand and appreciate that you are being a good parent who is always putting their child s interest first.

I am so glad that you are listening to this show because I would like for you to factor in some ideas that are often not  talked about.  When we want to make the best decision, we want to gather all the information we can and then sit and think about thinks logically.  You hear me talking about this a lot.  I am a huge fan of logical thinking and common sense thinking.  This is where I am going now.

I would like for you to think about what happens when you remove breastmilk from your babies daily diet. What are you going to replace your milk with?  If you have looked at every angle and decide that you have no choice  but to stop either temporarily or permanently, I hope that you will consider donated human milk as the first food for you baby.  When we are talking risk factors regarding small amounts of medication getting to your baby through your milk, you also have to consider what food your baby will be getting in place of your milk.  Formula has known risks associated with it.  Breast milk is a living substance that is perfectly suited for your baby each and every day.  It is resilient enough to withstand the times a mother has a need for medication and still make milk of excellent quality.

Breastmilk is a living substance that is perfectly suited for your baby.  Your milk is resilient enough to withstand the times you need to take a medication.  Your milk will still be of excellent quality and perfectly suited for your baby even if small amounts  pass through your milk.  If you are told it is not safe, be sure you have the most recent and up to date information before making any changes.

Why do I say this?  Because I want you to make an educated decision and not just act on fear or not think that switching to formula is without risk.
There are well known and document risks associated with introducing your baby to formula. Their gut is not use to this food  on a round the clock basis and a regular diet of formula may not sit well in their tummies.  They could also have a strong allergic reaction to formula, so this transition should not be taken lightly.  If your baby has not drank from a bottle, he may need time to transition to this method of feeding.  Another issue is, if your pumping and dump is temporary, but your baby has had bottles for a number of days, they may sqawk at going back to breastfeeding.

Their are also risks to your supply by switching to exclusive pumping.  You will want to meet with an IBCLC who can give you a care plan that works best for you.   It is a good day for me when I meet with a mom and are able to help her meet her goals of temporarily pumping, keeping up her supply, and helping her with tips to transition her baby back to the breast.  It is a good day when I share information on donated human milk to parents so they can avoid formula if that is their wish. I find that unfortunately, when moms are told to pump full time whether it be on a full term or a temp basis, they are usually given poor or incomplete information and this messes with their supply as well as the health of their breast tissue as they begin to suffer with engorgement or plugged ducts.  This is particularly so when moms need to wean abruptly.  It is a great day for me when I am able to help a mom do this safely so they don’t cause themselves any harm as the potential for getting breast infections and abscesses is great when this happens.

Changing what you feed your baby and how you feed your baby should not be taken lightly. You might decide that what fears you had about taking medication that you know was safe, well that the risk of needing to give formula or the risk of your baby not coming back to breastfeeding is a greater risk.   You will only be able to make the best decision if you are being given all the information you need to make an informed decision.

If faced with this decision, here are some questions you can ask  yourself and your physician?

Can I delay treatment?

Is there an alternative medication that is still effective and would be safer for my baby than what is prescribed?

Can I time feeds around the medication so that my baby gets less – ie. nurse then take the medication; not taking a “long-lasting” drug; etc.

Ask what percentage is actually getting passed through your milk?

Talk with your doctor about choosing an alternative medication.  These are ones that have high protein binding, high molecular weight, poor penetration to central nervous system, short half-life and low oral bioavailability.

Select drugs that are commonly considered safe to use with pediatric patients.

Once you decide to take a medication, learn what side effects you might expect.  Observe for side effects and when necessary contact your physician.

An excellent source of information regarding breastfeeding and medication safety is:  Infantrisk.org.  There is medical staff answering a warm line whose jobs it is to answer your questions about specific medications and their safety.

I applaud moms for being concerned and wanting to do all they can to be safe.  This is your job – to keep your baby healthy.  I want you to be questioning the safety of medications.  I want you to use excellent resources, such as your IBCLC who can help guide you through this time by offering education, practical information and steer you in the direction of appropriate resources.  You will then be able to factor in what you have learned and be able to have an intelligent discussion with your provider.  You know I am a huge advocate of parents being a partner in your babies health care.  The focus of this show has been on medication safety while breastfeeding.  As you can see, this conversation easily lends itself to thinking about your role as a parent and how you can learn to advocate for yourself and for your baby