I'm an Auntie!.......and a debate ques.

iVillage Member
Registered: 03-19-2003
I'm an Auntie!.......and a debate ques.
37
Tue, 09-16-2003 - 11:42am
My SIL had her baby this last week. A precious little boy! Benjamin Ray - he was 3 weeks early, but still 6lbs 11oz and 19in. Hooray!

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?

Michelle

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Avatar for cl_sunny_side_up
iVillage Member
Registered: 03-25-2003
Tue, 09-16-2003 - 12:28pm
I'm with you on this one......L3 would be my limit. And within L3 it would depend on the drug and why I was taking it. If there were a safer drug to take I would opt for that one.


christine


~christine~

iVillage Member
Registered: 03-25-2003
Tue, 09-16-2003 - 12:44pm
I'm not a real risk taker when it comes to things like this, so for me, I try not to take anything. It has to be really bad for me to take even a tylenol-I don't even need one hand to count the # of times. I do have to take synthroid, but I believe that it is an L1, in fact, if I didn;t take it, I could have problems BFing. If there was no other way around it, I guess I might take something that was L3 or lower, after I did research to satisfy myself, but I really don;t want to take any drugs at all.

Janet

Avatar for cl_sunny_side_up
iVillage Member
Registered: 03-25-2003
Tue, 09-16-2003 - 12:48pm
I am more concerned with taking meds while pregnant than while bfing. I wouldn't even take Tylenol for my headaches while pregnant. Didn't drink caffeine.....

It's different wrt bfing for me. When it comes to taking meds, that is. Other things that are avoidable.....should be avoided. But, when *you* need to take something for your own health and well-being. Weigh the risks and benefits.


christine


~christine~

iVillage Member
Registered: 07-31-2003
Tue, 09-16-2003 - 5:52pm
I'll take tylenol. That's about it asidefrom my prenatals and yin Chaio complex. I have high blood pressure and PCOS which I had taken rx's for prior to getting pregnant and will go back on them when I'm done bf'ing. What I found with many perscriptions (my high bp fo rone) is that docs consider it fine to bf and take because there has been hardly ANY research done on the affects it may have on the nursling. And I cannot do that. SO- I eat like a health freak (which I basically am anyway) and exercise my but off...

Kimberley & Baylor

Avatar for yogamom4
iVillage Member
Registered: 04-01-2003
Tue, 09-16-2003 - 6:15pm
i suffer from massive major migraines~~~~ i get all symptoms from blindness in one eye to stuff coming out both ends,, with my first preg i wouldn't even touch tylonol,, i just suffered with my second and 3rd and 4th child the dr perscribed me vicodin,, he said it was much worse for me to suffer than what the meds would do to baby, and for insomnia which i would be up for days in end he perscribed me ambien ,, he said it was safe for pregnancy a catagory b ~ whatever that means~ just in the past few mths i ended up in the er and had to have a shot of morphine in the butt for my migraine and even that didn't take it away,,~~~thats how bad mine are!!!~~~ now i have to self inject with imitrex,,that is the only thing that works and let me tell you 15 min after giving myself the med i am up and ready to go ,, if i didn't have the medicine i could be hiding in bed for up to 2 days,,my older kids would be fending for themselves and i would try having the baby sleep with me all day,, so for me the medicine is better for my whole family if i take it,, the doc told me if i was worried to just pump and dump the first feeding after i take the medicine

yoga

Vicky ~32~

SAHM  To

Kelsey The Brainiac

Avatar for yogamom4
iVillage Member
Registered: 04-01-2003
Tue, 09-16-2003 - 6:16pm
oh and congrats on being an auntie!!!!!!!!!!!!!

yoga

Vicky ~32~

SAHM  To

Kelsey The Brainiac

iVillage Member
Registered: 03-25-2003
Tue, 09-16-2003 - 6:55pm
I don;t take any meds while pg either-just the synthroid, which IS necessary while pg. Uncontrolled hypothyroidism in pg causes higher miscarriage & retardation rates.
iVillage Member
Registered: 03-25-2003
Tue, 09-16-2003 - 9:40pm
I feel totally happy taking L1 and L2 drugs. L3 I'll take if there are no appropriate, safer drugs available. If I needed an L4 drug a lot of things would start to come into play such as the age of my nursling, the type of effect my nursling might experience, the frequency I would be taking the medicine and the length of the course of treatment (a single dose, a week, indefinately...) it would be the sort of decision I would agonise over and would cause me guilt and worry whichever way I chose.

Isabel





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iVillage Member
Registered: 03-26-2003
Tue, 09-16-2003 - 10:27pm
I'm with you Michelle: I'd take L1-3, but would have to read up more on any specific L4 before taking it. :-)

Fio.

iVillage Member
Registered: 03-25-2003
Wed, 09-17-2003 - 8:22am
As most of you know I suffer from chronic depression so I take Effexor to treat it. I am 18.5 weeks pg right now and plan to continue taking it while nursing. Not sure what category it's in (if someone could look it up when they have a chance that would be great). It's an SSRI (selective serotonin reuptake inhibitor) and most studies on SSRI show the risk of fetal abnormalities at about the same as a regular pg (w/o meds) 1-2%. Not treating depression while pg can lead to low birth weight and premature delivery. The benefits outweigh the risks as far as I am concerned.

I left myself untreated during my last pg and I am positive that lead to my inability to endure the trials I was having breastfeeding. So because of that and my desire to bf this baby I will stay on my meds while nursing.

I think I would probably take up to an L3 after that I probably wouldn't risk it.

Judi

P.S. Congrats Michelle on becoming an auntie!!!


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