Breastfeeding & Medications
Many women take regular medications and many women may get sick where medications are necessary to get them well again. When a mother is breastfeeding she may be told to interrupt breastfeeding, "pump and dump" or stop breastfeeding altogether when medications are introduced. Most of the time, this is completely unnecessary and actually introduces more risk for the lactating mother and for the nursing child. For the mother, interrupting breastfeeding can lead to a higher risk of plugged ducts, mastitis, a breast abscess or worse, loss of milk supply. And let's not forget the risk to the baby's health and baby's gut from introducing artificial infant formula and how bottles may interfere with the breastfeeding relationship.
Most medications are actually quite safe to continue breastfeeding as normal and take your medication as needed or prescribed. Thomas Hale's Medications & Mothers’ Milk Book is the gold standard for all medical professionals as a pharmacology drug guide for nursing mothers. This amazing reference book is written by Dr Hale, a world-renowned expert in perinatal pharmacology. This book lists every medication on the market, containing references, current research, complete, and evidence-based information on the transmission of maternal drugs into human milk. As lactation professionals, we are trained to understand the information inside and the details about how the drug enters or does not enter human milk. A new edition of this book comes out every 2 years and the latest, came out in 2019.
Each drug is rated with a Lactation Risk Category:
L1 = Safest (Extensive Data, Compatible)
L2 = Safer
L3 = Limited/No Data, Probably Compatible
L4 = Possibly Hazardous
L5 = Contraindicated
And most drugs fall into the range of L1-L3. Very few medications are contraindicated. Radioactive, chemotherapy, illegal drugs of abuse and iodine based medications are a a few of the small number of medications where it is appropriate to interrupt breastfeeding. When a prescribed medication is an L4 or L5, often there are other drug alternatives that carry a lactation risk of between L1-L3 and those would be a better choice for the lactating mother.
Another great point to note is: often if a medication is safe to use directly with the child, it would also be safe for the lactating mother to use and continue to breastfeed. Many antibiotics fall into this category.
During cold and flu season, many moms inquire about decongestants to ease their discomfort. Decongestants are a medication that one would need to be cautious about. There is not concern for the baby, but rather to the mother's milk supply. There is an ingredient, pseudoephedrine, you would want to look at the label and search for. This particular ingredient, has been shown to suppress or reduce milk supply. Because of this, it would be wise to avoid a medication that contains this ingredient and select a decongestant that is free of pseudoephedrine or use other natural methods of relieving congestion.
Here are some key points to remember about breastfeeding and medications, from Medications and Mother's Milk, Hale, 2019, preface ix.
"Be slightly more cautious with premature infants or neonates. Be less concerned about older infants." (or toddlers)
"Medications used in the first three days to four days (postpartum) generally produce subclinical levels in the infant due to the limited (small) volume of milk" (colostrum)
"Recommend that mothers with symptoms of depression or other mental disorders seek treatment. Most of the medications used to treat these syndromes are safe"
"Most drugs are quite safe in breastfeeding mothers. The hazards of using formula are well known and documented."
Local La Leche League Leaders and Lactation Consultants often own a copy of this book and sometimes a primary care physician will as well. Your Lactation Consultant or local La Leche League Leader are both very knowledgeable about medications and breastfeeding and can help you understand the information in this book. It is a good idea to contact someone that owns a copy of this book when you are concerned about a medication you may require and would like information about how to proceed. They can share the information with you, and you can then bring that information to your physician to discuss your plan.
You may also call Dr Hale's staff M-F (806)-352-2519 or visit here anytime, www.infantrisk.com for more information on medications and breastfeeding.
Another Gold Standard resource (online) is the National Institute of Health: Toxnet and LactMed. You may browse by medication name and find information about breastfeeding and the medication.
https://www.ncbi.nlm.nih.gov/books/NBK501922/
I hope this helps you now or in the future feel more comfortable about your breastfeeding relationship with your child and any medications you may take. And please pass this along to anyone you may feel would benefit.
Every drop counts!
Summer J Friedmann, IBCLC
6/2012