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
- 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.
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.