Abstract
[Extract]
The breastfeeding mother is the sole nutrition source for most infants, especially in the first few months of life. Ideally, mothers would remain healthy, producing milk of optimal quality and quantity. In reality, they may be suffering from lack of sleep, fatigue, dehydration, a chronic medical condition or an infection. It is therefore not surprising that many will require medication (prescribed, over-the-counter or complementary), at some stage while breastfeeding. When faced with the need to take medication, the breastfeeding mother is likely to be anxious. She may have already received conflicting advice from sources including her general practitioner, obstetrician, paediatrician, pharmacist, midwife, lactation consultant, counsellor, family, friends, the media and the internet. 1 The incidence of premature cessation of breastfeeding due to concerns about medication use or medication non-adherence is unknown; however, maternal self-report surveys implicate medication as a contributing factor to early weaning. In a climate of increasing litigation, health care providers need to consider not only the evidence on the clinical significance of drug excretion into breastmilk for an individual woman, but communicate that they have weighed benefit against risk. It is no longer sufficient to simply review the manufacturer's product information, which provides a legal rather than evidence-based perspective on breastfeeding risk. To
adequately communicate the benefit-risk ratio to the mother, the health professional requires an understanding of:
• factors influencing the excretion of a drug (therapeutic medicine or lifestyle) into breastmilk;
• drug influence on milk quantity and quality; and
• how to quantify clinical risk to the infant of drug presence in breastmilk.
While the term 'medicine' has generally replaced 'drug' to describe pharmacological use with therapeutic intent, the more global term 'drug' is more generally used in this chapter, to incorporate all paradigms of use while breastfeeding -therapeutic, lifestyle and illicit.
The breastfeeding mother is the sole nutrition source for most infants, especially in the first few months of life. Ideally, mothers would remain healthy, producing milk of optimal quality and quantity. In reality, they may be suffering from lack of sleep, fatigue, dehydration, a chronic medical condition or an infection. It is therefore not surprising that many will require medication (prescribed, over-the-counter or complementary), at some stage while breastfeeding. When faced with the need to take medication, the breastfeeding mother is likely to be anxious. She may have already received conflicting advice from sources including her general practitioner, obstetrician, paediatrician, pharmacist, midwife, lactation consultant, counsellor, family, friends, the media and the internet. 1 The incidence of premature cessation of breastfeeding due to concerns about medication use or medication non-adherence is unknown; however, maternal self-report surveys implicate medication as a contributing factor to early weaning. In a climate of increasing litigation, health care providers need to consider not only the evidence on the clinical significance of drug excretion into breastmilk for an individual woman, but communicate that they have weighed benefit against risk. It is no longer sufficient to simply review the manufacturer's product information, which provides a legal rather than evidence-based perspective on breastfeeding risk. To
adequately communicate the benefit-risk ratio to the mother, the health professional requires an understanding of:
• factors influencing the excretion of a drug (therapeutic medicine or lifestyle) into breastmilk;
• drug influence on milk quantity and quality; and
• how to quantify clinical risk to the infant of drug presence in breastmilk.
While the term 'medicine' has generally replaced 'drug' to describe pharmacological use with therapeutic intent, the more global term 'drug' is more generally used in this chapter, to incorporate all paradigms of use while breastfeeding -therapeutic, lifestyle and illicit.
| Original language | English |
|---|---|
| Title of host publication | Breastfeeding management in Australia |
| Editors | Wendy Brodribb |
| Place of Publication | Melbourne |
| Publisher | Australian Breastfeeding Association |
| Chapter | 21 |
| Pages | 279-323 |
| Edition | 5th |
| ISBN (Electronic) | 978-1-925766-21-9 |
| Publication status | Published - 2019 |