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Date: Thu, 05 Oct 1995 18:56:11 EDT
From: LHSQ76A@prodigy.com (Dr Valerie D Raskin)
Subject: Medications in general during breast feeding
As in pregnancy, the issue is one of weighing the alternatives. No one would ever suggest that [a psychotropic medication] should be added to milk or formula. However, one needs to weigh the individual case: what are the risks of untreated maternal illness (many committed breast feeders will choose to be sick rather than to wean), what are the known benefits of breast milk (a summary: fewer infant infections, proper jaw formation, possibly a lower risk of obesity later, highly emotionally gratified mother-infant dyads -- a recent study even indicated a lower risk of breast cancer), and what are the known or possible adverse effects of the medication. People who follow this issue closely fall into one of two categories: 1) those who have concerns about the "unknown" neurodevelopmental effects and therefore avoid medication and 2) those who find it hard to get too excited about very tiny levels of exposure and so watch the baby closely for sleep, appetite, bowel changes and developmental milestones.
From: LHSQ76A@prodigy.com (Dr Valerie D Raskin)
Date: Fri, 21 Jun 1996 14:16:27, -0500
Subject: Medications in general during breast feeding
Breast milk conveys more than a bottle and really wonderful cuddling. Breast milk is the recommended feeding method according to the American Academy of Pediatrics, Public Health Service, AFP, and AMA.
Date: 18 Jul 96 04:22:33 EDT
From: Leslie Gise <76106.413@compuserve.com>
Subject: Medications in general during breast feeding
Drug levels may be concentrated 30-40 times in the infant's brain over blood levels. The blood brain barrier is not well developed in an infant. Drug levels in breast milk and serum levels in a baby are not entirely reassuring. Breastfeeding is a wonderful thing but it is not necessary. And why would one want to poison a newborn baby with an immature brain, liver, and kidneys? At least during pregnancy the drug is metabolized by the mother's organs and goes through the placenta. I would try to get her to wean the baby. If it is an emergency you can start the drug first and then talk about weaning. Pediatricians do not seem sufficiently alarmed about this. We will never be able to judge subtle neurobehavioral effects.
Date: 18 Jul 96 23:49:59 EDT
From: Leslie Gise <76106.413@CompuServe.COM>
Subject: Medications in general during breast feeding
You cannot get all women to go along with this since they glorify breastfeeding and it becomes a symbol of being a good mother. But I have my point of view. I know others don't share it. Many women who did not get to breastfeed for other reasons, but took psychotropic drugs, are really happy years later. Several have said this to me. Some are those who have started national lay groups for postpartum depression. One said she would have worried for 10 years of her daughter's life that every time something went wrong it was because of her taking meds when she was breastfeeding. Just because women kick and scream that they want to breastfeed does not mean that they will not be grateful years later if you help them not do it. Think about it.
Date: 24 Jan 97 21:32:20 EST
From: Leslie Gise <76106.413@compuserve.com>
Subject: Medications in general during breast feeding
There are no good data, so it is a matter of clinical judgment. Psychiatrists do not agree. There is a difference between what we do and what we recommend. I have done a lot of this work. I do not believe in breastfeeding while taking medication. It is not big deal to bottle feed a baby. Millions of people have been bottle fed and they are fine. I believe it is a process. I talk about it with the woman, don't get hysterical, and see if I can get her to wean the baby, gradually, under the supervision of the pediatrician. If not, I tried.
Date: Sat, 1 Mar 1997 00:25:02 -0500 (EST)
From: bb281@freenet.carleton.ca (Ann Van Regan)
Subject: Breast feeding
Lately there have been a number of postings concerning lactating women and the safety of medications for both moms and babies.
La Leche League International is an authority on preserving the nursing relationship in special situations.
Two services that they offer may be of interest to members.
I thought this might be helpful. I'm not even a member anymore, but was a leader in my early mothering and midwifery days.
Date: 07 Apr 97 13:45:08 EDT
From: Leslie Gise <76106.413@CompuServe.COM>
Subject: Medications in general during breast feeding
I believe we are responsible to adequately prepare our patients for decisions about this. With a planned pregnancy, I always introduce the option of not breastfeeding as the safest. Many women are appreciative of this conservative point of view. Hitting them with weaning at the last minute may be traumatic. If they accept the idea of not breastfeeding even before they get pregnant, it is much easier, and a better (kinder) way to handle it clinically.
From: BJSCHWARTZ@delphi.com
Date: Mon, 07 Apr 1997 19:55:27 -0400 (EDT)
Subject: Medications in general during breast feeding
There ia a "teratology hotline" in Utah that evaluates all meds in terms of conception and on through nursing. The number is (801) 328-2229. Call them once and they will give you a local number.
Date: Wed, 30 Apr 1997 15:50:00 -0600
From: CClarkMD <CClarkMD@concentric.net>
Subject: Medications in general during breast feeding
There are some well documented "no-no"s, but then there are the issues of risk of no treatment and difficulty of giving up breastfeeding. There are clearly times where breastfeeding is the least of your concerns because of the risks of say a post-partum bipolar depression with mild psychosis and passive wishes of harm to self or baby. I always consult with the pediatrician regarding any situation where psychotropics must be considered.
From: LHSQ76A@prodigy.com (Dr Valerie D Raskin)
Date: Wed, 21 May 1997 15:13:47, -0500
Subject: Medications in general during breast feeding
A principle that is useful in treating lactating a woman is to consider the age of the infant. The older the baby, the better their ability to clear any medication and the less likely they are to rely on breast milk as their only food. Since medications diffuse rather than accumulate in milk, a baby who relies solely on milk for nutrition is likely to get a higher exposure than a baby who nurses less often or takes other sources of nutrition and fluid. If the mother or physician is extremely uncomfortable prescribing, the mother could give the baby formula (or cow's milk or juice) in lieu of the next feeding, an especially useful strategy when one is prescribing short acting medications.
I find it helpful to talk to the pediatrician. They are very pro-breast feeding and usually much more comfortable and experienced in making these tough clinical judgment calls. It also helps the patient, since it can be very distressing if she receives two contradictory medical opinions.
Date: 01 Jun 97 21:12:47 EDT
From: Leslie Gise <76106.413@compuserve.com>
Subject: Medications in general during breast feeding
It is always my first choice to get a woman off drugs if she is pregnant or breastfeeding, but it is a risk benefit decision. If the mental illness is too severe or too brittle or she starts to relapse when the dosage is slightly lowered, that influences the decision.
This topic is indexed under the following subjects:
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Dr. Bob is Robert Hsiung, MD,
dr-bob@uchicago.edu
URL: http://www.dr-bob.org/tips/split/Medications-during-breast-.html
Original tips copyright 1994-97 original authors.
Web page copyright 1995-97 Robert Hsiung.