Ask the Midwife Taking Medications While Breastfeeding

by Gail Chapin,
Certified Nurse Midwife


My last column answered a question one of our readers had about taking certain medications for some dental work she needed to have done while breastfeeding. In addition to the information I gave her regarding the specific medications she was going to use, I want to discuss some more general guidelines for taking medications while nursing. There are several points to consider when deciding whether or not a drug is safe to take while nursing.

AGE: The older a baby is, the better he can metabolize drugs that get into the breast milk.

YOUR NEEDS: A healthy baby needs a healthy mother. Sometimes, your need for a certain medication maybe more important. In these cases, you might try pumping and discarding the milk until you are finished taking the medication. Ask your health care provider if there is an alternative medication that would be safe to take while nursing.

DURATION OF TREATMENT: If you have a chronic health problem, such as high blood pressure, you may be taking a drug over a long period. But maybe you need medication for only a few days, as is usual with many antibiotics, or even just once, as with an anesthetic for a dental procedure or an X-ray. If only brief drug therapy is needed, you can avoid exposing your infant to harmful amounts of the drug with minimal disruption to your normal pattern of breastfeeding.

DRUG HISTORY: If a drug has been used for many years - especially if it has been given frequently to infants or to nursing mothers - the risks it poses to the breastfed baby are quite predictable. This is not so, however, for a drug that is new on the market, or one that has never been used in children or infants.

EFFECTS ON MILK PRODUCTION: Certain drugs can decrease a mother’s milk production. Be sure to ask about this.

PERSISTANCE OF DRUG IN THE BLOODSTREAM: Some drugs are eliminated from the body after only a few hours, whereas others remain a long time and accumulate. Accumulation potential is measured by the “half-life” of the drug; “Long-acting” drugs - those with long half-lives - are more likely to persist in milk than are “short-acting” drugs, those with short half lives. Long-acting drugs are also more likely to accumulate in the baby and affect her health.

COORDINATING FEEDINGS AND DOSAGE: If a drug is short-acting, or quickly eliminated, you may be able to time the doses in a way that will minimize the amount of drug in your milk peaks between feedings. If you are on a once-a-day medication, you might take it after the last feeding of the evening, and substitute milk expressed during the day or formula for the nighttime feedings; by morning the amount of drug in your milk may be down to an acceptably low level.

Do you have a question about pregnancy, birth or women’s health? Send it to:

Gail Chapin CNM
The Birth Place
14478 Molly Pitcher Highway
Greencastle, PA 17225
Or call, 717-593-9173.