You Can
Still Breastfeed
Written by Jack Newman, MD, FRCPC
Article appeared in July/Sept 1998 issue of
"Keeping Abreast"
Over the years, many, many, many women have
been wrongly told to stop breastfeeding.
The decision about continuing breastfeeding
when the mother must take a drug, for example,
involves more than consideration of whether
the medication appears in the mother's milk.
It also involves taking into consideration
the risks of formula feeding for the baby,
which are substantial, the risks of not breastfeeding
for the mother, which are substantial, and
other issues as well. For example, feeding
a breastfeeding baby by bottle for the time
the mother is on medication (rarely less than
5 days), will very often result in the baby
refusing the breast forever or at least becoming
very difficult on the breast.
On the other hand, it should be taken into
consideration that some babies just will not
take bottles, so the advice to stop is not
only usually wrong, but impractical as well.
Furthermore, it is easy to advise the mother
to pump her milk when she is not feeding the
baby, but adequate pumping is often very difficult
to do for some mothers, with the result that
the mothers may become very painfully engorged,
which may further lead to serious complications.
Breastfeeding and Maternal Medication
Most drugs appear in the milk, but only in
very tiny amounts. Although a very few drugs
may still cause problems for infants even
in tiny doses, this is not the case for the
vast majority. Mothers who are told they must
stop breastfeeding because of a certain drug
should ask to be prescribed an alternative
medication which is acceptable for breastfeeding
mothers. In this day and age, it is rarely
a problem to find such an alternative. If
the prescribing physician does not know how
to proceed, s/he should get more information.
If the prescribing physician is not flexible,
the mother should seek another opinion.
 Most
drugs may be considered safe for the mother
to take and continue breastfeeding if:
|
| 1. |
they are
commonly prescribed for infants. Examples
are amoxycillin, cloxacillin, most antibiotics.
|
| 2. |
they are
considered safe in pregnancy. Drugs enter
directly into the baby's bloodstream when
used during pregnancy. The baby generally
gets much higher doses at a much more sensitive
period during pregnancy, than during breastfeeding.
This is not an absolute, however, as during
pregnancy, the mother's liver and kidneys
will get rid of the drug for the baby |
| 3. |
they are
not absorbed from the stomach or intestines.
These include many drugs which are given
by injection. Examples are gentamicin, heparin,
lidocaine or other local anaesthetics used
by dentists.
The following frequently used drugs are
also generally safe during breastfeeding:
acetaminophen (Tylenol, Tempra), alcohol
(in reasonable amounts), aspirin (in usual
doses, for short periods), most antiepileptic
medications, most antihypertensive medications,
tetracycline, codeine, most nonsteroidal
antiinflammatory medications, prednisone,
thyroxine, propylthiouracil (PTU), warfarin,
tricyclic antidepressant medications, sertraline
(Zoloft), paroxetine (Paxil), other antidepressants,
metronidazole (Flagyl), Nix, Kwellada. |
| 4. |
Medications
applied to the skin, inhaled or applied
to the eyes or nose are almost always safe
for breastfeeding. |
| 5. |
You can still
breastfeed after general, regional or local
anaesthesia. As soon as you are up to it.
Medications you might take afterwards for
pain are almost always permitted. Immunizations
given to the mother do not require her to
stop breastfeeding (including with live
viruses such as german measles, Hepatitis
A and B). |
| 6. |
Get reliable
information before stopping breastfeeding.
Once you have stopped it may be very difficult
to restart, especially if the baby is very
young. |
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