Drugs, Herbs & Lactation Risk

Tuesday’s Tips: Helpful Counseling Tips for Medications, Herbs & Galactagogues from Dr. Frank Nice

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As a lactation specialist or one aspiring-to-be, you may find yourself getting asked questions regarding the safety of prescription and over-the-counter (OTC) drugs by your breastfeeding clients. Or maybe it’s not medications, but the safety of herbs or the use of Galactagogues.

As lactation professionals (and those aspiring to be), it’s essential we stay within the scope of our training and certification. Diagnosing and prescribing prescription and OTC medications, herbs and galactagogues are outside the scope of practice for IBCLCs (and other lactation specialists) – unless of course, you’re also a licensed health care provider who has the ability to diagnose and prescribe medication. What we CAN do as lactation specialists is to counsel our breastfeeding clients and provide them with evidence-based resources so that they can make an informed decision that is best for themselves and their family.

In the Middle East where I used to live and practice, it was not common practice to question your physician’s recommendations, ask questions, or even to begin an open dialogue about potential alternatives, risks and benefits, etc. To question your doctor was a big no-no and it was something that just wasn’t done.

But because my client’s (and their infant’s) health and well-being come first, I encouraged every single one to bring every single evidence-based resources to their health care provider – to ask questions, demand answers and to begin an open dialogue. Yes, I admit I probably committed a few cultural faux pas, but it was worth it.

I found this not only enabled those I worked with to make informed decisions that worked best for them and their families, but it EMPOWERED them as well. The cherry on top was that it also educated health care professionals on lactation issues, which was often desperately lacking. Due to this approach, I was able to establish working relationships with local health care providers and to network. It was a win-win.

Dr. Frank Nice, RPh, DPA, CPHP

You may be wondering where to start when counseling your breastfeeding families on prescription and OTC drugs, herbs and galactagogues. How do you go about it? What approach would you take? What questions should you be asking and answering? Well, thanks for Dr. Frank Nice over at Nice Breastfeeding, he’s got all of this covered.

He has shared a wealth of information in order to help you help your breastfeeding families. Best of all, it’s all FREE and immediately accessble – just click here for practical, relevant counseling tips that you can begin applying with soon as the situation arises.

This link is divided into 3 sections: 1) About Mom, 2) About Baby, 3) Useful PDFs (on several topics including but not limited to Domperidone, Galactalogues and Herbs, and Recreational Drugs). These are free, downloadable and are perfect resources to share with your breastfeeding families.

And don’t forget to encourage your clients to share these handouts with their health care providers – not only will this create an open dialogue of how to best approach their situation and meet their needs, but it will also help to educate health care providers as well.

There is also a helpful ‘Patient Resources’ section with  Useful Links that you can share with your expecting and breastfeeding clients. Again, these are free!

Dr. Frank Nice, RPh, DPA, CPHP,  founder of Nice Breastfeeding, has over 40+ experience specializing in medications and  breastfeeding. He has also authored 2 books: Nonprescription Drugs for the Breastfeeding Mother, 2nd Edition (2011) and The Galactogogue Recipe Book (2017).

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Free Lactation & Drug Safety Resource List

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Free Lactation & Drug Safety Resource List

Author’s Note:  This post used to be a static page. I turned it into a blog post to make it more accessible and easier to search. Providing lactation support can be difficult and trying at times – particularly when it comes to medications/herbs and lactation safety and compatibility. There are several great lactation/drug compatibility resources and databases out there but many don’t know where to search or how to access. Compiling all of the evidenced-based resources into one space, so it can be more accessible by not just lactation consultants and those aspiring to be, but also parents and health professionals was the ultimate reason behind the creation of this post.

Do your clients ever call you wondering if a particular medication is compatible with breastfeeding? Many times nursing mothers are told to “pump and dump” or wean by their physicians when in fact, it’s unnecessary. Other times, it’s assumed if a medication is over-the-counter or an herb, it’s completely safe. This is not always the case.

Check below for the most widely used evidence-based resources in order to evaluate drug risk and safety during lactation. This list is arranged by alphabetical order and is by no means exhaustive, so if you’ve found another database or resource helpful, let me know so I can add it.

Questions for lactation professionals and nursing mothers to consider when evaluating risk levels of drugs, herbs, chemicals, etc. during lactation:

1) Will the drug, etc. affect my baby?
2) Will the drug, etc. affect lactation?
3) What are the risks of weaning?
4) What are the options?

For tips on how to counsel your breastfeeding clients on medications, galactagogues and herbs, see these tips by Dr. Frank J. Nice, RPh, DPA, CPHP.

Electronic Databases 

Breastfeeding Network –  Provides FREE Fact Sheets on a wide array of drugs, medical procedures and health conditions and compatibility with breastfeeding available here. These are great to share with your clients (and to encourage them to print them out and discuss safety concerns or potential alternatives with their health care provider). Also provides a detailed description of an ‘Introduction to the Safety of Drugs Passing Through Breastmilk’ here. For common FAQs concerning breastfeeding and generic medications, see here. Also contains general ‘Information on Breastfeeding’here, ‘Thinking about Breastfeeding’ here, ‘Breastfeeding and Perinatal Mental Health’ here and common ‘Questions about your Baby’here.

TIP: when using drug search databases: Since drug names can differ by country and even more so if it’s a generic vs. name brand drug, if the drug you are searching does not show up in the database search engine, then google that particular drug for the active ingredient and search by that instead.

e-lactancia – Compiled by pediatricians affiliated with APILAM. Uses risk levels 0 (no risk) -3 (very high risk). Covers “medical prescriptions, phytotherapy (plants), homeopathy and other alternative products, cosmetic and medical procedures, contaminants, maternal and infant diseases and more.” For common FAQs concerning lactation and medications, see here. Very easy to use and understand. A great resource to share with families so they can look up their own medications. Available in English and Spanish.

Infant Risk Center – Researched and compiled by Dr. Thomas Hale, PhD and author of the renowned and widely used medical lactation risk and reference guide, ‘Hale’s Medications and Mothers’ Milk.’ This reference guide is updated every 2 years, with the most recent edition published in 2017 and a new edition coming out in 2019). This resource uses lactation risk categories 1 (safest) – 5 (contraindicated). It covers prescription medications, chemicals, herbals, vitamins and radioisotopes/radiocontrast agents. This reference guide is also affiliated with the Infant Risk Center at Texas Tech University Health Sciences Center. A detailed description of ‘Drug Entry Into Human Milk’ is available here. If you have a question regarding a particular drug, you can call a free helpline at (806) 352 – 2519.

Medications & Mother’s Milk is an electronic database also established by Dr. Hale. Annual subscriptions are available at varied prices for individuals and groups/institutions. Mobile apps are also available for both androids and iOS – one is for healthcare professionals ($9.99) and the other is a simplified version for parents ($3.99). You can view options here.

LactMed – Sponsored by the National Institute for Health (NIH)’s US National Library of Medicine TOXNET Toxicology Data Network. It provides peer-reviewed, fully referenced, evidence-based resources. Users can look up lactation risk of both drugs and chemicals. This site is highly medicalized and may be too versed in “medical speak” for the average consumer to fully understand. LactMed also offers a mobile free app for both android and iOS.

MotherRisk – Sponsored by The Hospital for Sick Children in Toronto. It provides evidence-based information about the compatibility of prescription and over-the-counter medications, herbal products, chemicals, radiation, chronic diseases, infections, occupational, environmental, and other exposures during pregnancy and lactation. Also covers general FAQs about medications and lactation. Various brochures are available here. Offers a FREE MotherRisk Hotline: 1-877-439-2744, which is open Monday – Friday 9 a.m. to 12pm and 1 to 5 p.m. Eastern Standard Time.

Additional Drug Safety & Lactation Resources

Breastfeeding &  Human Lactation Study Center (which is a part of the Division of Neonatology at University of Rochester Medical Center’s Golisano Children’s Hospital) under the direction of Ruth A. Lawrence, M.D. Healthcare professionals can call (585) 275-0088 at no cost for information on drug risk and compatibility and to consult on difficult breastfeeding issues. Note: This hotline is for healthcare professionals ONLY, not for parents or your breastfeeding clients. For more information, see here. See here for a breastfeeding site geared specifically toward your breastfeeding clients and families.

Cindy Curtis, RNC, IBCLC, CCE, CD of Breastfeeding Online has compiled a comprehensive and beautifully organized list of lactation risk and compatibility with direct links to articles on breastfeeding and alcohol, herbals, epidurals, antidepressants, social drugs, cigarettes, prescription and non-prescription drugs and more. This is an accessible and quite handy resource to share with your breastfeeding clients or lactation specialists-in-training.

Frank J. Nice, RPH, DPA, CPHP of Nice Breastfeeding has written several books on medications and compatibility with breastfeeding: ‘Nonprescription Drugs for the Breastfeeding Mother’ (2017) here. ‘Recreational Drugs and Drugs Used to Treat Addicted Mothers: Impact on Pregnancy and Breastfeeding’ (2016) available here. ‘The Galactagogue Recipe Book’ (2017) which discusses dosage, uses, and cautions of galactogogues here. There are free downloadable pdfs on a wide array of lactation and drug risk categories including herbs and galactagogues, recreational drug use and Domperidone are available here. Free patient resources with helpful links are available here. You can find information for healthcare providers on how to counsel breastfeeding mothers who have drug-related questions here.

International Breastfeeding Centre established by Dr. Jack Newman, MD, IBCLC provides a general overview of maternal medications and breastfeeding in a Q&A blog post format, addressing general FAQs, whether or not to continue breastfeeding, how drugs get into breast milk and lactation compatibility with specific medications here. If you have a question about a particular drug’s compatibility with breastfeeding (or you’re dealing with a difficult breastfeeding case in general and would like some guidance and feedback), Dr. Newman answers emails from Lactation Specialists at no charge here. Information sheets on a wide array of lactation topics are available here, many of which are translated into different languages here.

Kelly Bonyata, BS, IBCLC of Kellymom has compiled lists of lactation risk databases in English and other languages, common FAQs on specific drugs, treatments and medical procedures, lactation risk resources and a detailed list of reference links here.This is an accessible, easy to understand resource to share with your breastfeeding clients.

La Leche League International (LLLI) has also published some articles and FAQ fact sheets on medications and breastfeeding. It also has a comprehensive resource of hyperlinked articles addressing breastfeeding with maternal illness, conditions, diseases and  if medications/treatments are compatible. LLLI’s site, including it’s articles (typically written  for mothers and parents by mothers (who are also breastfeeding counselors), are fantastic reat resources to share with nursing mothers and families as they are easily accessible, usually short and sweet, and written for an audience without a medical background. Just click on the title(s) below:

Wendy Jones, BSc, MSc, PhD, MRPharmS of Breastfeeding and Medication.This comprehensive site includes free downloadable Fact Sheets, evidence-based useful links on medication and breastfeeding, E-Learning Packages/Training Packs, aimed at GPs (latest cost was £40.00), which can be purchased here. She has also authored the books, “Breastfeeding and Medication.” (2018) and “Why Mothers’ Medication Matters” (2017).

Herbs & Breastfeeding

Kelly Bonyata, BS, IBCLC of kellymom.com has created a simple, accessible resource list of specific herbals and natural treatment and compatibility with lactation here. For information on marijuana and breastfeeding, see here. These are both fantastic, easy to read and understand resources to share with your breastfeeding clients.

Sheila Humphrey, BSc, RN, IBCLC has written the ‘The Nursing Mother’s Herbal’ (2003) available here, which discusses the effects of a wide array of herbs, dietary supplements and natural remedies on lactation and lactation-related maladies such as mastitis, plugged ducts, thrush and more. Her book is organized into Herb Safety Categories A (no contraindications) – E (Avoid. Toxic plant with no justifiable medical use). See here for a more thorough description of the Herb Safety Categories and see here for a review of her book from LLLI.

This list is by no means exhaustive. If you have a evidence-based resource on drug safety and lactation that you recommend and it’s not included in the list, then please, send me a message with a description and relevant info so that I can include it. Thanks a bunch, xx

Freebie Friday: FREE Podcast on “Marijuana & Breastfeeding”

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Yup, it’s the end of the week already. That means it’s time for FREEBIE FRIDAY! This week’s freebie is a FREE Podcast on “Marijuana and Breastfeeding”
by Anne Eglash MD, IBCLC and Karen Bodnar MD, IBCLC.

From the Institute for the Advancement of Breastfeeding & Lactation Education (IABLE) website:

“Join us to learn about the 2018 American Academy of Pediatrics statement on marijuana during pregnancy and breastfeeding. Dr. Bodnar summarizes the major points in the AAP’s 2018 statement on marijuana during pregnancy and breastfeeding. Learn the latest recommendations on how to counsel families regarding perinatal marijuana use!”

It was originally recorded in September 2018, but don’t worry, it’s still available as a podcast for free. Just click here to listen to it.

Quick tip: When you click on the link to view the Podcast, check out the “Programs” header on the left side of the site. You’ll find lots more FREE lactation resources including Podcasts, Videos, Breastfeeding Handouts, Breastfeeding Education for Healthcare Providers, Clinical
Questions for the Week, Conferences and more.

Happy listening (and learning). Oh, Happy Friday too!

Do you have an idea for FREEBIE FRIDAY? Don’t be shy! Share it with Galactablog – you will be given full credit. If you’re a company, private practice, NGO, etc. and have a FREE opportunity or item to offer to Galactablog readers, let us know. As long as you are WHO Code Compliant, you’ll be given full consideration. You can contact us here or email: galactablog@gmail.com.