Maternal Medications and Breastfeeding
By Gwen Gotsch
Oak Park IL USA
From: NEW BEGINNINGS, Vol. 17 No. 2, March-April 2000, pp. 55-56
We provide articles
from our publications from previous years for reference for our Leaders and
members. Readers are cautioned to remember that research and medical information
change over time
Most mothers and most health
professionals know that medications taken by breastfeeding women may
appear in their milk. So when a physician scrawls something on a prescription
pad and hands it to a mother, no one is surprised when the doctor also
tells the mother to wean her baby. But no one is very happy about the
situation either. Sudden weaning exposes both mother and baby to significant
health risks and emotional stress. If the conversation between patient
and physician ends here, there are difficulties ahead. Instead, a mother
in this situation needs to begin asking questions and participating
actively in an ongoing discussion about her health care. Granted, it's
not easy to challenge a doctor's advice, especially if you're sick and
concerned about your own well-being. But there are good reasons to talk
with your doctor about alternatives to weaning, even temporary weaning.
First is the fact that breastfeeding
matters. Feeding artificial baby milk, that is, infant formula, is not
equivalent to breastfeeding. Physicians who do not treat a lot of nursing
mothers or who have no personal experience with breastfeeding may not
realize that there's more involved than just how a baby gets nourishment.
Even if they're aware of the nutritional and immunological benefits
of breastfeeding, many don't know that weaning the baby from the breast
will also affect how the mother comforts and cares for her baby. Many
are also not aware that it can be difficult to get a baby back to the
breast after several days of bottle-feeding. The physician has an obligation
to respect a mother's feelings, values, and concerns about breastfeeding.
A second reason for talking
further with a doctor about weaning is that formula-feeding is not risk-free.
Yes, many babies do fine on formula (and some even go to medical school
when they grow up), but this is an example of human beings' ability
to adapt to less-than-ideal circumstances, not evidence that formula-feeding
is as good as breastfeeding. With a slight change of perspective, the
many benefits of breastfeeding can be seen as potential problems with
artificial feeding: more ear infections, more gastrointestinal illness,
greater risk of allergy, SIDS, childhood leukemia, juvenile diabetes,
and other health problems. Studies have shown that breastfed children
have an intellectual edge during the elementary school years, which
means that formula-feeding may have subtle negative effects on a child's
development. If a physician can view breastfeeding from this vantage
point, exposing a child to infant formula becomes a much greater concern.
Actually, there are very
few drugs that are not safe to take while breastfeeding. This is the
third and perhaps most compelling reason for asking a doctor to reconsider
whether weaning is really necessary when a mother takes medication.
If there are compelling reasons a mother must take a drug that has been
shown to be dangerous to her infant, weaning may well be necessary.
But often, if mother and doctor seek out more information, they find
that there is little reason to worry about a particular drug or that
there are alternative ways to treat the mother's medical problem.
What determines whether
a drug will affect the baby?
Most medications taken by
a mother will appear in her milk. What's important is not whether the
drug is in the milk, but how much of the drug gets to the baby and what
the effects will be. Here are some factors to consider:
- Newborns and premature
infants are less able to metabolize drugs than older babies or nursing
toddlers. Medications that a physician might not want to use in the
mother of a newborn may not raise concerns when the baby is older.
- How much milk a baby takes
from the breast influences how much drug gets into his system. A six-month-old
baby who is exclusively breastfed takes a greater volume of milk than
a younger baby or than a toddler who nurses mainly for comfort.
- Some drugs stay in a mother's
system longer than others. It may be easier for baby's body to handle
short-acting forms of a drug rather than preparations released over
12 or 24 hours.
- Sometimes it's possible
to calculate when the levels of a drug in mother's milk are likely
to be lowest, based on what physicians know about how the body uses
the medication. Then dosages can be timed so that the baby is exposed
to less of the drug. However, this may not be practical when a baby
nurses often around the clock or has unpredictable feeding habits.
- Newer drugs may promise
quicker action or fewer side effects than older preparations, but
there may not be any information available about effects on breastfed
babies. Sometimes mother and doctor may decide to use an older drug,
if it is known to be safe for the baby.
- Sometimes it's possible
to delay the use of a medication until the baby is older or not nursing
as frequently.
- The doctor who is prescribing
the medication for the mother should consult the baby's doctor before
advising a mother to wean. Pediatricians are often better informed
about drugs in human milk than specialists in other areas. If there
are concerns about a drug, it's often possible for the mother and
the pediatrician to monitor the baby for possible side-effects.
- It's always wise to consider
whether medication is truly needed. There may be other ways to deal
with symptoms.
Long-term use of medications
Women with chronic health
problems such as diabetes, lupus, arthritis, epilepsy, or thyroid disease
may need to take medication during the entire time they are nursing
their babies. It is almost always possible to find medications that
are compatible with breastfeeding. Often, women in these situations
are accustomed to working with health care providers in managing their
disease, especially while pregnant. If the mother makes it clear to
her caregivers that breastfeeding is important to her, they can work
together to find solutions to any problems about medications and breastfeeding.
Physicians increasingly treat
postpartum depression with medications and may recommend that a mother
wean her baby in order to take antidepressants for several months. This
is a situation in which it's important to seek out further information
and weigh the risks and benefits very carefully. Weaning may be difficult
emotionally for a mother who already feels she's not doing anything
very well. In some cases, after a careful investigation of the drug,
the mother, her partner, and the baby's doctor may decide that the benefits
of taking medication along with the benefits of continued breastfeeding
outweigh any risk to the baby. Or they may decide to treat the depression
in other ways that don't involve medication. This issue of NEW BEGINNINGS
features personal stories from mothers who chose various ways to treat
postpartum depression.
Where to go for information
about drugs
Health care givers often
turn to the Physicians' Desk Reference (the PDR) for information
about drugs. However, this is not a good source for information about
drugs and breastfeeding. Information in the PDR comes directly
from pharmaceutical companies, whose first concern is avoiding liability.
When there are no studies that prove beyond a doubt that a drug is safe
for nursing mothers, the drug companies must advise against using it
while breastfeeding-even if what is known about the drug suggests that
there is little cause for concern.
A better source is the American
Academy of Pediatrics Committee on Drugs, which in 1994 published an
article titled "The transfer of drugs and other chemicals into
human milk." This listing of drugs is based on hundreds of reports
from the medical literature and is easily available in medical libraries.
(See the reference list at the end of this article for more information.)
The article is reprinted in La Leche League International's BREASTFEEDING
ANSWER BOOK, a resource owned by most La Leche League Leaders. La Leche
League Leaders also have access to other resources on medications in
mother's milk with references that can be passed along to a physician.
Medical journals publish
new information about medications in human milk all the time. In this
day of computer searches, fax machines, and the Internet, asking a doctor
to find out more about a drug is not asking a lot. BREASTFEEDING ABSTRACTS,
which is published quarterly by LLLI, features a lead article about
a medical topic related to breastfeeding, as well as abstracts of major
journal articles about breastfeeding. It also includes a list of articles
that may be of further interest to those wishing to educate themselves
about breastfeeding. Seeking out additional information can make it
possible for a mother to continue to breastfeed with complete peace
of mind, or to know that in her special medical situation, weaning was
indeed necessary.
Keeping the lines of
communication open
You should always consult
your doctor before taking any medication while breastfeeding. This includes
over-the-counter medications as well as prescription drugs. When a physician
prescribes medicine for a nursing mother, she should remind him that
she is breastfeeding and be certain that the drug is compatible with
continued nursing.
When questions come up about
the safety of a drug during lactation, continue to keep your doctor
informed. Even if the two of you must agree to disagree about a course
of action, your doctor must know how you are treating your condition
and whether your baby is continuing to nurse at the breast. If you find
that you cannot work with your doctor to resolve a problem, you always
have the option of seeking a second opinion from another physician.
Especially during the early
months of breastfeeding, mother and baby are like a single biological
unit. What affects one will affect the other. This is why it's important
for a nursing mother to take good care of herself and be cautious about
what she puts into her body. Some drugs are potentially dangerous for
nursing babies, so it's wise to seek a doctor's advice about taking
any medication, but it's equally necessary to let your doctor know that
continuing to breastfeed is very important to you and your baby.
References
Hale, T. Medications and
Mother's Milk, 8th ed. Amarillo, TX: Pharmasoft, 1999-00.
Howard, C. R. and R. A. Lawrence.
Drugs and breastfeeding. Clin Perinatol 1999; 26(2):447-78.
Lawrence, R. Breastfeeding:
A Guide for the Medical Profession, 5th ed. St. Louis: Mosby, 1999.
Mohrbacher, N. and Stock,
J. THE BREASTFEEDING ANSWER BOOK, rev. ed. Schaumburg, IL: La Leche
League International, 1997.
Page last edited Sun Oct 14 09:30:24 UTC 2007.
