Taking Care Of Your Health Doesn’t Mean You Have To Stop Breastfeeding
Breastfeeding on Drugs:
Taking care of your health doesn’t mean you have to stop breastfeeding
By Kate Rope
Two months after my first daughter was born, I developed debilitating inflammation around my heart. I had suffered from it during pregnancy and now it was back. I called my rheumatologist in a panic to ask what medication I could take. We had managed it with steroids during my pregnancy, but now, I was breastfeeding and wanted to know what would be a safe for my baby.
”At a certain point,” my doctor said, “you have to prioritize your health and stop breastfeeding, so you can take care of yourself.” She didn’t say it with compassion, but with annoyance, as if I was stubbornly avoiding taking care of myself. That wasn’t it at all. Breastfeeding had been one of the only parts of having a baby that had gone as planned. And I really liked doing it. Being able to breastfeed was a part of taking care of myself. But, so, of course, was getting relief from the pain.
I insisted that there must be a medication that would allow me to do both. And, guess what? After I pressed her to do some research, I found out there was! I went on it, found relief, and breastfed for another 7 months. What I did stop doing after that phone call was going to that rheumatologist. I switched to a doctor who listened to what I needed and took the time to find medications that worked for a breastfeeding mom.
My story has a happy ending, but not so for many moms. According to a study released by the Centers for Disease Control and Prevention in February, one of the major reasons women stop breastfeeding before they plan to is because they have to go on medication.
That is “very frustrating” to Jenny Thomas, MD, a pediatrician and breastfeeding medicine specialist at Lakeshore Medical Clinic in Franklin, Wisconsin, because “most medications are compatible with breastfeeding.” In fact, says Thomas, “it is better to assume that medications are compatible with breastfeeding than not.” But that is the exact opposite of what many doctors do. Often, says Thomas, even if a doctor consults the most recent information, he or she may still recommend ceasing breastfeeding or pumping and dumping your breast milk “just to be safe.”
”A lot of doctors aren’t aware of the actual studies behind specific medications,” adds Diana West, an international board certified lactation consultant and media director for La Leche League International. “They are often going by the package inserts that always warn against breastfeeding, but which are not based on specific studies.” Instead, says West, they are intended to “protect against lawsuits.” And, sometimes even if a doctor has said it is ok for a woman to take a medication, the pharmacist who fills her prescription may consult those same package inserts and warn her against using it.
But it’s actually pretty hard for a medication to negatively impact a breastfeeding baby. It has to clear several formidable hurdles to reach an infant in any measurable way. First it has to reach a high enough level in the mother’s breastmilk and then, it has to be a medication that can be absorbed by an infant’s gastrointestinal tract. If it clears those two, it has to do so at a high enough level to affect a breastfeeding infant (and that affect may be different depending on a child’s age). And many, many medications don’t. Thomas offers a step-by-step explanation of milk transport into breastmilk on her website as well as some general guidelines about what kinds of medications can be taken while breastfeeding. She usually tells her patients: “They not allowed to have chemotherapy, drugs that would make them glow, or anything that would get them arrested.”
If you are faced with a medication choice, Thomas recommends contacting a lactation consultant or the health care practitioner who “is the most supportive of your breastfeeding.” And, says Thomas, the best thing you can do is to advocate for yourself by doing your own research.
4 resources to help:
LactMed, run by the National Institutes of Health, is an up-to-date, searchable database of medications and what is known about them during breastfeeding. Often, if a drug might be incompatible with breastfeeding, Lactmed will list others that can be used instead. They also offer a free app you can access from your phone and a downloadable widget you can put on a website.
The Infant Risk Center at the Texas Tech University Health Sciences Center mans a hotline (806-352-2519) that breastfeeding moms can call to discuss the compatibility of specific medications with breastfeeding.
Medications and Mother’s Milk, written by the executive director of the Infant Risk Center, Thomas Hale, PhD, is a comprehensive book that many pediatricians and lactation consultants rely on when making medication decisions.
The Complete Guide to Medications During Pregnancy and Breastfeeding is an A to Z directory of drugs and what is known about their use during pregnancy and while breastfeeding. Full disclosure: I am the coauthor of this resource, and my own experience taking medication during pregnancy and breastfeeding led me to team up with Carl P. Weiner, MD to take his research and turn it into easy-to-understand language for pregnant and breastfeeding moms.
The bottom line that I want to share with all breastfeeding moms or those who plan to breastfeed is that you can take care of your health and the health of your child without stopping breastfeeding.
After my youngest was born, I suffered my second bout of postpartum anxiety and needed an antidepressant to weather it. This time I had my pediatrician and a reproductive psychiatrist on my side. We chose a medication that was compatible with breastfeeding, and, 17 months in, my healthy daughter still loves to breastfeed, and I feel good. That’s the kind of happy ending we need more of.
Kate Rope is coauthor of The Complete Guide to Medications During Pregnancy and Breastfeeding, and a freelance writer who survived a difficult pregnancy and postpartum anxiety. She lives in Brooklyn with her husband and two daughters.