3 Steps to Easing Your Mind
By Lisa A. Goldstein
Motherhood—especially if it’s your first time around—can be taxing. When you add a cold, flu, or more serious illness to the equation, it can feel positively overwhelming. The good news is that it’s always possible to breastfeed when sick, unless the mother is so ill that she is too weak or is in the hospital, says Angela Jacobi, a child nurse and certified lactation consultant.
Getting sick while nursing is an entirely different situation than for a bottle-feeding mother who is sick. If it’s a cold or flu, the bottle-feeding mother can give her baby to someone else and go to bed. “The nursing mother will still need to empty her breasts, either by pump or Baby,” Jacobi says. “She can’t just ‘bail out,’ or she will run the risk of either becoming engorged or losing her milk. However, the literature on breastfeeding is very clear. The baby should still be breastfed or given expressed breast milk. Breast milk is a most robust food and is not easily contaminated or infected, even with mastitis.”
Step 1: Don’t Worry About Baby
While babies may get sick through contact, regardless of how they’re being fed, catching it through breast milk shouldn’t be a concern. Mary Koniz Arnold of Poughkeepsie, New York, was told as much by her doctor and lactation experts when she nursed her kids. She recalls being encouraged to continue nursing as the “antibodies that are fighting the sickness are passed on through the breast milk and are beneficial to the kid,” she says.
“Any disruption in nursing can undermine the process—if the baby gets used to the bottle, [he or she] might eventually reject the mother’s breast, and that would jeopardize all the continuing and future benefits of breastfeeding: optimum nutrition for the baby, passing benefits of the mother’s immune system to the baby, and for the mother, natural child spacing and protection against breast cancer because of the suppression of estrogen and production of other hormones,” Arnold says.
Step 2: Take Your Medicine
Arnold, who nursed her two kids for three years each, never got the go-ahead for antihistamines during allergy season. When ragweed was in bloom mid-August through mid-September, she just suffered. That was 14 years ago. Now, most over-the-counter medications have been found to be safe for breastfeeding mothers, Jacobi says. This is especially true for cough and cold preparations, though long-term use of pseudoephedrine is a concern, because it has the potential to decrease milk, not because it’s dangerous to the baby.
In most cases, Jacobi says, topical creams and external medications like nasal spray and eye and ear medications have virtually no impact on breastfeeding. “In a perfect world, breastfeeding mothers would never have to take a medication, but I don’t live in ‘Perfect’ and neither does anyone else,” she says.
To find out the safety of medications and breastfeeding, Jacobi recommends getting Dr. Tom Hale’s book, Medications and Mother’s Milk. Other sources Jacobi suggests are the baby’s pediatrician (especially if he or she is an IBCLC), the American Academy of Pediatrics, La Leche League International, or the International Lactation Consultant Association.
Step 3: Avoid Misinformation
Sometimes even referring to sources can result in confusion. This happened to Judy Musa, a New York resident and professional working, lactating mom with a 10-month-old. She got strep throat and was told by her midwife, pediatrician and pharmacist that nursing was OK with the antibiotics. She developed a subsequent yeast infection from the antibiotics. She was told that it was unclear whether Diflucan—the yeast infection pill—was safe to take when nursing. “I ended up pumping and dumping and only nursing at night to minimize the baby’s exposure to the Diflucan,” Musa says. “The information that is provided indicates that there will be some secretion into breast milk, so the pharmacist thought it best to avoid nursing for a few days.”
The experience of being sick while nursing was frustrating for Musa. When she finally discussed Diflucan with her midwife, the midwife told her that Diflucan is prescribed all the time and doesn’t affect nursing babies. In fact, it’s pretty much the same drug given to babies with thrush.
When asked about this contradictory information that is all too common, Jacobi wasn’t surprised. “Despite breastfeeding initiation rates of somewhere between 60 to 90 percent—depending on a lot of variables—we really live in a bottle-feeding society,” she says. “It’s no wonder that when a breastfeeding mother needs medical or pharmacological information, she gets contradictory answers, because nobody really knows the answers.”
When well-meaning doctors, nurses, pharmacists, or dietitians don’t know the answer to a question about medication safety during breastfeeding, Jacobi says, they will err on the side of the most conservative answer so as not to be wrong. The most commonly used reference is the most conservative drug information source, the Physicians’ Desk Reference. “All medications now carry a disclaimer—written by the lawyers—to not take a drug if pregnant or nursing,” Jacobi says. “This is the ultimate example of ‘never be wrong.’”
According to Jacobi, drugs that are absolutely unsafe for breastfeeding include all street drugs (heroin, crack cocaine, PCP, etc.), certain drugs for cancer chemotherapy and lithium. She points to Dr. Hale’s book for other, lesser-known drugs.
To deal with this, Jacobi says mothers have to learn to be proactive and ask about medication alternatives when confronted with a situation where she’s told to quit breastfeeding. “The bottom line is [this]: Protecting the milk so the baby can continue to be breastfed is really that important,” she says.
Medication and safety aside, what’s a nursing mother to do when she’s feeling lousy? “Get as much help at home as possible,” Jacobi says. “And go to bed until she feels well.”
