Some of the new features added to Medications and Mothers’ Milk 2008, thirteenth edition include:
- More than 70 new drugs.
- Rigorous updates to hundreds of drugs and tables.
- Updated tables on radiocontrast agents.
- Updated tables on cold and cough remedies.

Buy Medications and Mothers’ Milk now!

Post from: Breastfeeding 1-2-3

Chlorphenesin relaxes skeletal muscle and can depress the central nervous system and cause respiratory depression (slow or shallow breathing) in infants. Phenoxyethanol is a preservative that is primarily used in cosmetics and medications. It also can depress the central nervous system and may cause vomiting and diarrhea, which can lead to dehydration in infants.

Mothers should discontinue use of the product and watch for the following signs of infant distress (and seek immediate medical assistance for any of these symptoms):

~ decrease in an infant’s appetite
~ difficulty in awakening the child
~ limpness of extremities
~ decrease in an infant’s strength of grip
~ a change in skin color.

Mothers using the cream may suffer from dermatitis as well.

The FDA says consumers are strongly encouraged to report adverse events related to this product or any FDA approved product to MedWatch, the agency’s voluntary reporting program, by e-mail at www.fda.gov/medwatch/report.htm, or by phone at 800-332-1088, or by fax to 800-332-0178. Consumers may also mail reports of adverse events to MedWatch, Food and Drug Administration, 5600 Fishers Lane, Rockville, MD, 20852-9787.

Thanks to Marijke at the new b5media pregnancy blog, Womb Within, for the information on this story!

Post from: Breastfeeding 1-2-3

Breastfeeding has been shown to reduce stress and protect maternal mood. Breastfeeding also reduces stress of babies of depressed mothers and protects them from the harmful effects of maternal depression. Treatment approaches that are anti-inflammatory have efficacy in treating depression. These include EPA and DHA, exercise, cognitive therapy, herbal anti-depressants such as St. John’s wort, and standard antidepressants.

Unfortunately, many breastfeeding mothers will get poor medical advice from their doctors about the benefits and risks of traditional anti-depressant medications or alternative depression treatments while breastfeeding.

Treatment Options for Postpartum Depression in Breastfeeding Mothers

Check out these resources for information:

~ the study quoted above: Kendall-Tackett, K. “A New Paradigm for Depression in New Mothers: the Central Role of Inflammation and How Breastfeeding and Anti-Inflammatory Treatments Protect Maternal Mental Health.” International Breastfeeding Journal. 2007, 2:6 (March 30, 2007).

~ Thomas W. Hale Ph.D.’s Medications Forum

~ the lactation and medication LactMed database

~ the American Academy of Pediatrics Transfer of Drugs and Other Chemicals into Human Milk

~ Kellymom.com on alternative treatments for postpartum depression

~ Kellymom.com on psychiatric medications and breastfeeding

Technical Resources for Medical Professionals and Others:

~ Depression In New Mothers: Causes, Consequences, And Treatment Alternatives by Kathleen Kendall-Tackett, Ph.D., IBCLC; see La Leche League book review here.

~ The latest edition of the drug and lactation guide Medications and Mothers’ Milk by Thomas W. Hale, Ph.D.

More on Mental Health

For more posts on mental health, see the mental health theme day round-up by Alicia at Mental Health Notes.

Your Experience

Breastfeeding mothers, please feel free to leave a comment about your personal experience with depression. As always, I remind mothers to consult a physician when considering any treatment (traditional or alternative) while breastfeeding.

Post from: Breastfeeding 1-2-3

Oversupply

When my first daughter was born, I struggled with oversupply. In theory oversupply sounds great because it eliminates any worry about having enough milk for the baby. In reality, it can cause a lot of problems including painful engorgement, an overactive letdown (which can cause the baby to choke, sputter, and pop off the breast), a foremilk-hindmilk imbalance (leading to green and gassy stools), plugged ducts, and mastitis.

I wish I had known more about correcting oversupply in the first place. In the end it took about 12 weeks for my supply to regulate.

Plugged Ducts

Off and on over that first year, I experienced several plugged ducts:

~ Kellymom on Plugged Ducts and Mastitis
~ NEW BEGINNINGS article on Plugged Ducts

I became adept at hand-expressing to remove the little white milk plug that was blocking the milk duct. One time, though, I found that I had damaged the nipple skin at the site of the plug, and the sore simply would not heal. I tried Lansinoh and I tried expressing breast milk on the nipple and letting it air dry. The white, cracked sore did not go away.

Thrush

Eventually I spoke to a La Leche League leader, who suggested I consult my doctor to see whether it could be thrush. I wasn’t in terrible pain and my baby didn’t have white patches in her mouth, but thrush can exist without such symptoms or signs. My gynecologist first prescribed Nystatin for me and my baby, and when that didn’t work, we moved on to Diflucan. (I also sanitized all of my clothing and any toys or other items that had been in my baby’s mouth). When Diflucan didn’t work either, I began to suspect I didn’t have thrush (that’s what I think in retrospect), or I had a stubborn case.

Gentian Violet and Grapefruit Seed Extract

I started looking for alternative remedies for thrush, and happened upon information about using Gentian Violet:

~ Using Gentian Violet – Dr. Jack Newman
~ Thrush Remedies including Gentian Violet (see also the warning on its use) — AskDrSears.com

Gentian violet is purple and does indeed stain your nipples, baby’s mouth, and clothing. I bought a few pink/purple outfits and put my baby in them for the duration of our treatment! Whether or not I actually had thrush, this is the product that finally helped my nipple heal.

Later on I learned about grapefruit seed extract and its antimicrobial properties. I tried Nutribiotic – GSE Liquid Concentrate anytime I had an open sore, or my baby developed a yeasty diaper rash. I also take it internally when I’m battling a bout of plugged ducts and/or mastitis. It’s also an effective cleaner! Just make sure you dilute it. Plain sterile water works for topical applications, and a little orange juice (or grapefruit juice!) works well to mask the bitter taste when you take it internally. A small bottle of GSE seems expensive ($10.50 or so on-line or at a natural foods store) but a little goes a long way and I still have my original bottle four years later.

~ Grapefruit Seed Extract for Treatment of Thrush – AskLenore.com
~ Identifying and Treating Thrush (with GSE) – Dr. Jay Gordon

It’s convenient that these remedies do not require a prescription, but as always, consult your physician, your child’s physician, and/or a pharmacist before using any medication.

Other Participants in the Carnival

~ Tongue Tie – Motherwear Breastfeeding Blog
~ Supplementing – Mama’s Magic
~ Oversupply, Blebs, Plugged Ducts, and Mastits – Half Pint Pixie
~ Plugged Ducts and Mastitis – Speech Act
~ Low Milk Supply and the Mini-Pill – Tales of Life with a Girl on the Go
~ Getting Rid of Thrush – Nurturing Notes
~ Sore Nipples, Engorgement, and Medications – BreastfeedingMums
~ Surviving Mastitis – Blessed Nest Perch
~ Supplementing during the First Week – Hobo Mama

Post from: Breastfeeding 1-2-3

VideoJug: Does general anesthesia affect breastfeeding?

Post from: Breastfeeding 1-2-3

What are they you ask? Let me give you a few…

1. Babies that are breastfed have a reduced risk for developing diabetes later on in life.

2. Prolonging the introduction of cow’s milk in genetically at risk babies may also give them a “leg up.”

3. Moms who are insulin dependent will most likely use less insulin while breastfeeding and it is absolutely compatible and safe in conjunction with breast milk. The insulin molecule is very large and does not pass through to the breast milk.

Now, there are some considerations that go along with breastfeeding while diabetic. For one, you are at risk for developing skin infections and mastitis. Newborn jaundice is also more common in breastfed babies, but that is easily treated. And I absolutely advise any diabetic mother to coordinate her breastfeeding efforts with her OB/Gyn, PCP and endocrinologist. Medications, hormone levels and blood sugars need to be closely monitored.

But by all means… go ahead and put that baby to breast. Living with a chronic disease like diabetes should not inhibit you from enjoying all that comes with “mommyhood”!

Post from: Breastfeeding 1-2-3

Ultra-fast codeine metabolism occurs in people who have a mutation in the gene coding for a liver enzyme called CYP2D6. The mutation is uncommon, but not rare. [Sandra Kweder, MD, deputy director of the FDA's office of new drugs] says it occurs in 1% to 10% of Caucasians, about 3% of African-Americans, about 1% of Hispanics and Asians, and — surprisingly — in some 28% of North Africans, Ethiopians, and Saudi Arabians.

The Bottom Line for Nursing Mothers

Does this warning mean that breastfeeding mothers should avoid prescription and over-the-counter medications with codeine, or that women who need pain medication after giving birth should not breastfeed? That’s not the case at all. “This announcement today does not mean women who need pain medicine should not breastfeed. The benefits of breastfeeding are well documented,” said Janet Woodcock, MD, the FDA’s deputy commissioner and chief medical officer, in a press conference about the warning. The FDA simply advises doctors to prescribe the lowest dose of codeine needed for the shortest amount of time, and advises nursing mothers to watch for signs of morphine overdose in their infants. Signs of morphine overdose in a nursing baby include:

* increased sleepiness,

* difficulty breastfeeding,

* breathing difficulties, and/or

* limpness.

Of course any mother who notices such symptoms in her infant should seek medical attention. For more information on the use of codeine during lactation, search the LactMed database for “codeine.”

Post from: Breastfeeding 1-2-3

A: Domperidone is an anti-nausea medication that also happens to increase serum prolactin in women. It’s used in combination with frequent nursing or pumping to induce lactation or increase milk supply.

Domperidone is readily available outside the United States but is not available through most pharmacies in the U.S. It’s not illegal though and women can order it with a doctor’s prescription through “compounding pharmacies” in the U.S. or without a prescription directly from pharmacies in other countries.

Dr. Jack Newman and lactation consultant (and adoptive mother) Lenore Goldfarb have developed three protocols for induced lactation: (1) the Regular Protocol for women who have six or more months before bringing a baby into the family, (2) the Accelerated Protocol for women with little time to prepare for arrival of the baby and for re-lactating women, and (3) the Menopause Protocol for women who are menopausal due to surgical removal of the reproductive organs or naturally occurring menopause. Each of these protocols involves taking domperidone.

In June 2004, the U.S. Food and Drug Administration issued a warning against the use or import of domperidone. A reading of the warning raises two concerns: (1) is domperidone safe, and (2) is it illegal to import it into the U.S.? The easy answer first–In spite of the harsh warning about importing the drug, Dr. Newman explains:

It is perfectly legal for a US doctor to prescribe domperidone even though it isn’t available in the US [see exception below]. Any Canadian pharmacy can send you domperidone if you get a prescription from your doctor. And it is legal for a US citizen to bring domperidone into the US for personal use provided it is accompanied by a doctor’s prescription, a letter stating that the medication is for the patient’s personal use, and the shipment does not exceed a 3 month supply.

Domperidone is also available from compounding pharmacies in the U.S. with a prescription, and countries other than the U.S. and Canada without a doctor’s prescription. According to Dr. Newman, a doctor’s prescription is not necessary to import the drug as long as the drug is not a controlled substance, it is for personal use, it does not exceed a three-month supply, and the patient lists the name and address of a doctor who will be overseeing the patient’s use of the medication.

As always, when a woman has questions about the safety of a particular medication, she should consult her doctor, do her homework and make an informed decision. The good news is that domperidone is approved by the American Academy of Pediatrics for use by breastfeeding mothers. Domperidone is listed as a medication “usually compatible with breastfeeding” and there are no reported signs or symptoms in the infant.

With respect to the FDA warning, the Breastfeeding Answer Book says:

Note: In June 2004, the US Food and Drug Administration (FDA) advised that domperidone should not be used by breastfeeding mothers. Members of the La Leche League International Health Advisory Council are questioning this.

In Thomas Hale Ph.D.’s Medications and Mothers’ Milk he has this to say about the FDA caution:

Recently the US FDA issued a warning on this product stating that it could induce arrhythmias in patients. These claims were derived from data many years old where domperidone was used intravenously as an antiemetic during cancer chemotherapy…. Many of these patients were undergoing extensive chemotherapy and were extremely ill, and hypokalemic to begin with. Further, intravenous domperidone produces plasma levels many times higher than oral use. Thus far, we do not have any recently published date suggesting that domperidone used orally in breastfeeding mothers is arrhythmogenic.

p. 278. Domperidone is also discussed on Dr. Hale’s medications forum.

Further drug information can be found by searching for “domperidone” in the LactMed database I wrote about here.

Post from: Breastfeeding 1-2-3

One simple–and free–option is to breastfeed an infant while the shot is administered, a technique advocated by the American Academy of Pediatrics.

On a friend’s advice, Jennifer Astman of Santa Monica, Calif., decided to nurse her 2-month-old son while he was given three vaccinations earlier this year. She told the nurse about her plan, and the nurse was fine with it, she says. “I was so focused that I didn’t get a chance to get upset,” says Ms. Astman, who was very nervous going into the appointment, “and as a result the baby was more calm.”

Chernova, Yuliya. “Just a Spoonful of Sugar…” Wall Street Journal. B9-B10 (April 3, 2007).

I first learned of this technique from my childhood friend Jen (remember the “Cheap and Easy” one?) I’m sorry to say though that when I attempted to nurse my baby while shots were administered, the nurse barked a stern warning at me, “She’ll bite you!” Why I listened to her I’ll never know. It’s highly unlikely my avid nurser would bite and even less likely she’d break the skin. Lesson learned and I will use that memory to remind myself to speak out in favor of breastfeeding and to stick up for what’s best for my baby.

The notion that breastfeeding helps with pain management is rooted in science. The BBC reports that breastfeeding relieved pain from a needle prick for blood testing better than swaddling, using a pacifier or giving a placebo.

The researchers say that the key to the effect of breastfeeding may be that an infant simply draws comfort from the close proximity of its mother.

Alternatively, breastfeeding may help to divert attention away from the pain of a needle prick.

They also suggest that the sweetness of breast milk may be a factor.

Another theory is that breast milk contains a high concentration of a chemical which could ultimately trigger the production of natural painkillers called endorphins.

“Breastfeeding ‘kills baby’s pain.’” BBC News. (July 19, 2006).

Post from: Breastfeeding 1-2-3

If a baby manages to bite, check for broken skin. Rinse the nipple with water. While generally mothers are told not to use soap on their breasts (both because the scent might bother the baby and because soap removes essential oils on the breast), if there is an open wound, a mother should consider using a mild non-antibacterial soap once a day to prevent infection. Another option is to make your own saline rinse described by Kellymom. Rinse with plain water and pat dry gently. Then express some breast milk onto the sore and let it air dry. Breast milk has antibacterial and healing properties and sometimes that’s all it takes to get a sore to heal. Lansinoh nipple cream is also helpful. It helps with moist wound healing and it’s bacteriostatic.

According to the Breastfeeding Answer Book, another option for healing the wound is a topical antibiotic ointment like Bactroban or Polysporin. Absorption through the skin is minimal so very little gets into the breast milk and it is metabolized quickly by the baby. Alternate this treatment with lanolin cream.

If the wound does not heal or starts to get worse, or signs of a infection appear such as redness, pus, tenderness and warmth to the touch, seek medical attention. A doctor may prescribe an all-purpose nipple ointment and/or oral antibiotics to help resolve the problem.

It’s important to continue removing milk from the breast as the mark heals. If nursing is uncomfortable, try starting the nursing session on the other breast first and switch to the sore side second when the baby will not be sucking as hard. Experiment with different positions. Use a breast pump or hand express.

It’s not easy dealing with this situation but it can be worked through and it’s worth it!

Post from: Breastfeeding 1-2-3