I asked a friend of mine, Dorle Verrinder, to answer some common questions about breastfeeding that I often get asked.
She has an M.Sc in Dietetics and a special interest in breastfeeding support. She completed additional paediatric modules with the British Dietetic Association, and undertook a specialist breastfeeding training course with the Association of Breastfeeding Mothers, a breastfeeding charity in England. She is a registered dietitian with the Health Professions Council of Namibia, and a member of the International Lactation Consultants Association (ILCA).
Medication and Breast Milk
If you are reading this you have probably decided you want
to breastfeed, or you are already breastfeeding – congratulations! There is
overwhelming evidence in the scientific literature proving the benefits of
breastmilk for the baby as well as the mother, and the more and the longer you
breastfeed, the more and the longer these benefits continue.
But what about medication? You
may be wondering – what if I have pain of some sort, or need to take
antibiotics for an infection, will I need to stop breastfeeding? What about my
regular prescribed medication which I need to continue – does that mean I won’t
be able to breastfeed?
The good news is that
there is a wide range of medications that you can safely take while you
breastfeed without harming your baby. The benefits of breastfeeding in many
cases far outweigh the risks that may exist if the baby is exposed to the
medication through breastmilk. Or, if a medication is known to be unsafe for
the baby, there is often another medication that can be prescribed in its
place.
You may have already checked information leaflets on common
medications and found that it always seems to say that the medication is not
suitable for breastfeeding mothers. So what does that mean?
When a medication is licensed,
the manufacturer applies to get the medication licensed for treating a
particular condition and a particular group of patients. If the drug is used
outside its license, the person who prescribes the medication takes the
responsibility. Medications are not tested on breastfeeding mothers, in fact it
would be totally unethical to do so. Therefore, the manufacturers must make sure
they write on the medication leaflet that the drug is not licensed for
breastfeeding mothers. As a consequence, going by a manufacturer’s summary of
the medication’s characteristics, very few drugs are licensed for use during
breastfeeding.
However, this does not mean that these
drugs are necessarily “unsafe” during breastfeeding. Few medications
that pass into breastmilk reach a level that produces a therapeutic effect in
the baby, and therefore it does not usually present a meaningful risk to the
baby (there are exceptions of course).
To determine a drug’s safety for your
breastfeeding baby, a number of factors are considered to make a
judgement on whether the medication is likely to harm your baby or not. For
instance, how well your baby’s body takes up the drug, how much actually passes
into the milk, how the drug is metabolised (some drugs are turned inactive by
the liver and are flushed out of the body with the urine without having an
effect), whether your baby drinks when the drug has its highest concentration in
your system which means more of the drug passes into the milk, and how much
milk overall your baby is drinking.
Your baby’s age is important
- in the first 3 days after birth, your breast allows more substances to pass
through. Even though medication passes into the milk more easily in this
period, the total volume is still low because your baby takes so little of the
colostrum (30-100ml or even less per day). Also, very young babies and preterm
babies have immature organs and may not be able to deal with medications as
well as older babies.
Some conditions require treatment
incompatible with breastfeeding, for instance, if the mother has
cancer, she likely may have to stop breastfeeding for the duration of each
course of treatment, because the medication may harm her baby. Medications for
other conditions, like some type of painkillers or inhalers are generally safe
to take meaning that likely you can continue breastfeeding as normal.
The final decision about whether or
not a medication is safe to be taken by you while breastfeeding lies
with your doctor who prescribes the medicine. What the prescriber also needs to
consider is whether there are any medical conditions in your baby that would
make him or her more vulnerable to any effects of the medication, how much of
the drug reaches your baby, and how this amount compares to a dose that would
be given directly to your baby if it is used to treat children.
So what can you do if you
have been told by your doctor you need to stop breastfeeding because of the
medication you are taking? Discuss with your doctor if there is another
medication that can be prescribed, ask your doctor to refer to a prescriber
knowledgeable in prescribing during lactation, or your doctor may consult
“Hale’s Medication and Mothers’ Milk” which list all the characteristics of a
medication and what information is known as to its safety during lactation.
Remember, you and your baby are
unique in terms of your health and breastfeeding circumstances and
each prescribing decision must be made individually. It is important for the prescriber and you to
weigh up the disadvantages for your baby of NOT getting breastmilk, what would
happen if you do not receive your treatment, and how the medication may affect
your baby.
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If you really need to stop
breastfeeding because of your treatment, there are a few things to
consider. In an ideal scenario, you can prepare for a breastfeeding break by
building up stocks of expressed breast milk and freezing it so that you can
feed your own milk to your baby rather than using formula. This will not only
save you money, but also ensures that your baby continues to receive your
liquid gold and all its protective goodness which formula is lacking. Another
thing to consider is that if breastfeeding is interrupted even just for a day
or two, your milk supply will be affected, unless you express milk to continue
to stimulate the breasts to tell the body to continue making milk. Reducing
feeds gradually, especially in the early weeks of breastfeeding, is vitally
important to avoid engorgement in the mother.
In conclusion, try to get
as much information as possible and don’t be afraid to ask for alternatives
when faced with the possibility of having to stop breastfeeding when you are
not really ready to do so.
If you would like further support or advice please feel free to contact Dorle. All of my clients and fans receive a free 15 minute telephone consultation with Dorle if you mention you got her details from me.
Have a great day!
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