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Drugs and breastfeeding:
There are actually few medications that are contraindicated during breastfeeding, including
bromocriptine, cyclophosphamide, cyclosporine, doxorubicin, ergotamine, lithium,
methotrexate and phenindione. Many other medications may require temporarily stopping
breastfeeding, are compatible with breastfeeding, can be used with caution, or the effect on
the baby is unknown but may be of concern. If a medication is thought to be incompatible
with breastfeeding, ask if there is an alternative that would be safe for you to take instead.
The kind of advice you get for dealing with these types of common problems can tell you a lot about how knowledgeable and/or supportive your Paediatrician is about breastfeeding. This is important, because prevention and early treatment of breastfeeding problems can help to maximise your chances of long term breastfeeding success. Another way to tell if your doctor supports breastfeeding is by the type of anticipatory guidance that is offered at your doctor visits. Is breastfeeding even mentioned? How is it discussed? At well child visits during the first year I used to ask 'Are you still breastfeeding?' I didn't mean it in a negative way, because I also asked formula fed babies 'Are you still feeding Enfamil/Similac?', but I came to realise that, while not intended, the emphasis may have been seen to be on the word 'still,' like I was surprised that a mom was continuing to breastfeed. Instead, I now ask 'How is breastfeeding going?'
Other anticipatory guidance should provide information about potential problems, such as nursing strikes, biting, nipple pain, engorgement and how to know if a baby is getting enough to eat by the number of stools and wet diapers he is having and how well he is gaining weight. I also regularly, especially in the nursery and at the two week, six month and one year visit, ask about the mother's long term breastfeeding plans. Does she want to continue until her baby is a year old as per the American Academy of Paediatrics recommendations (this also gives me a chance to let her know about this recommendation)? Does she want to continue to breastfeed her toddler? Many people don't recognise that the one year recommendation of the AAP is more a minimum and not a recommendation to wean or not breastfeed your toddler. The AAP policy statement on Breastfeeding and the Use of Human Milk actually states 'It is recommended that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired.'
You may think it doesn't matter if your Paediatrician is supportive of breastfeeding since you can get information and advice elsewhere, including from a lactation consultant or friends and family members, but you should still have a doctor on your side to watch out for, prevent and treat more serious problems, such as dehydration, excessive weight loss, serious jaundice, etc. Simply ignoring your Paediatrician's advice because you think he or she is not being supportive of your breastfeeding can be dangerous in some situations. If you are having problems and don't feel your doctor is being supportive, then you can always ask if you can have an evaluation by a lactation specialist and a recheck in your doctor's office the next day.
Twenty years ago, there was little support for mothers wishing to breastfeed, from both health care workers and the general public. The year was 1981, and I was a new mother living in rural Iowa, with no family near and few friends. Being well aware of the benefits of
breastfeeding, I embarked upon the challenge to breastfeed my first-born son, despite the influences of a bottle-feeding world. I made the decision with the faith that the process would occur naturally. Assuming that was my first mistake. After my son's delivery, the nurses at the hospital gave me minimal instruction. The bulk of that instruction included showing me how to position a silvered spotlight over each nipple, after each nursing session, to reduce any nipple discomfort. Spotlight? There was nothing about spotlights in my college textbooks, nor in the pamphlets my doctor gave me. Egads!
Other than maintaining a healthy diet, I thought being prepared to breastfeed merely meant buying a good nursing bra and some nursing pads! Needless to say, promptly after returning home with baby, daddy was sent out to purchase one silvered spotlight, with clasp, and a package of 40 watt bulbs. Little did I realise just how ineffective this bit of instruction would be. At my baby's two-week check-up, I mentioned to the paediatrician my concern over my milk supply. My son was nursing so frequently, yet he seemed unsatisfied, and I was very sore, to say the least. The paediatrician told me he was gaining weight so everything must be okay and that his irritability was probably just colic. Of course, he could offer no remedy for the colic, since it's cause was unknown, but he did tell me to keep using the light, it would get better. Granted, the light helped, but each feeding delivered excruciating nipple pain, and it never lessened.After struggling with the colic and sore nipples for nearly three months, and diligently engaging in 10-20 minute nipple sunning sessions after each feeding, which were, like clockwork, no farther apart than 1.5 hours, I guiltily surrendered to formula and bottles. The only consolation I was able muster up for my failure was thinking that I, at least, managed to get all that great colostrum into him. Some was better than none.
Consequently, the experience was so disheartening, I was unable to muster up the courage to try it again with his siblings. I basically blamed the whole experience solely upon my inability to breastfeed. Years later, I realized how wrong my perceptions of the experience really were. Simply put, if I had known then that my baby was actually latching improperly, or if I had been given an inkling to monitor my diet for foods he might have been sensitive to, I'm convinced my breastfeeding venture would have been more rewarding and successful for both of us. Fortunately, in today's "Information Age," breastfeeding mothers have access to assistance, through even the most difficult breastfeeding situations, and support from a growing population of breastfeeding comrades. Finding answers is as close as the phone book, the local library and the Internet.
One of the leading organizations providing this access is La Leche League International. LLLI is a non profit organisation dedicated to protecting, promoting and supporting breastfeeding. They offer breastfeeding education and encouragement through mother-to-mother support groups, telephone counselling and extensive interaction with physicians and health care providers. Currently, there are 8,000 Leaders and 3,000 local Groups in the United States alone. La Leche League Groups meet regularly in communities world-wide to share breastfeeding information and the mothering experience. Each year, an estimated 750,000 American mothers call La Leche League with questions and concerns. Telephone counselling is available 24-hours a day, along with access to an extensive library of breastfeeding literature. (U.S. 1-800-LALECHE)
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