Questions on Using Medications
Susan Buckley
West Hartford Connecticut, USA
From: LEAVEN, Vol. 35 No. 4 August-September 1999 pp. 89-90
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
Leaders often receive calls
from mothers with questions about taking medications while breastfeeding.
The circumstances prompting such calls can be disconcerting for everyone
involved. The mother may feel ill. Her stress, compounded by family
responsibilities, may push her beyond her ability to cope. The baby,
sensing a change in the familiar routine, may seek reassurance by asking
to nurse more frequently than usual. The family wants mother to get
well quickly so life at home can return to normal. The doctor, perhaps
unfamiliar with medications and breastfeeding, may suggest weaning while
taking the prescribed drug.
Leaders who answer drug calls
often feel anxiety, too. We want the breastfeeding relationship to continue
but at the same time, we want to assure the health and safety of the
baby and mother. It can be tempting to refer these calls to a more experienced
Leader, yet "learning by doing" is the best way to gain experience
helping a nursing mother with a question about a medication.
"What did your doctor
say?" is a good first question to ask a mother, perhaps followed
by, "Why do you think your doctor said that?" Sometimes a
mother assumes her doctor knows she is nursing. Occasionally a mother
will hesitate to tell her doctor that she is breastfeeding because she
fears that the doctor will not be supportive of her choice. If she hasn't
already done so, encourage the mother to tell her health care provider
that she is breastfeeding.
A mother may prefer to bring
her question to an LLL Leader where she knows she will find support.
Keep in mind, however, that when a mother does not mention breastfeeding
to her health care provider, she misses an opportunity to build a rapport
as well as educate him or her about breastfeeding. A failed attempt
to work out a satisfactory solution may lead a mother to realize that
she must find a practitioner who is more suited to her needs. All doctors
do not evaluate a drug's compatibility with breastfeeding in the same
way so the mother may need to contact more than one doctor before she
finds the support she seeks.
Some health care providers
will prescribe a treatment without asking the mother how she feels about
the recommendation. Leaders can provide a valuable service by encouraging
the mother to request treatment options. We can then help the
mother sort her options into risk/benefit categories. We can suggest
that she talk to her doctor on a feeling level with phrases such as
"I feel very uncomfortable about trying..." or by stating
"Breastfeeding is very important to me." Offering a mother
the skills and moral support she needs to converse with her medical
practitioner is as vital as providing her with specifics about a given
drug.
The most important point
to remember is that Leaders cannot diagnose, prescribe or advise. We
can certainly give the mother the information we have but we
can not offer advice about a particular medication. It is much
more appropriate to say, "How upset you must be feeling. Being
sick and having decisions to make can't be easy. Let me read to you
what it says here on page___ in this book called ___. I can't tell you
whether or not to take this medication because I'm not qualified to
prescribe, but if you would like, I can give you a reference to share
with your health care provider so the two of you can talk about it."
Remember that the reference
or citation is only a beginning. The mother needs the information interpreted
and applied to her own situation by her physician. These tasks fall
outside the scope of a Leader's responsibility and expertise.
Sometimes a mother has a
difficult time making a decision about a medication, even though her
health care provider, the baby's health care provider and our LLL-approved
resources indicate that it is compatible with breastfeeding. We can
dialogue with a mother to help her identify her concerns. it may be
helpful to share the tried and true statement, "Many mothers have
found..." along with an example. It can also be helpful to give
the mother a better understanding of how a medication works in the body.
Some seemingly benign medications easily pass into human milk while
other more powerful medications may pass less readily or not at all.
An Area Professional Liaison Leader can usually supply this type of
information to Leaders who request it.
A mother who responds with
"Yes, but..." may be overwhelmed with the responsibility of
making a decision. She may be waiting for someone else to make it for
her. As another mother, our heart certainly goes out to her. As a Leader,
we cannot make a decision for her.
Several commonly held misconceptions
concern the compatibility of a Mother's treatment with her desire to
breastfeed her infant.
Misconception: Medications
prescribed for pregnant women are also appropriate for breastfeeding
women.
Whether or not a medication
can be taken during pregnancy is not a means of determining if the drug
is compatible with breastfeeding. Medications taken during pregnancy
are potentially transferred directly to the bloodstream of the fetus
through the mother's blood. Medications taken by the mother during lactation
are potentially transferred to the baby via her milk and may be absorbed
through the infant's digestive tract. Each medication, therefore, needs
to be examined individually to determine how it is present in the mother
and how it could affect the infant.
The baby's physical development
is an area of concern. The vulnerability of different systems and organs
varies during the pregnancy, so some medications are not used during
certain trimesters. After a critical stage of development has passed,
possible exposure to the mother's medication may be less of a concern.
A premature infant might be more at risk than a full-term infant or
older baby because the premature nursling lacks physical maturity. An
older baby or toddler who receives solids or supplements receives less
of a drug relative to his body size than does a baby who is exclusively
breastfed.
During pregnancy, the fetus
relies upon the mother's body to help excrete toxins. After birth the
baby must excrete toxins on his own even though a newborn kidney and
liver functions are not fully mature. For this reason some substances
can build up in a newborn's body even though the effects are short-lived
in the mother.
In short, while most medications
do not require the mother to wean, one cannot look at the drug's use
during pregnancy to determine compatibility with breastfeeding.
Misconception: Over-the-counter
medications are safe to take while breastfeeding.
Over-the-counter medications
(OTCs) should be looked at with the same consideration as prescribed
medications. Are they necessary? Are there other treatments available?
Do they cross into human milk? Will they have any effect on the quality
or quantity of the mother's milk? What is the age and health of the
nursing infant? Are there known side- effects? If so, what are they?
Because OTCs are available
without consulting a doctor or pharmacist, some women believe that they
are not "real" medications. When a mother chooses to use an
OTC, it becomes her responsibility to check with her health care provider
as well as other resources and watch the nursing baby for any possible
effects. Most OTCs or the ingredients from which they are made are listed
in the American Academy of Pediatrics "The Transfer of Drugs and
Other Chemicals Into Human Milk" on pages 525-538 of the BREASTFEEDING
ANSWER BOOK, 1997 edition. When necessary, Leaders can contact a Professional
Liaison (PL) Leader for access to other appropriate references.
It is important for the mother
to provide accurate information on the OTC she is considering using.
Some products have similar names yet vary widely in dosage, strength
and duration. There is a tendency for a mother to want to take the strongest
and longest-lasting medication available. When a woman is breastfeeding,
however, the smallest effective dose and the shorter-acting preparations
are usually better choices. Remember that we, as Leaders, never recommend
a medication or say it is safe.
Misconception: Herbal
remedies are compatible with breastfeeding.
A mother may believe that
a medication derived from herbs is natural and, therefore, safe. She
might not even mention that she is taking an herbal remedy when asked
if she is taking any medication. Herbal remedies are far from benign.
Some can increase or decrease the milk supply; others can cause babies
to be sleepy or show symptoms of colic. Most important, some are contraindicated
when breastfeeding. Since herbs are not regulated in the same way that
other drugs are, it is important for a mother to have a good resource
person or trustworthy source to ascertain purity, strength, uses and
contraindications. PL Leaders can help Leaders with specific herbal
questions. (See also LEAVEN Jun/Jul 1998,
pages 43-47.)
Misconception: A PL Leader
will be able to provide a definitive answer to a drug 's compatibility.
While PL Leaders have access
to the most recent and reliable information that is published on most
medications, there are some medications about which safety during lactation
is unknown. Especially for new drugs, information is frequently lacking
or incomplete. Drugs are not routinely tested on breastfeeding women
and their babies; most of the available information is based on case
studies, individual instances when a woman and her doctor decided to
use the medication and report the outcome. The more information a Leader
can provide about the mother's and baby's health, the age and feeding
patterns of the baby, the dose and the duration of the medication, the
better able the PL Leader will be to provide helpful information to
assist the mother to make her own decision.
In very few instances a prescribed
medication is not compatible with breastfeeding, yet it is the best
medication for the situation. A mother faced with the necessity of weaning
is often relieved to find out that she may need to wean only temporarily.
It can be quite comforting to learn that she can keep up her milk supply
through hand-expression or pumping and that the Leader will be there
to help her re-establish breastfeeding when the course of the medication
is completed.
It is possible that weaning
must be permanent, though this is quite rare. When this is the case,
the mother needs to be reassured that she has given her baby the best
possible nutrition for however long she has been nursing. She can be
encouraged to remember that above all else, she is important to her
baby. Her ability to be available to carry on her relationship with
her baby supersedes her feeding method.
Although Leaders may still
feel some anxiety when a mother calls asking about the compatibility
of a medication with breastfeeding, it is helpful to relax and remember
that LLL provides resources for answering such questions. PL Leaders
are available to provide information and support to Leaders when medical
questions arise. Remember, however, that the skills Leaders use in any
helping situation-active listening, asking the mother to identify the
problem, helping her sort through multiple concerns, discussing options
and sharing information but not advice-are also the keys to helping
a mother with a drug-related question.
Bibliography
Leader's Handbook. Schaumburg,
Illinois: LLLI, 1998; 208-13.
Mohrbacher, N. and Stock,
J. Breastfeeding Answer Book. Schaumburg, Illinois: LLLI, 1997; 500-13.
Publications for Parents
Mohrbacher, N. When a
Nursing Mother Gets Sick. Schaumburg, Illinois: LLLI, 1996. Publication
No. 21a.
THE WOMANLY ART OF BREASTFEEDING,
6th edition. Schaumburg, Illinois: LLLI, 1997; 312-14.
Publications for Leaders
Briggs, G., Freeman, R. and
Yaffe, S. Drugs in Pregnancy and Lactation, 5th edition. Baltimore:
Williams and Wilkins, 1998.
Hale, T. Medications and
Mothers' Milk, 1998-99, 7th edition. Amarillo, Texas: Pharmasoft
Medical Publishing, 1998. (See guidelines in the review of the 6th edition
in LEAVEN, Feb/Mar 1998, page 13.)
Humphrey, S. Sage
Advice on Herbs and Breastfeeding. LEAVEN Jun/JuI 1998; 43-47.
Lawrence, R. Breastfeeding.A
Guide for the Medical Profession, 5th edition, St. Louis: Mosby,
1998; 351-93; 744-867.
Riordan, J. and Auerbach,
K.G. Breastfeeding and Human Lactation, 2nd edition. Boston:
Jones and Bartlett, 1998; 163-89; 190-219.
This article was adapted
from three sources: "Answering the Drug-Related Call " by
Jeanne Amaral-Silva of Billerica, Massachusetts, USA and published in
LLL of Massachusetts/Rhode Island/Vermont's Yankee Wellspring, Winter
1999; "A Difficult Question About a Medication " by Sarah
Chaikin of Brigantine, New Jersey, USA and published in LLL of New Jersey's
Nursery Notes, Fall 1998; "Medical Misconceptions"
by Sandee Luttkus of Westhope, North Dakota, USA and published in LLL
of Minnesota/Dakotas' Northern LLLights, Winter 1998.
Page last edited Sun Oct 14 09:31:53 UTC 2007.
