Breastfeeding, Medication, and the Right to Choose
By Lindsey Rock
Before I had Harper I knew I would breastfeed her. I did not know of anyone currently breastfeeding. But I knew it was right for us.
I have Crohn’s disease and am diagnosed bipolar, so I have spent most of my life on one medication or another. I have always been a good girl and done what the doctor says. When I became pregnant I went off all my medications cold turkey, including lithium and a benzodiazapine (clonopin). I had no idea how long I would be able to remain off my medications but knew that I would breastfeed for as long as I could.
“I have Crohn’s disease and am diagnosed bipolar, so I have spent most of my life on one medication or another.”
My initial goal was three months, as it seemed like this was what was normal and acceptable. As the six-month mark passed I thought, “Just try and stop me!” Life went on, unmedicated, uncomplicated. Both my general practitioner and my psychiatrist said that I was their only Crohn’s or bipolar patient to successfully breastfeed—a feat I am most proud of!
The First Red Flag
When Harper was 7 months old, I found myself admitted to the hospital with a bowel obstruction. The first night in the ER, I asked for—and they supplied me with—a breast pump. It was my first night away from her. As the hours progressed, the only medication I was given was morphine, generally safe to take while nursing. Every doctor and nurse who saw me was informed I was a nursing mom.
When it became clear that I had a bowel obstruction, I was told I might need to go on prednisone (a corticosteroid drug). This was the first red flag. It is contraindicated to take prednisone if you are bi-polar. I also thought that it was unfavorable to take while breastfeeding. Dr. Thomas Hale says that taken orally, the transfer into milk is minimal, dependant on maternal doses. Regardless, I said absolutely no way, but I was resigned to add, “Unless there is no other alternative.”
I was in the hospital for five nights and four days. I fought long and hard to keep the breast pump. I argued a number of times about continuing to pump/dump and refusing unnecessary but possibly preventative medications. I later found out there was no need for me to dump my milk! I remained only on morphine. The only alternative to the medication was to have an “NG tube.”
This is a tube that goes up your nose, down your throat and into your stomach. It then sucks all the contents out of your stomach. In the best-case scenario, the inflammation causing the obstruction goes down and the obstruction goes away. Luckily this worked for me, but not without several doses of Ativan and the creation of a vulgar new sign language.
I was miserable. I was also “nil by mouth,” so how was I to keep my milk? I wasn’t even allowed a sip of water. I could barely keep down an ice chip. I continued to pump every four hours and could only get out 1 ounce in 30 minutes. All this and virtually no support from a nurse or doctor. Only one lovely, young female resident gave her support and only gentle reminders that if I had to go on prednisone at least I tried really hard and I’d at least gone seven months, “What a great mom.” When I was being discharged the doctor asked only out of curiosity, “How long do women normally breastfeed?” The resident spoke up and informed him “Two years is recommended.”
The Second Red Flag
I could have weaned her at 7 months; she took the bottle with no problems. However, I felt strongly that it was not time to wean. And it wasn’t. Again life went on, unmedicated, uncomplicated.
When Harper was 10 months old, I was due for my regular check in with the shrink. I knew he was beginning to feel anxious to get me back on medications. As fate would have it, the day of the appointment, I attended my very first La Leche League meeting. I had a lengthy discussion with the two leaders about my situation and my reluctance to go to this appointment. They reminded me that going on medications was my choice. They also told me about Dr. Hale and Dr. Jack Newman. One leader even said she knew a mom on lithium who still nursed and that most antidepressants are safe to take, too.
Every time I saw this doctor he asked how much longer was this going to go on? It made me very nervous, but I assured myself I would not give in. I would tell him in all honesty, “I don’t know” and “I’m not willing to wean at this time.” The appointment did not go how I would have liked. The doctor had no desire to listen to what I wanted. When I said that I had been feeling increasingly depressed he immediately prescribed me Epival, a heavy-duty mood stabilizer and told me to wean “within the next few weeks.” I cried the whole way home. But then I talked to my family and my LLL leader. I made an appointment to see my general practitioner the next morning; I wanted a second opinion.
I saw my general practitioner the next day and explained the whole situation. I told him that I had been on antidepressants before without a mood stabilizer and been fine. I agreed I needed to go on something. The depression was getting bad. He listened to everything I had to say, and he listened to my concerns about the previous day’s appointment. He also agreed with me that weaning did not have to be an option if I didn’t want it to be. We discussed what medications would be safe to take and less invasive. Though my psychiatrist hadn’t cared to discuss them with me, there were plenty of options.
In the end I left his office with the suggestion of staying off all medications and trying 50 milligrams of vitamin B6. He told me that there was a 5 percent chance it would help, but wouldn’t hurt to try. If it didn’t help we would re-evaluate the situation and discuss safe antidepressants.
Harper is now 18 months. I am not on any medications, and I take my B6 everyday. It does help, and we are still happily nursing. I fired my psychiatrist. After some thought and some time to clear my head, I wrote him a letter. I told him why I felt it was inappropriate to tell me to wean, to tell me “this is a compromise” and to prescribe a medication that is contraindicated for breastfeeding, especially when there were so many other alternatives. (When Harper was around 16 months old, I consulted a naturopath. I tried a homeopathic remedy as a constitutional, and it made a world of difference.)
Sometimes moms do need to go on medications and are faced with the idea of weaning. All too often doctors treat the disease and not the patient. Many doctors do not understand why weaning would be an unfavorable choice for a nursing mom and baby. They want to make you better regardless of what you have to sacrifice. There are many drugs and medical situations that are unavoidable, and along with this may come the unavoidable decision to wean your child. I say “decision” because we must always remember that we do get a say. You are free to make this choice.
I fought hard for my right to breastfeed my daughter, and it was worth every minute of it. It was for all the right reasons. If you are ever faced with a medication or treatment you are unsure of, there are great resources and support out there. Without my LLL leader, I may not have known that some medications are safe and that those were viable options. Listen to your instincts and dig for answers—they are out there. Only you know what is right for you and your baby.