Mama`s Milk Gazette - La Leche League of Florida and Caribbean

Mama’s Milk Gazette
La Leche League
of Bermuda Newsletter November
Look Inside
Breastfeeding Through
the Holiday Season.........4
Breastfeeding and
Alcohol………..…...…..….5
2013 Meeting
Schedule
Meetings are held in the
First Floor Conference
Room at King Edward VII
Memorial Hospital on the
second Saturday of the
month at 10:30am. All
pregnant women, mothers
and babies are welcome.
January 12
Is Breastfeeding
Really Important?
February 9
Getting to Know
Your Baby
For
breastfeeding
assistance,
call 236-1120
or email
[email protected]
Check us out on
Facebook:
La Leche League
of Bermuda
2012
Taking Medication While Breastfeeding
Over the years, far too many women have been
wrongly told they had to stop breastfeeding
because they must take a particular drug. If
someone suggests that you should wean
temporarily while taking a certain medication,
keep in mind that the potential risk of mom‘s use
of medication while breastfeeding needs to be
weighed against several factors:
The known risks of formula feeding,
including allergy, increased illness, etc.
Many of the risks of formula feeding are not
apparent for many years.
The risk of baby not going back to the
breast. Many babies have a hard time
returning to breastfeeding after temporary
weaning.
The risk to mom‘s milk supply. Milk supply
may be compromised since pumps do not
provide the same stimulation to supply as
does a nursing baby.
Keep in mind that it is not appropriate to use
pregnancy risk categories to determine the risk
of a drug to a breastfeeding mother and her
baby, since the entry of drugs into human milk is
different than the entry of drugs across the
placenta. Most drugs appear in the milk, but
usually only in tiny amounts. Although very few
drugs may still cause problems for infants even
in tiny doses, this is not the case for the vast
majority.
It is not uncommon to see doctors using the
Physicians‘ Desk Reference for information on
medications and nursing. This reference
contains the package inserts from the
pharmaceutical manufacturers. Almost across
the board, they indicate that the medication
should not be taken while pregnant or
breastfeeding. The warning statements they use
Over the years, far too many
women have been wrongly
told they had to stop breastfeeding because they must
take a particular drug.
are designed to protect themselves from
lawsuits. The information in the PDR is based
on the manufacturer‘s studies on the product,
but not other studies that have been done. In
general the manufacturers have done no
studies on lactating women, and thus say that
there is no information (even if studies have
been done by others).
If you have any questions about a specific
medication, either prescribed by your doctor or
an over-the-counter medication, please contact
La Leche League. We have access to an online
searchable database from Dr. Thomas Hale‘s
Medications and Mothers’ Milk: A Manual of
Lactational Pharmacology. This is a worldwide
best-selling reference for evaluating medication
use and giving pharmacological advice to
breastfeeding mothers.
One of the best online sources for information
on breastfeeding and medications is the
LactMed Database (which became available in
2006), maintained by the National Library of
Medicine. If your doctor does not know about
this resource, spread the word!
The good news is that there are very few
medications that are contraindicated by
breastfeeding, and safer alternatives may be
available, so please contact us to receive
accurate and complete information about your
medication before you make a decision to wean.
Over-the-Counter Medications and Breastfeeding
With the cold and flu season upon us, many breastfeeding
mothers may have questions about over-the-counter
medications and their safety.
General guidelines
Treat only the symptoms you have: avoid a
combination medicine when a single one will do the job.
Short-acting forms of drugs (6 hours or less) are
generally better than the long-acting varieties.
Use nasal spray instead of oral medications when
possible.
Take any medication right AFTER you nurse and only
as needed.
Nasal sprays or gels
Nasal sprays are generally considered compatible with
breastfeeding. Of the preparations available for treatment
of allergic symptoms, the nasal steroids (e.g., Flonase,
NasalCrom) are considered to be, by far, some of the most
effective and safest to use in breastfeeding moms.
Although there is so far no data specifically on these
intranasal steroids, it is known that the plasma levels of the
drug are extremely low, and thus milk levels would be
even lower.
Nasal sprays containing oxymetazoline are probably not a
problem, but oxymetazoline is long-acting and thus not the
first choice for nursing mothers. A shorter acting
alternative is phenylephrine.
Cough Medicines
Name of medication
Codeine
Dextromethorphan
Guaifenesin
** Per Medications’ and Mothers’ Milk by Thomas Hale, PhD (2012 edition)
Cough & sore throat meds
Sore throat sprays or lozenges are generally
considered safe, as are cough drops. Avoid eating
excessive amounts of cough drops containing
menthol. Large amounts of menthol can reduce milk
supply.
Many forms of Robitussin, Delsym and Benylin are
considered compatible with breastfeeding. Always
check the active ingredients, as there are many
versions.
Pain meds
Both Advil/Motrin (Ibuprofen) and Tylenol (Acetaminophen)
are considered compatible with breastfeeding.
Aleve (Naproxen) is also AAP-approved for nursing
mothers, but (per Hale) should be used with caution due to
its long half-life and its effect on baby‘s cardiovascular
system, kidneys and GI tract; short-term, infrequent or
occasional use is not necessarily incompatible with
breastfeeding.
Aspirin use is discouraged in children due to the risk of
Reye‘s syndrome. Although the risk is probably low, it is
also discouraged in nursing mothers because of the
potential risk of Reye‘s syndrome and bleeding.
See Pain medications and breastfeeding for more
information.
Eye drops
Eye drops designed for cold/allergy symptom relief are
considered compatible with breastfeeding.
Page 2
Lactation Risk Category**
L3 (moderately safe)
L1 (safest)
L2 (safer)
Decongestants
Both pseudoephedrine and phenylephrine are generally
considered to be safe for the breastfed baby, but
pseudoephedrine may reduce milk supply.
Be very cautious about taking pseudoephedrine on a
regular basis, as it has the potential to permanently
decrease your milk supply. If you do take
pseudoephedrine and notice a drop in milk supply (many
moms do not, but research shows that it can decrease milk
supply by as much as 24%), simply stop the medication
and take measures to increase milk supply – the problem
should resolve fairly quickly.
Many meds have been reformulated so they no longer
contain pseudoephedrine — they‘re using phenylephrine
instead. Per Hale, ―Because of pseudoephedrine‘s effect
on milk production, many have concerns that
phenylephrine may suppress milk production as well.
There is no evidence that this occurs at all.‖
Antihistamines
Mom‘s use of sedating antihistamines (including Benadryl
and Chlor-Trimeton products) are generally regarded to be
compatible with breastfeeding, but always double-check
the active ingredients as they can vary greatly. Monitor
your infant for possible drowsiness if you use this type of
antihistamine. The non-sedating antihistamines (below)
are generally preferred and are less likely to sedate baby.
The ingredients of Claritin, Claritin-D, Clarinex, Allegra,
Allegra-D, and Zyrtec are generally regarded to be
(Continued on page 3)
Nasal Sprays
Name of medication
Lactation Risk Category**
Beclomethasone (Vanceril, Beclovent,
Beconase)
L2 (safer)
Cromlyn sodium (Nasalcrom)
L1 (safest)
Fluticasone (Flonase)
L3 (moderately safe)
Mometasone (Nasonex)
L3 (moderately safe)
Oxymetazoline (Afrin, some forms of
Sinex)
Phenylephrine (in some forms of Sinex
and Neo-Synephrine)
L3 (moderately safe)
L3 (moderately safe)
Triamcinolone Acetonide (Nasacort)
L3 (moderately safe)
** Per Medications’ and Mothers’ Milk by Thomas Hale, PhD (2012 edition)
compatible with breastfeeding (again – always doublecheck the active ingredients). Loratadine (Claritin) has
been studied and the amount of loratadine that passes
into breastmilk is extremely low. Claritin-D and Allegra-D
have the decongestant pseudoephedrine added (see
above about possible effect on milk supply). Dr. Hale
has said that he prefers the non-sedating antihistamines
(even though they are long-acting) over the sedating
allergy medications.
some anecdotal reports. If you feel that your supply has
decreased, it could simply be a byproduct of decreased
nursing frequency or dehydration due to your illness.
If you feel that a medication is the cause of a sudden
drop in milk supply, then stop taking (or decrease your
use of) the medication – if the medication is indeed the
cause, then supply should increase again soon after you
stop taking it. When using an antihistamine, it can be
helpful to step up your fluid intake quite a bit. As with any
Milk supply: A common concern is that the sedating medication, take it only as needed, and discontinue use
antihistamines might lower milk supply but, per Dr. Hale, as soon as you can.
there is no current research supporting this belief – only
Decongestants
Name of medication
Lactation Risk Category**
Phenylephrine
L3 (moderately safe)
Pseudoephedrine (Sudafed,
Dimetapp Decongestant)
L3 (moderately safe)
** Per Medications’ and Mothers’ Milk by Thomas Hale, PhD (2012 edition)
Antihistamines
Name of medication
Brompheniramine
Chlorpheniramine
Cetirizine (Zyrtec)
Desloratadine (Clarinex)
Dexbrompheniramine
Diphenhydramine (Benadryl)
Doxylamine (Unisom)
Fexofenadine (Allegra)
Loratadine (Alavert, Claritin)
Triprolidine
** Per Medications’ and Mothers’ Milk by Thomas Hale, PhD (2012 edition)
Lactation Risk Category**
L3 (moderately safe)
L3 (moderately safe)
L2 (safer)
L2 (safer)
L3 (moderately safe)
L2 (safer)
L3 (moderately safe) Caution –
particularly if infant has apnea or
other respiratory syndromes.
L2 (safer)
L1 (safest)
L1 (safest)
Page 3
Breastfeeding Through the Holiday Season and Avoiding Holiday Weaning
The holiday season can be stressful for some
breastfeeding mothers with the extra shopping trips,
entertaining family and guests, socializing and activities.
It can be especially challenging if this is your first holiday
with a new baby.
The risk of holiday weaning is not just isolated to holidays,
but is present any time mother and baby are busy and
distracted.
When a nursing mother plans her holidays as much and as
realistically as possible, holiday weaning need not occur
and breastfeeding can continue smoothly through
this busy period. Here are some tips for
nursing through the holiday season:
Too many missed feedings at the
breast combined with supplemental
bottle feeding can lead to an
unintentional premature weaning.
Prioritize feedings. With all
the extra activity, both mom and
baby can get distracted, leading to
delayed or even completely missed
nursing sessions. This can disrupt
a baby‘s mood and temper, increase
your risk of a plugged duct or a breast
infection, and increase the chances of
premature weaning. Try to stick to your
pre-holiday routine – this is important to both your
child‘s and your own well-being.
Mothers should be aware of a disruption in the normal
course of breastfeeding called ―holiday weaning.‖ This
occurs when a baby weans due to the distraction and
celebration of a holiday or other special event. A busy
mother may unintentionally overlook her baby‘s needs. It
may be easy to put off a nursing session when there are
so many demands on her time.
Watch baby’s cues. Continue to keep a close
Bottles of expressed milk or formula or solids may be
offered to tide baby over, or perhaps baby consents to wait
– and wait – for nursing time to come around. Then
suddenly the mother realizes baby hasn‘t nursed at the
breast all morning, or even longer.
baby close to nurse wherever you go.
eye on your baby even if you‘re out shopping or at a
party, and nurse him when he shows early signs of
hunger. Your baby will be more settled if he is nursed
sooner rather than later.
Use a sling or other carrier. This will keep
Take care of yourself. You don‘t have to follow
a strict diet while breastfeeding, but eat healthy foods,
Too many missed feedings at the breast combined with
supplemental bottle feeding can lead to an unintentional
premature weaning. Young babies are particularly
vulnerable to ―holiday weaning.‖ If milk is not removed
frequently from the breasts, a mother‘s body will get the
signal to produce less milk. A decrease in milk production
and milk flow may cause baby to become frustrated and
fussy at the breast. This, in turn, can lead to more
supplemental bottles and even less time at the breast.
This scenario may seem far-fetched, but holiday weaning
is a real occurrence that can catch nursing mothers by
surprise. Some mother and baby pairs have a more
sensitive breastfeeding relationship that can be
jeopardized by just a few days of extra activity.
(Continued on page 5)
Page 4
drink plenty of fluids, and rest when possible to stay
energized. Stressing your immune system can make
you more prone to plugged ducts and breast
infections.
It’s OK to say no. As a mother, your family must
take priority when planning and participating in holiday
events. If an activity will take you away from your
nursing baby, or interfere with his naptime, and you
aren‘t comfortable with that, don‘t be afraid to decline
an invitation. If a well-meaning family member wants
to feed the baby, simply say, ―Thank you for offering,
but we are breastfeeding‖ and smile!
Accept help. Don‘t be shy about accepting or
asking for help with your holiday preparations. But, if
family members or friends want to help, give them a
task, not your baby. You have your baby to nurse and
take care of, so suggest and accept help with
cleaning, cooking, shopping; wherever you can get it!
Face criticism with confidence. During
holiday events, you may encounter unsupportive
comments or unwanted advice on your breastfeeding
or mothering choices. Take a moment now to renew
your confidence in yourself and your decision to
breastfeed your child. Let friends and family
members know that you cherish your breastfeeding
relationship.
What about Drinking Alcohol and Breastfeeding?
‗Tis the season for celebrating and breastfeeding mothers
may be asking how it will impact their baby if they partake
in a cup of delicious eggnog at Thanksgiving, a mug of hot
mulled wine for Christmas or a glass of champagne to
welcome in the New Year.
breastfeeding baby are directly related to the amount the
mother ingests. When the breastfeeding mother drinks
occasionally or limits her consumption to one drink or less
per day, the amount of alcohol her baby receives has not
been proven to be harmful.
Breastfeeding mothers
receive conflicting advice
about whether alcohol
consumption can have an
effect on their baby, which
often leaves mothers feeling
like they have more questions
than answers. So, what
information should a mother
who is considering drinking
while breastfeeding know?
The effects of alcohol on the
Alcohol passes freely into mother's milk and has been
found to peak about 30 to 60 minutes after consumption,
60 to 90 minutes when taken with food. Alcohol also freely
passes out of a mother's milk and her system.
It takes a 120 pound woman about two to three hours to
eliminate from her body the alcohol in one serving of beer
or wine...the more alcohol that is consumed, the longer it
takes for it to be eliminated. It takes up to 13 hours for a
120 pound woman to eliminate the alcohol from one highalcohol drink. The effects of alcohol on the breastfeeding
(Continued on page 6)
Page 5
(Continued from page 5) Alcohol and Breastfeeding
baby are directly related to the amount the mother
consumes.
levels and breast milk production. Thus it is presumed that
the polysaccharide from barley may be the prolactinstimulating component of beer. Non-alcoholic beer is
equally effective.
The American Academy of Pediatrics considers alcohol
compatible with breastfeeding. It lists possible side effects if
consumed in large amounts, including: drowsiness, deep
sleep, weakness, and abnormal weight gain in the infant,
and the possibility of decreased milk-ejection reflex in the
mother. The drug transfer table is available at http://
aappolicy.aappublications.org/cgi/content/full/
pediatrics;108/3/776/T6 and the full text of The Transfer of
Drugs and Other Chemicals Into Human Milk can be found
at http://aappolicy.aappublications.org/cgi/content/full/
pediatrics;108/3/776
Dr. Jack Newman, member of the LLLI Health Advisory
Council, says reasonable alcohol intake should not be
discouraged at all. As is the case with most drugs, very little
alcohol comes out in the milk. The mother can take some
alcohol and continue breastfeeding as she normally does.
Prohibiting alcohol is another way we make life
unnecessarily restrictive for nursing mothers.
Thomas W. Hale, R.Ph. Ph.D., member of the LLLI Health
Advisory Council, says this in his book Medications and
Mothers' Milk (12th ed.): Significant amounts of alcohol are
secreted into breast milk
although it is not considered
harmful to the infant if the
amount and duration are
limited.
The absolute amount of
alcohol transferred into milk
is generally low. Beer, but
not ethanol, has been
reported in a number of
studies to stimulate prolactin
Mama’s Milk Gazette
is produced by
La Leche League
of Bermuda
Editor: Alex Hasselkuss
We welcome your
comments and
suggestions.
Please contact us at
236-1120
[email protected]
or on Faceboook at
La Leche League
of Bermuda
Page 6
When the breastfeeding mother
drinks occasionally or limits her
consumption to one drink or less
per day, the amount of alcohol her
baby receives has not been proven
to be harmful.
Excess levels of alcohol may lead to drowsiness, deep
sleep, weakness, and decreased linear growth in the infant.
Maternal blood alcohol levels must attain 300 mg/dl before
significant side effects are reported in the infant. Reduction
of letdown is apparently dose-dependent and requires
alcohol consumption of 1.5 to 1.9 gm/kg body weight (6).
Other studies have suggested psychomotor delay in infants
of moderate drinkers (2+ drinks daily). Avoid breastfeeding
during and for 2 - 3 hours after drinking alcohol.
Adult metabolism of alcohol is approximately 1 ounce in 3
hours, so mothers who ingest alcohol in moderate amounts
can generally return to breastfeeding as soon as they feel
neurologically normal. Chronic or heavy consumers of
alcohol should not breastfeed.
So go ahead and enjoy a modest amount of holiday cheer if
you are so inclined and raise a toast to a happy and healthy
New Year!
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