Being a new mom can be stressful. On top of caring for your newborn, you need to heal physically and emotionally from pregnancy and labor. Sometimes you need medication to feel better. But for women who breastfeed, how do you know which medications are safe for your baby?
We talked to UNC maternal-fetal medicine expert Alison Stuebe, MD, for guidance.
The Breast and Placenta Are Not the Same When It Comes to Medication
When you are pregnant, most of what you consume is passed along to your baby because you are connected by the placenta and umbilical cord. A drug you take can transfer through the placenta and into your baby’s bloodstream.
The breast works differently. Some drugs don’t enter milk at all, and others are not absorbed by the baby. It’s misleading to assume that what can pass to the baby in utero will also pass through breast milk, Dr. Stuebe says.
“Sadly, many providers are ill-informed about this because they presume the placenta and breast work the same way, but they do not,” Dr. Stuebe says. “When I teach medical students during their OB rotation, I ask them if they have seen a placenta that looks like a breast or vice versa. And they look at me like I’m crazy, and I say, ‘That’s because they are not the same.’”
For example, ACE inhibitors, which are used to treat conditions such as high blood pressure, scleroderma and migraines, are not safe during pregnancy because they can damage the baby’s kidneys.
However, they are fine for a breastfeeding mother because these types of drugs do not cross into breast milk, Dr. Stuebe says. So don’t assume that you can’t take something while breastfeeding because you couldn’t take it during pregnancy; find out.
Ibuprofen is another drug that’s not recommended in pregnancy but is safe for breastfeeding moms and their babies. “Most drugs enter milk at very low levels and are safe,” Dr. Stuebe says. “And if a particular drug enters milk at higher levels, there is usually another drug in the same family that is safe to use.”
Find a Reliable Source on Medication and Breastfeeding
Talking to your provider about your medications and concerns is always important, but not all providers are informed on this topic, Dr. Stuebe says.
“I think the first thing for patients to know is they need to go to a reliable source, and there are some wonderful ones available for mothers and providers,” Dr. Stuebe says. “Many providers don’t receive education about lactation pharmacology (medicines’ effect on breast milk), so they aren’t aware of these resources.”
She recommends the National Library of Medicine’s LactMed site.
“You simply type in the name of the drug, and it tells you what we know about its effect on breast milk,” Dr. Stuebe says. “And that information is considerably more reliable than we physicians might get in some drug databases that we carry around on our smartphones.”
That’s because inconsistencies persist regarding drug safety in lactation in commonly used medication databases, according to a recent study by Anitha Muddana, UNC research coordinator in the Department of Obstetrics & Gynecology and UNC School of Medicine.
Pharmacists also use these databases. So even the professionals may be working off incorrect information.
“So what happens is you go to your pharmacy, and the pharmacist uses one of these databases and then slaps a sticker on your medication saying, ‘Do not take this medication when you’re breastfeeding,’ when it’s actually OK,” Dr. Stuebe says. “Then the mom does not take her medication or stops breastfeeding when it was actually fine.”
In addition to LactMed, Dr. Stuebe says UNC Health Care offers a breastfeeding consultation service for mothers in the hospital that is staffed by providers from the departments of Obstetrics & Gynecology, Family Medicine and Pediatrics. Your physician can consult with this physician team, and together they can determine if a medicine is safe for a breastfeeding mother.
Moms can also get high-quality information from MotherToBaby.org or by calling the Infant Risk Center at (806) 352-2519. Nurses and a pharmacologist staff it and continuously update the database to ensure the most up-to-date information.
It’s helpful to print the information you access and bring it to your baby’s next doctor visit. Dr. Stuebe suggests providing it to the office staff when you check in.
“Give your baby’s provider the chance to familiarize herself with the information before she talks to you,” Dr. Stuebe says.
If you have questions about a medicine while you are breastfeeding, visit LactMed or talk to your health care provider.