Maintaining supply when I can't BF?HELP

iVillage Member
Registered: 12-26-2007
Maintaining supply when I can't BF?HELP
19
Fri, 04-02-2010 - 9:44pm

My daughter is 6 months 1 week old. I have exclusively breastfed her since birth. Unfortunately, I have uveitis and have to use steroids and prednisone drops that are contraindicated while BF'ing to decrease the pressure in my eye and bring my eye back to a normal state. Essentially, the meds are necessary or I could lose vision in my left eye due to the increased pressure.

I was and am extremely upset about this since I LOVE bfing my baby girl. I have been left with no options as the amount can be secreted into the bmilk. So.... my question is... I may be on this medication for 1 week. I am planning on pumping and already am during this time and my husband is going to feed our daughter formula as much as he can during this time.

I have never had issues with supply. She is gaining well. She weighs 21 pounds at 6 months.

Will my supply drop drastically even with pumping? What can I do to ensure that after I stop taking the medication I can have my daughter BF exclusively again?

Will she forget to latch on? Has anyone out there had to stop BFing and then gone back to BFing and been successful???

Should I take funegreek and eat oatmeal? What else can I do???

I am so depressed that I have to stop BFING temporarily and I hope with all my heart that we can go back to nursing exclusively after. Any advice and experience would be greatly appreciated.

TIA,
Alli

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iVillage Member
Registered: 01-12-2006
Fri, 04-02-2010 - 11:03pm

What drugs are you prescribed specifically? I don't have Hales book but someone here will look them up for you. Docs frequently say "don't breastfeed" sort of as a CYA. And I once had a pharmacist tell me I couldn't take Zyrtec and breastfeed (she pointed it out right on the box how it says not too take while breastfeeding) ... but apparently didn't remember that Zyrtec is actually approved for use in infants directly down to 6 mos old (mine was almost 12 mos). At any rate, we are frequently told we can't breastfeed while taking a certain medication. But when you actually look up the info on the drug, it turns out to be fine.

I will say that I once was prescribed steroids for my asthma (Medrol pack I think) and it was actually rated safe for breastfeeding. I'm not sure about prednisone, but I think it's safe too (I know it was given to my own DD for an allergic reaction.

Actually ... here's some info on prednisone, which apparently is approved by the AAP for use in nursing mamas.

Follow up with the drug names and we'll get you more info.

HTH

iVillage Member
Registered: 12-26-2007
Sat, 04-03-2010 - 6:24am

Hi-
Thanks for your reply. The bottle feeding is not going well. I feel so horribly that my daughter and I can't continue to breastfeed until the medication heals my eye. I explained this to my Doctor (not my regular one) and she didn't seem to care at all. She cries and screams when she eats. I am afraid the experience will be so traumatic for her that she will not want to go back to breast feeding. I am so sad. Despite my explaining the importance to my doctor she wanted to prescribe "The strongest" meds out there and simply said..... can't you just give her formula? I am angry and I am going to try and switch to less harmful meds with my regular doctor who was on vacation. I hope to be able to because she is not taking well to formula. She essentially refused to eat last night when my husband tried to feed her.

Here are a list of the medications- they are all eye drops.

Predinlosone I take every three hours- one drop.

Isohomotropin twice a day.

Dorzolamide - Twice a day.

Brimonidine- Twice a day.

Thanks in advance for your help,
Alli

iVillage Member
Registered: 09-10-2009
Sat, 04-03-2010 - 8:13am

I'm looking all your medications up in Dr. Thomas Hale's book "Medication and Mother's Milk" which is THE bible of lactation pharmacology.


Prednisone is lactation category L2 (safer) and AAP approved for nursing moms.


Dorzolamide is L3 (moderately safe) because there

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iVillage Member
Registered: 12-26-2007
Sun, 04-04-2010 - 12:41am

Thanks so much for looking up this information. I am trying to get an appointment with my regular eye doctor for Monday/ Tuesday to see if I can go on a different medication. Have you found any information about the last mediation that I had listed?

I am very concerned since my supply seems to be affected at this point. I honestly don't know what I will do if I dry up? I am pumping every three hours every other breast. Should I do both breasts every three hours? If so, for how long? Does Dr. Hale's book mention that those medications can affect milk supply? How long does it take for supply to dry up if it will? I am just worried (which I know doesn't help) because i DO NOT want to even think about the idea of having to give her formula from now on.

So, how can I prevent this from happening. I am assuming I may have to take the meds for 5 days more. I will eventually taper off and not take as many until it is every other day, every two days, and then nothing.

All the advice you have would be so appreciated. I am in desperate need of keeping my supply up and getting back my daughter to BF again.

TIA,
Alli

P.S. If I have to avoid BFing for 5 days will she forget how to suck at this age?

iVillage Member
Registered: 01-12-2006
Sun, 04-04-2010 - 12:57am

Why are you only pumping one breast every 3 hours? If you are worried about maintaining supply you should be double-pumping every 2-3 hours for 15 minutes minimum or 5 min past the flow of milk. Double pumping will help you in your effort to maintain your supply. What kind of pump are you using? In general, the more milk you remove from the breast (via nursing or pumping) the better.

For the time being, definitely move to double pumping ... do not let 6 hours pass between milk removal from each breast. I have oversupply and would only nurse one side every 5 hours, but when pumping away from my child, I always pumped both breasts simultaneously.

Feel better soon. And definitely stay on top of your doc. Also, don't forget that you can talk with your baby's pediatrician about these meds as well.

iVillage Member
Registered: 12-26-2007
Sun, 04-04-2010 - 1:25am

Thanks for the response and your advice. I REALLY APPRECIATE IT. I am pumping now and using the Avent manual pump. Do you think an electric pump would be better? If so, which one? I am going to switch to double pumping for 15 minutes which is what I am doing now. I just pumped both sides. I was doing only one side since that is how I feed her normally since I have never had a supply issue.

Thankfully my eye is feeling better, but, these meds have to be taken and then I gradually taper off. I am hoping to get an appointment with a doc on Monday to see if he can switch me to less "harsh" meds (the last two are supposedly contraindicated. I am thinking if there is any info that is okay on the last one i may start breastfeeding again. I miss it.

THANKS AGAIN....
Alli

iVillage Member
Registered: 11-06-2006
Sun, 04-04-2010 - 9:16am

Alli,

I just tried searching LactMed for Isohomotropin since that's one of the meds you were having a hard time finding info on, and it's not in their database either (this is the NIH lactation/medication reference). Can you double check the spelling? Is there another name for this drug?

Here's what it says about Brimonidine:

Summary of Use during Lactation:
Limited information indicates that maternal use of brimonidine 0.2% ophthalmic drops do not adversely affect their nursing infants. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.

Drug Levels:
Maternal Levels. Relevant published information was not found as of the revision date.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants:
A woman used brimonidine 0.2%, timolol gel-forming solution 0.5%, dipiverin 0.2%, and dorzolamide 0.5% drops for glaucoma while nursing a newborn. The frequency of medication use and extent of nursing were not stated. All medications were given immediately after nursing with punctal occlusion of the tear duct. The infant's vital signs were closely monitored with no signs of bradycardia or apnea.

A woman was using ophthalmic drops containing 0.5% timolol and 0.2% brimonidine twice daily in the right eye for 6 months. During this time, she breastfed her infant (extent not stated) apparently without harm to her infant.

Possible Effects on Lactation:
Relevant published information was not found as of the revision date.

AAP Category:
Not listed.

Alternate Drugs to Consider:
Brimonidine

References:
1. Johnson SM, Martinez M, Freedman S. Management of glaucoma in pregnancy and lactation. Surv Ophthalmol. 2001;45:449-54. PMID: 11274697
2. Madadi P, Koren G, Freeman DJ et al. Timolol concentrations in breast milk of a woman treated for glaucoma: calculation of neonatal exposure. J Glaucoma. 2008;17:329-31. PMID: 18552619

Substance Identification:

Substance Name: Brimonidine

CAS Registry Number: 59803-98-4

Drug Class:
Adrenergic Alpha-Agonists
Antiglaucoma Agents

Administrative Information:

LactMed Record Number:
775

Last Revision Date:
20090929

Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

And here's Dorzolamide:

Summary of Use during Lactation:
Limited experience with the use of ophthalmic dorzolamide indicate that it is unlikely to adversely affect the breastfed infant. To substantially diminish the amount of drug that reaches the breastmilk after using eye drops, place pressure over the tear duct by the corner of the eye for 1 minute or more, then remove the excess solution with an absorbent tissue.

Drug Levels:
Maternal Levels. Relevant published information was not found as of the revision date.

Infant Levels. Relevant published information was not found as of the revision date.

Effects in Breastfed Infants:
A newborn infant was breastfed during maternal therapy with ocular timolol, dipivifrin, dorzolamide, brimonidine and several doses of acetazolamide. The drugs were given immediately following breastfeeding and no apnea or bradycardia was observed in the infant.

Possible Effects on Lactation:
Relevant published information was not found as of the revision date.

AAP Category:
Not listed, but another carbonic anhydrase inhibitor acetazolamide is rated as usually compatible with breastfeeding.

References:
1. Johnson SM, Martinez M, Freedman S. Management of glaucoma in pregnancy and lactation. Surv Ophthalmol. 2001;45:449-54. PMID: 11274697
2. American Academy of Pediatrics. Committee on Drugs. The transfer of drugs and other chemicals into human milk. Pediatrics. 2001;108:776-89. PMID: 11533352

Substance Identification:

Substance Name: Dorzolamide

CAS Registry Number: 120279-96-1

Drug Class:
Antiglaucoma Agents
Carbonic Anhydrase Inhibitors

Administrative Information:

LactMed Record Number:
98

Last Revision Date:
20090903

Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.

To me it sounds like either of these would be safe to use and breastfeed.

Erica

during pregnancy

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baby

iVillage Member
Registered: 01-12-2006
Sun, 04-04-2010 - 9:23am

I really don't know what to tell you on the pump ... generally I wouldn't think a manual pump ok for more than occasional pumping (possibly even pumping at work). I wouldn't think it the best for maintaining supply. But I also don't think you should need to go buy an expensive electric pump (we'd recommend the Lansinoh for you, which is about $150 and thus substantially less money than the Ameda Purely Yours or Medela PISA that are also good electric pumps). You could see an LC about renting a pump for a month, even though you only need it for a week or so. If you can rent for a shorter period that might be a really good option for you.

I don't know exactly how it works, but I'm fairly certain I've read that double pumping (meaning pumping both breasts at the same time) raises prolactin levels. Since the pump doesn't stimulate the breast as well as nursing hopefully you won't end up in a major oversupply issue again. I'm just afraid that w/o any nursing at all, pumping one breast every 3 hours w/ a manual pump is going to cause you to experience a dip in supply that you'd have to work hard to reverse for a couple of weeks after returning to nursing.

Glad you're feeling better. And hope you get to your normal doc soon.

iVillage Member
Registered: 12-26-2007
Sun, 04-04-2010 - 12:26pm

Thank you so much Erica for putting all this information on here for me. I truly appreciate it especially since she WILL NOT eat. We have tried syringe, cup, bottle and it is all not going well. She has not eaten well at all and screams and pushes when we try and feed her.

I did misspell the medication you couldn't find... the correct spelling is ISOPTO Homatropine also called (homatropine hydrobromide opthalmic solution).

THANKS SO MUCH FOR YOUR HELP. I really appreciate it.

Alli

iVillage Member
Registered: 12-26-2007
Sun, 04-04-2010 - 2:15pm

Thanks again for your help with this. I am at my wits end with worry since she is refusing to eat. We have to force her, she doesn't seem like herself. She still is having wet diapers, but, not as many. I am waiting for the pediatrician to call me back too. I hope this is over soon. THANKS so much for your help and your encouragement.

Alli

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