I asked a friend of mine, Dorle Verrinder, to answer some common questions about breastfeeding that I often get asked. 
 
She has an M.Sc in Dietetics and a special interest in breastfeeding support. She completed additional paediatric modules with the British Dietetic Association, and undertook a specialist breastfeeding training course with the Association of Breastfeeding Mothers, a breastfeeding charity in England. She is a registered dietitian with the Health Professions Council of Namibia, and a member of the International Lactation Consultants Association (ILCA).
 
Medication and Breast Milk
If you are reading this you have probably decided you want to breastfeed, or you are already breastfeeding – congratulations! There is overwhelming evidence in the scientific literature proving the benefits of breastmilk for the baby as well as the mother, and the more and the longer you breastfeed, the more and the longer these benefits continue.
 
But what about medication? You may be wondering – what if I have pain of some sort, or need to take antibiotics for an infection, will I need to stop breastfeeding? What about my regular prescribed medication which I need to continue – does that mean I won’t be able to breastfeed?
The good news is that there is a wide range of medications that you can safely take while you breastfeed without harming your baby. The benefits of breastfeeding in many cases far outweigh the risks that may exist if the baby is exposed to the medication through breastmilk. Or, if a medication is known to be unsafe for the baby, there is often another medication that can be prescribed in its place.
You may have already checked information leaflets on common medications and found that it always seems to say that the medication is not suitable for breastfeeding mothers. So what does that mean?
 
When a medication is licensed, the manufacturer applies to get the medication licensed for treating a particular condition and a particular group of patients. If the drug is used outside its license, the person who prescribes the medication takes the responsibility. Medications are not tested on breastfeeding mothers, in fact it would be totally unethical to do so. Therefore, the manufacturers must make sure they write on the medication leaflet that the drug is not licensed for breastfeeding mothers. As a consequence, going by a manufacturer’s summary of the medication’s characteristics, very few drugs are licensed for use during breastfeeding.
 
However, this does not mean that these drugs are necessarily “unsafe” during breastfeeding. Few medications that pass into breastmilk reach a level that produces a therapeutic effect in the baby, and therefore it does not usually present a meaningful risk to the baby (there are exceptions of course).
 
To determine a drug’s safety for your breastfeeding baby, a number of factors are considered to make a judgement on whether the medication is likely to harm your baby or not. For instance, how well your baby’s body takes up the drug, how much actually passes into the milk, how the drug is metabolised (some drugs are turned inactive by the liver and are flushed out of the body with the urine without having an effect), whether your baby drinks when the drug has its highest concentration in your system which means more of the drug passes into the milk, and how much milk overall your baby is drinking.
 
Your baby’s age is important – in the first 3 days after birth, your breast allows more substances to pass through. Even though medication passes into the milk more easily in this period, the total volume is still low because your baby takes so little of the colostrum (30-100ml or even less per day). Also, very young babies and preterm babies have immature organs and may not be able to deal with medications as well as older babies.
Some conditions require treatment incompatible with breastfeeding, for instance, if the mother has cancer, she likely may have to stop breastfeeding for the duration of each course of treatment, because the medication may harm her baby. Medications for other conditions, like some type of painkillers or inhalers are generally safe to take meaning that likely you can continue breastfeeding as normal.
 
You can check the safety of specific medications during breastfeeding here: www.breastfeedingnetwork.org.uk.
 
The final decision about whether or not a medication is safe to be taken by you while breastfeeding lies with your doctor who prescribes the medicine. What the prescriber also needs to consider is whether there are any medical conditions in your baby that would make him or her more vulnerable to any effects of the medication, how much of the drug reaches your baby, and how this amount compares to a dose that would be given directly to your baby if it is used to treat children.
 
So what can you do if you have been told by your doctor you need to stop breastfeeding because of the medication you are taking? Discuss with your doctor if there is another medication that can be prescribed, ask your doctor to refer to a prescriber knowledgeable in prescribing during lactation, or your doctor may consult “Hale’s Medication and Mothers’ Milk” which list all the characteristics of a medication and what information is known as to its safety during lactation.
 
Remember, you and your baby are unique in terms of your health and breastfeeding circumstances and each prescribing decision must be made individually.  It is important for the prescriber and you to weigh up the disadvantages for your baby of NOT getting breastmilk, what would happen if you do not receive your treatment, and how the medication may affect your baby.  

If you really need to stop breastfeeding because of your treatment, there are a few things to consider. In an ideal scenario, you can prepare for a breastfeeding break by building up stocks of expressed breast milk and freezing it so that you can feed your own milk to your baby rather than using formula. This will not only save you money, but also ensures that your baby continues to receive your liquid gold and all its protective goodness which formula is lacking. Another thing to consider is that if breastfeeding is interrupted even just for a day or two, your milk supply will be affected, unless you express milk to continue to stimulate the breasts to tell the body to continue making milk. Reducing feeds gradually, especially in the early weeks of breastfeeding, is vitally important to avoid engorgement in the mother.
In conclusion, try to get as much information as possible and don’t be afraid to ask for alternatives when faced with the possibility of having to stop breastfeeding when you are not really ready to do so.
If you would like further support or advice please feel free to contact Dorle. All of my clients and fans receive a free 15 minute telephone consultation with Dorle if you mention you got her details from me.
 
Have a great day!