You Can Still Breastfeed

by Jack Newman, MD, FRCPC

Introduction

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:





  1. 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.
    Medications applied to the skin, inhaled or applied to the eyes or nose are almost always safe for breastfeeding.
  2. You can still breastfeeding 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.
  3. Immunizations given to the mother do not require her to stop breastfeeding (including with live viruses such as german measles, Hepatitis A and B).





Get reliable information before stopping breastfeeding. Once you have stopped it may be very difficult to restart, especially if the baby is very young.

Breastfeeding and Maternal Illness

Very few maternal illnesses require the mother to stop breastfeeding. This is particularly true of infections. Most infections are caused by viruses. Most infections caused by viruses are most infectious before the mother realizes she is sick. By the time the mother has fever (or cold, runny nose, diarrhea, vomiting, rash etc), she has already passed on the infection to the baby. However, breastfeeding protects the baby against infection, and the mother should thus continue breastfeeding, in order to protect the baby. If the baby does get sick, he usually is less sick than if breastfeeding had stopped. But often mothers are pleasantly surprised that their babies do not get sick at all. The baby was protected by his mother's continuing breastfeeding.

The only exception to the above is HIV infection in the mother. Until we have more information, it is considered safer for the baby that the mother who is HIV positive not breastfeed, at least where the risks of bottle feeding are acceptable. There are situations, however, even in Canada, where the risk of not breastfeeding is elevated enough that the mother who is HIV positive should nevertheless breastfeed her baby. The final word is not in, however.

Most other maternal illnesses raise questions because of the drugs the mother might have to take. These should rarely be a problem (see above).

X-rays and scans: Ordinary X-rays do not require a mother to stop breastfeeding even when used with contrast (e.g. IVP). A CT scan, MRI scan, even when used with contrast do not require a mother to stop. A radioactive scan (e.g. lung scan, bone scan) does not require a mother to stop. The only exception is a thyroid scan. However, most of the time the scan does not have to be done. See below.

A not uncommon problem in the early months after delivery is a condition called postpartum thyroiditis, a temporary derangement in the thyroid gland's function. A useful test to help understand the condition is a thyroid scan. However, the test requires that radioactive iodine be given to the mother and this material must not be given to nursing mothers. The radioactive iodine will be found in the milk for weeks, and concentrated in the baby's thyroid. There are ways of dealing with postpartum thyroiditis without doing this test. The drugs a mother might have to take to treat postpartum thyroiditis are compatible with continued breastfeeding (e.g. propranolol, propylthiouracil)

Breast Problems

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By alicel on 11/08/11 at 4:32 pm

From what I understand, not enough of the drug is in breast milk to be active, however it is still present. The drug sertraline has also been linked wit  ...

By Twinkle on 06/22/09 at 3:55 pm

I agree, its a great article. I think the information about medications was really helpful. Dr. Jack Newman is such a wonderful resource to the nursin  ...

By Madeline410 on 06/22/09 at 2:07 pm

This is a great article. I feel that too many moms think that they have to stop nursing when a problem comes up. I would love to see more encouragement   ...

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