All too often, breastfeeding mothers are told to stop breastfeeding because they need to be on a medication that is thought to be harmful to the baby. Or mothers are advised to “pump and dump” – feed their baby an alternative (donor milk/formula), express their own milk and throw it away in order to maintain their milk supply while on the prescribed drug. For many, this interruption which usually occurs during the early few weeks when breastfeeding is being established, is sufficient to sabotage the entire effort.
To be fair, the information on drugs in breastfeeding that has been available to most doctors in the past is quite limited. Many doctors will give the advise that they give because they feel it is the safest one for the baby. After all, most drug labels warn against their use during lactation. And since carrying out research on breastfeeding mothers and their infants is frowned upon by the scientific community, there has not been a lot of data available on the true safety of these drugs. This puts mothers who need treatment and doctors who want to provide it, in a challenging situation.
The study of the transfer of drugs from mother to baby through her breast milk is a complex one. Not all medications are the same, and their transfer and effects depend on many factors. In general, most drugs that nursing mothers ingest will show up in their breast milk. However, the amount found in breastmilk is usually not more than 1% of the dose ingested by the mother. (Lawrence R. Breastfeeding: A Guide for the Medical Profession. 2011) That amount of drug is generally too small to be of any real consequence.
Thankfully, there are more resources available to us now than in the past. There is a more concerted effort to identify which medications are truly harmful to a nursing infant, and there are more resources and references available to mothers and medical professionals alike.
1. In August 2013, the American Academy of Pediatrics published an update to its guidelines in the article The Transfer of Drugs and Therapeutics into Human Breast Milk: An Update on Selected Topics. In essence, the AAP states that most medications are likely safe for breastfeeding mothers. There is some debate regarding the AAP stand on galactagogues like domperidone (see Dr. Jack Newman’s comments on this here) but for the most part, it is a helpful reference.
2. The online resource LactMed is free to use and has a handy downloadable app. Simply type in the name of the drug you are searching for and it will bring up the available information.
3. Dr. T.W. Hale, author of Medications and Mother’s Milk, has recently released a new app for the iphone and android called InfantRiskCenter. The app costs $9.99 to download and is the most comprehensive database I’ve seen so far. The format is great – simple and easy to read, and there is information is specific to your trimester in pregnancy or the age of the baby you are nursing.
These resources were really made for the use of medical professionals, so please do not self-medicate or self-diagnose. But if you are a nursing mother and being told to stop breastfeeding because you need to take a medication that is deemed “safe” or “probably safe” by one of these references, please share it with your doctor.