I'm an Auntie!.......and a debate ques.
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|Tue, 09-16-2003 - 11:42am|
My SIL is not nursing. It is really strange for me, but she has a very good reason. She has to take a medication that is not safe while breastfeeding (L4 rating). It was a risk for her baby to even take it while pg (it is a Pg risk category D), but it is one of those things where the benefit outweighs the risks. After doing her research, she decided that it would be better to not breastfeed and take this med - which I agree with & support her decision (although she is sad to not be bf'ing - she said she is going to look into different meds that should work as well, if not better, for her and are safe to take while bf'ing so she can bf her next baby).
So, my debate question is this - and I know we have touched on it a couple times previously - when it comes to meds & bf'ing, what sort of risk is too great? As you know, Fio & I have a great book called *Medications and Mothers' Milk* that is considered the "bible" of meds & bf'ing. The author has Lactation Risk Categories (much like the pg risk categories) and assigns them to each drug based on studies of lactating women taking the drug and based on what the known properties of the drug are. This is how he breaks them down:
L1 Safest: Drug which has been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possiblity of harm to the breastfeeding infant is remote; or the product is not orally bioavailable in an infant.
L2 Safer: Drug which has been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant. And/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.
L3 Moderately Safe: There are no controlled studies in breastfeeding women, hoewever the risk of untoward effects toa breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant.
L4 Possibly Hazardous: There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits from use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g. if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).
L5 Contraindicated: Studies in breastfeeding mothers have demonstrated that there is significant anddoumented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to the infant. The risk of using the drug in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.
Personally - I feel comfortable taking anything rated L1 & L2. L3, I do feel comfortable taking, but it would depend on the situation & medication. L4, I would have to do research before making my decision - and it would have to be an extreme circumstance and only for a short amount of time - and even then, I would seriously consider pumping & dumping. L5 - these are contraindicated, so it wouldn't even be something to research/consider.
Where do stand? Is something like Tylenol or Advil too big of a risk for you to take while bf'ing (both are L1, btw)? Or is L3 your limit...somehwere inbetween?