Breastfeeding, Drugs & Medications
Have you been told you must not breastfeed because you need to take medication?
That advice may not be accurate.
Before you make any permanent changes to your baby’s feeding, fact-check your doctor or pharmacist.
That is pretty confronting. We rely on our health professionals to give us up-to-date, evidence-based medical advice. So how could they be mis-informed about drugs and breastfeeding?
“Unfortunately, most healthcare professionals simply review the package insert or advise the mother not to breastfeed without having done a thorough study of the literature to find the true answer. Discontinuing breastfeeding is often the wrong decision, and most mothers could easily continue to breastfeed and take the medication without risk to the infant. Even the FDA [US Food and Drug Administration] has recognized this and now recommends that drug manufacturers carry out studies to determine milk levels of their drug.”
The general answer is doctors, pharmacists and other professionals tend to get their information on medications from the manufacturers who develop and market the drugs. These corporate entities are naturally risk-averse, with the Thalidomide disaster of the early 1960s still fresh in their memories. The threat of drugs to embryos and fetuses in the womb is very real and care in prescription is important because when you treat the mother you have no option but to expose the baby. However, breastfeeding is seen to be optional, a life-style choice really, which can be stopped. Ending breastfeeding before medicating mothers effectively removes all potential liability in respect to the baby.
“There are some rare situations in which a mother’s or baby’s illness means that breastfeeding cannot continue. Too often, though, health professionals recommend weaning the baby without thinking. In the vast majority of cases, stopping breastfeeding is detrimental to the baby and the mother and completely unnecessary. A health professional who is truly supportive of breastfeeding will make every effort to find ways for the mother to continue at the same time as helping her to cope with medical conditions.”
However, this blanket approach that all drugs and medications are contraindicated in pregnancy AND breastfeeding is not supported by the ample evidence available. Very few drugs must not be used by breastfeeding mothers. These are very specifically-prescribed medications used for significant medical conditions.
Doctors and pharmacists are often over-worked and under-resourced. They need to effectively resolve the problem in front of them and promptly move on to the next one. Unfortunately they are not always aware of resources beyond those they are used to referencing.
Experts in the field of drugs and breastfeeding include high-profile doctors and pharmacists who reference specific data and provide guidance to practitioners and parents around the world. They provide resources and training to health professionals and mothers which are easily accessible and are referenced and evidence-based.
Canadian Dr Jack Newman explains here: Breastfeeding and Medications Watch this video for detailed discussion about commonly prescribed medications:
US perinatal pharmacologist Dr Thomas Hale is author of the definitive book Hale's Medications & Mothers' Milk 2021: A Manual of Lactational Pharmacology . Dr Hale also established Infantrisk.com and Halesmeds , a database for health professionals.
In Melbourne Pharmacist Mr Rodney Whyte has a background of over 30 years of practice in hospital and community pharmacy, much of which has been as a specialist therapeutic medicines expert. As a part of his current position as a senior pharmacist at the Monash Medicines Information Centre at Monash Health (Victoria), Rodney also delivers presentations to an extensive and diverse range of hospital and community groups. Monash Medicines Information provides independent, therapeutic medicines information and advice for obstetricians, consultants and medical practitioners, midwives and nursing staff, pharmacists, other health-care personnel and members of the public.
Pump & Dump
While mothers might be told to wean immediately to commence a medication, sometimes the breastfeeding is recognised and she is advised to “pump and dump” - discarding her milk and feeding previously-expressed breastmilk or infant formula. The period of exclusion can be anywhere from hours to days - even weeks in extremes - without any reference to data. Estimations are made by everyone from radiographers to nurses who might have no training or experience in lactation or breastfeeding management. Mothers can even be told their child is too old to still be breastfed by administrative staff or allied health professionals arranging referrals for tests.
Before you make any significant changes to feeding your baby, get the facts right. Premature weaning due to maternal medication is increasingly a reason women are not meeting their breastfeeding goals and in the majority of cases this is unnecessary. Mothers who learn the facts after ceasing to breastfeed are rightfully angry and health professionals need to be better-informed to minimise this occurring.
