A breastfeeding mother may find herself in a difficult and complex situation when faced with making medical treatment decisions, especially when she is managing or becomes diagnosed with a health concern or chronic illness. As with pregnancy, much remains to be known about the effects of many medications on the breastfeeding infant.
Often the mother and her healthcare provider are left to discuss treatment options with limited information available to them. There are very few large, randomized clinical studies done to evaluate the effects of medications on lactating women and nursing babies, due to both practical and ethical concerns. Small studies are sometimes done to provide valuable information about medication levels in breastmilk, but often the number of participants in these studies is too small to make conclusions about adverse drug reactions and safety risks for the nursing infant.
A breastfeeding mother’s decision about taking a medication can be dismissed by even well-meaning friends, family and healthcare providers. Sometimes mothers will be told to “just stop breastfeeding” in order to take a medication, without consideration of the mother’s wishes and the potential effect on the infant of not breastfeeding. When this advice is given dismissively and the mother does not feel she is given information to make an informed choice, the effects can be profound emotionally and physically.
It is important that breastfeeding mothers seek out a healthcare provider who is knowledgeable and willing to openly discuss the available information on a medication so that they can make a joint, informed decision about treatment options. The labels of most medications instruct a lactating woman to discuss taking the medication with her doctor, but unless the doctor uses the available resources to have the conversation, he or she will not be able to provide a mother with the support she needs to make an informed decision. For example, the Physician’s Desk Reference, an information resource commonly used by healthcare providers, contains little to no detailed information on the use of specific medications in lactating mothers.
Some mothers also have difficulty figuring out who can provide her with information on medications and breastfeeding. After delivery, a new mother often sees her obstetrician for a few weeks or months. After that, she may return to her primary care provider for general healthcare. When she is breastfeeding, however, her own physician may feel more comfortable referring her to the baby’s paediatrician for questions about the compatibility of medications with breastfeeding.
It can be challenging for a mother to navigate the healthcare system, coordinate this care, and find a provider who is willing and able to consider the mother-baby dyad. Sometimes mothers find that a family practice physician who is able to treat both the mother and nursing infant together can bridge this gap. International Board-Certified Lactation Consultants (or IBCLCs®) are healthcare professionals trained in the clinical management of breastfeeding and creating a link between the mother, the baby, and the healthcare team.
When discussing treatment options, the breastfeeding mother and her family’s healthcare providers must consider the mother’s health concerns and balance this against the potential risks to her nursing baby. However, they should also consider her short—and long-term breastfeeding goals and the risks to her and her infant of not breastfeeding as well. This is a complex decision, and open, honest discussion is essential.
Generally, many medications are considered compatible with breastfeeding. However, no medications are completely “safe” and there are benefits and risks to be considered with all medications. Here are some questions that a breastfeeding mother may want to bring to the healthcare team when making a treatment decision:
• What are the possible risks to my infant if I decide to take this medication? Are there any known safety concerns?
• What are the risks to my own health or the health of my baby if I do not take this medication?
• For my infant, are the risks of breastfeeding while on this medication greater than the benefits of breastfeeding?
• Is there another option that is generally considered safer in lactation that may have the same or a similar effect?
• Is this a temporary situation or will I be taking this medication for a long time?
• If I am on the medication temporarily, can I use the method of pumping and dumping my milk in order to continue to stimulate milk production, so that I can resume breastfeeding once I am off the medication?
• Is there a way to take the medication that will minimize how much is passed on to the baby?
• Is this medication sometimes given directly to infants? If so, how does the amount the baby would get in breast milk compare to the amount that would be given to the baby?
• Can you help me understand the properties of this medication? How long does it take to clear from my system? When will I have the highest drug levels in my body? Are the molecules small enough to pass into breast milk?
• How does the age or health of my baby impact this decision?
Angela Quinn is a clinical scientist at Pfizer who has experience in clinical pharmacology as well as other therapeutic areas. She is also an International Board-Certified Lactation Consultant® (IBCLC®) and mother of five who has a special interest in helping mothers to reach their personal breastfeeding goals.