La Leche League International

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

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Tuesdays Tips & Tricks: Knitted Breastfed Baby Poop Diaper (a.k.a. ‘Happy Knappy’) as a Teaching Tool

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Photo courtesy of Philippa Pearson-Glaze, IBCLC (2017) from the website: breastfeeding.support

Do you knit? If not, perhaps you have a friend, neighbor, relative or co-worker that knits? It is definitely worth asking around (and being willing to bribe) if you do not – or perhaps using this as a perfect excuse to learn yourself – because this adorable knitted diaper demonstrating what normal breastfed baby poop looks like for the first 5 days (and in weeks 1-6 postpartum) is a great, effective teaching tool – not only for prenatal breastfeeding classes but also for home and hospital consultations you may be doing soon after birth.

I’m sure many of you have received frantic phone calls from scared, worried parents telling you their baby’s poop is black, green and/or yellow. A visual teaching aid like the ‘Happy Knappy’ not only teaches parents what to expect (and what’s normal) with regards to the color, consistency and size of an exclusively breastfed baby’s poop, but it also is an indicator if babe is getting enough milk or not, babe’s general health and how breastfeeding is going.  See Philippa Pearson-Glaze’s article, “Breastfed Baby Poop” for more detail on what exclusively breastfed baby poop should look like and how to use the ‘Happy Knappy’ as a teaching tool.

Wondering how to knit the ‘Happy Knappy’? La Leche League International has a FREE pattern here.

(courtesy of Alison Blenkinsop, 2014)

Don’t knit yourself? And you don’t know anyone who knits? Have no fear – next Tuesday’s ‘Tips & Tricks’ will feature DIY options that do NOT require any knitting whatsoever. Stay tuned.

Do you have musical talent? Want to make your clients giggle and give them a fun way to remember what normal breastfed baby poop looks like? Try singing the song, “The Five Days of Feeding” while you are demonstrating your ‘Happy Knappy.’

“The Five Days of Feeding” Song

Sung to the tune of “The Twelve Days of Christmas”

On the first day of feeding, your babe will give to you a wee and a sticky black poo.

On the second day of feeding, your babe will give to you
two little wees and a less sticky, thinner dark poo.

On the third day of feeding, your babe will give to you
three little wees, two little burpsand a big greeny-browny soft poo.

On the fourth day of feeding, your babe will give to you four little wees, three little farts, two little burps and a nice runny toffee-brown poo.

On the fifth day of feeding, your babe will give to you five bi-ig wees;
four little farts, three big burps, two overflows, and a large golden mustard-seed poo!

(Song from Alison Blenkinsop’s 2008 book Fit to Bust: A Comic Treasure Chest, chapter 5.)

Do you have a tip or trick that you think should be featured on Galactablog? If so, don’t be shy. Please share with me! You can contact me here.

Words from the Wise: Do’s & Don’ts of Running a Private Lactation Practice

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Guest Post By Brandy Walters, BBA, IBCLC, RLC   Brandy 2

In private practice, you are vulnerable. You are entering someone else’s home that you’ve never been to before. They may know about you, what you look like, about your family and more through your website or business Facebook page; however, you know nothing about them, except that they have a baby.  Just like in your mothering, listen to your instincts.  Google the address you are heading to BEFORE the day of the consult – not on your way there. If you have any sort of “funny feeling” you can say no. This is a relationship you are beginning and you have half of the say.

Blank and DOs and DON'Ts memo papers attached with green and pink pins.

  • Do not go to a home of someone you have not talked with. If you have only spoken with a male, never heard a mother’s voice or had all contact via text with a male, don’t go to the home. I did this once.  Exactly once.  I called the midwife I was working with and told her my mistake. She said to keep my phone in my hand with 911 dialed and my finger on Send OR simply cancel the appointment.  When I arrived at the condo, there was construction on the front so a large piece of plastic was over the door. A male answered the door and to the left of the door were three pairs of men’s shoes. I insisted he go up the stairs first and my heart stopped pounding when I saw a baby swing. I should not have put myself into that position.
  • Do not go to a home you feel weird about, have a funny vibe about or just plain do not want to go to.  You reserve the right to not service a client. Listen to yourself, your instincts and heart.
  • Do not say yes to someone you should say no to. You can say no to clients just like they can say no to you.
  • Do not leave yourself in an uncomfortable position. I had a client who laughed when I was finishing our very long 2.5 hour consult when I told her I would need my fee and needed to finish with her for the day. She said, “You expect payment?!” I responded, “Yes, we discussed it over the phone and my fee is $XXX.” She replied, “You get paid through the hospital, they sent you here.” I reminded her I was not from the hospital or affiliated in anyway with the hospital. She did write me a check and I deposited it immediately.
  • Do not go to the hospital as a private IBCLC. You don’t have privileges there. You don’t belong there. Your role is in home support.

    Do not talk about your family, your kids, your schedule, your breastfeeding experience. None of that matters. This is about the mother. The very needy mother in front of you, not you. If she asks, keep your answers simple. How many kids do you have? 3 boys. How long did you nurse your boys? Over a year each. Quickly bring the subject back to her: What is your breastfeeding goal?

Blank and DOs and DON'Ts memo papers attached with green and pink pins.

  • Do wear a name tag when you get out of the car before you enter a client’s house.
  • Do introduce yourself the minute the client answers the door.  Acknowledge everyone in the room including grandparents and especially a dad. Do use everyone’s name while talking to them, including the baby’s.
  • Do have the client sign a consent form first. Every time you see her. Every client you see.
  • Do give the parents a receipt for payment and any health reimbursement forms they can submit for possible reimbursement for your services. Any time our lactation codes get in front of the insurance companies, it is an opportunity.
  • Do wear business casual WASHABLE clothes. Jeans or shorts are not appropriate. Present yourself as a business person. But be sure everything you wear can be washed due to dog hair, baby spit, baby poop, baby drool and mommy tears. wash hands
  • Do wash your hands before touching the baby!
  • Do have boundaries and KEEP them. If you decide you don’t take texts or phone calls after 8 pm, do not take a call at 8:05 pm. If you don’t work on Sundays, do not do doctor reports or go over your finances.
  • Do go on online support/help forums, Facebook pages of La Leche League, birth worker groups and such. You can get referrals this way, learn about midwives in your area and develop relationships with the people you need for referrals.

But Do NOT get anxious, nervous and distraught if you see YOUR clients reaching out for more help other than yours. Social media is a means for mothers to get support. Some mothers need a lot of support and from different sources. Do NOT question your ability if she wants another opinion or reaches out for more ideas. Just know the ONE negative comment can hurt more than three referrals or satisfied clients.

  • Do take a vacation. Change your voice mail message, and put on your vacation responder on your email. If you are lucky enough to have another IBCLC in the area you can trust, ask her if you can refer people to her for that time and leave her number on your voicemail. Birth workers give and give and give. We need to  take a break and to recharge too.
  • Do continue your education. Either through CERPS or individual study, it is important to stay up-to-date in our field. Connect with other professionals and learn from them. Enroll in online breastfeeding conferences such as iLactation and Gold Lactation.  

Brandy Walters, BBA, IBCLC runs In Home Lactation Specialists, LLC. Look for her on Facebook. Stay tuned for part 4 coming soon.

Are you a lactation specialist (of any kind) in private practice? Consider sharing your experience – tips, lessons learned, do’s and don’ts, challenges, etc. in Galactablog’s “Words from the Wise” series. Contact us here or at galactablog@gmail.com.

Words from the Wise: The nitty gritty of starting your own private lactation practice

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Guest Post By Brandy Walters, BBA, IBCLC   Brandy 2

I want to begin by giving a ton of credit to La Leche League (LLL). La Leche League is the gold standard in breastfeeding peer support groups much like a specialist achieving the IBCLC credentials is the gold standard of lactation support. I was a LLL Leader for 10 years, including some time after I became an IBCLC. La Leche League helped me learn how to mother through breastfeeding. I went to a meeting every single month for three months with my first son and left the meetings thinking: “Ok! I can do this for one more month, so I can get to the next meeting. They were my life line.” But what LLL does in addition is help empower mothers – this is the coolest part of the organization to me. La Leche League is the core of my counseling and how I practice.

Read! Read! Read! – To dig deeper into the Art of Private Practice, I always refer back to The Lactation Consultant in Private Practice: The ABCs of Getting9780763710378 Started by Linda J. Smith. Linda knows what she is talking about. The book is a bit outdated as our world is more tech-savy now. In reality, I text mothers more than I talk to them. There has been talk of Face Timing, though I haven’t established the virtual video chat connection yet in my practice. I don’t however, charge for the extra communication. Any texting, phone calls or emails after the initial consult is included in my one-time fee. I don’t charge by the hour.

The Importance of Follow-up – 75% of my job is playing the role of cheerleader.  In order to maintain personal boundaries, I don’t answer texts after a certain time at night, though I do answer calls and texts every single day – even on Sundays. Boundaries are important! If you are not able to take a mother’s call because you are on the soccer field and you couldn’t possibly hear her, then call her back when you are able to give her ample time, energy and attention.

Making a Connection – I mentioned in a previous post about getting in touch with Pediatricians and Ob/Gyns in your area. You may ask how to do this! Well, this means making muffins, delivering flowers and walking in with a hand full of business cards or pamphlets and leaving them for the office staff (just like drug representatives do every day). I recommend repeating this during a random holiday and again during World Breastfeeding Week. Establish a relationship. Bring them lunch. Offer free breastfeeding classes to their staff during lunch. Get in front of your audience and those you want to refer your services.

Connect with birth groups, support groups, childbirth classes, maternity stores, birth and postpartum doulas, local hospitals and hospital-based IBCLCs, online forums and anyone birth related.  These people and groups ARE your referrals. Your business thrives on referrals. Send thank you notes for referrals in the mail – the old fashioned way. Give a shout out to groups on Facebook for referrals. Constantly thank the people who give you work.

How do I know who to connect with? Get out an old fashioned paper map, decide on your service area and which Pediatricians and Ob/Gyns to approach. Check out ILCA.org for other private practice IBCLCs in the area and connect with them. Territory is important and if you are in an area that already has an established IBCLC, approach her first before putting out your business sign. It is important to have a community you can rely on when you are on vacation. It is important to have someone you can refer to. It is important not to fight for a service area with a reputable established IBCLC. You can be an asset to her too!

Choose the Right Name –  I wanted people to know what I do. I wanted a mom to say, this lactation consultant comes to me and helps me with breastfeeding. I wanted a logo that made sense. I didn’t want to pay $200 to someone to make it. I had help and input from my husband. My goal with the S at the end of In Home Lactation SpecialistS, LLC has always been to hire more IBCLCs who go out and do the hands-on work. I think young women relate best to other young women. As I age, I hope to hand the day-to-day hands-on work to the lactation consultants I hire to do what work I do currently.

I will be very picky about IBCLCs I hire. La Leche League is my history and shaped me into the IBCLC I am. I tend to share the same philosophy as Leaders I work with. Two local LLL groups in my area refer to me with technical cases and those that are outside their scope. I appreciate the clients and the business for sure.

But what I value the most from the relationship is the reciprocal respect. I value what LLL  gives every breastfeeding mother. I am not in competition with LLL. This organization does an amazing job supporting mothers. I appreciate what they can give. I don’t want to be going on home consultations when I am 50 years old. This means I have 8 short years to foster a relationship with good solid private practice IBCLCs AND grow them within my business.

The Wrap-Up  – Like mothering, you need to do what works best for you, your family AND your business. This type of work can be flexible, but I do work weekends and nights in the summer so I can be home most of the day when my kids are home. This work is repetitive – do you know how many times in a consult I explain supply and demand? This work is all-encompassing when you have a mother you know would stand on her head if that would fix her problem yet you just can’t seem to put your finger on that one thing that will help her. How I run my business, facilitate my business and grow my business will not be the same as how you will. But that’s okay! This is your business. Figure out what works best for you and go with it.

Brandy Walters, BBA, IBCLC runs In Home Lactation Specialists, LLC. Look for her on Facebook Stay tuned for part 3 coming soon.

Are you a lactation specialist (of any kind) in private practice? Consider sharing your experience – tips, lessons learned, do’s and don’ts, challenges, etc. in Galactablog’s “Words from the Wise” series. Contact us here or at galactablog@gmail.com.

Free Breastfeeding Tips & Guide Brochures by LLLI

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bftipsandguide_360x475La Leche League International (LLLI) is offering pocket-sized Breastfeeding Tips & Guide booklets for free. You can order as many as you like, you just pay a flat $5 shipping rate (this shipping rate is valid in the USA, I’m not sure about foreign shipping rates). They are available in English and Spanish and you can order them here. Just a tip, they come as singles, so make sure if you want 25, 50, 100, etc. that you clarify the amount you want when ordering. You put quantity you want in your cart but aren’t charged anything but shipping at the end.

These little booklets are great to hand out at breastfeeding/baby fairs, prenatal and breastfeeding support groups or classes, maternity wards, clinics and pediatrician offices or even your private lactation practice. LLLI has granted its permission for the free distribution for the booklets (meaning: don’t charge money for them!). 

Check out an electronic view so you can see what topics the booklet addresses.

Are you aware of any other free breastfeeding brochures or booklets available? If so, please share them with me through my contact form or via Galactablog’s Facebook group.