Wednesday, December 06, 2006

When mum is sick

Can you still breastfeed when you are sick yourself? With cold, flu and tummy bug season upon us in Japan, this is a common question.

There are very few illnesses which would require a mother to stop nursing. You may feel tired, run down and unable to be much of a good mother, but the recommendation is to tuck yourself in bed with your baby and continue breastfeeding, rest, keep up your fluids, and if you need to take medications, let your doctor know you are breastfeeding. Most medications are compatible with breastfeeding, but here in Japan the doctor often says you will need to wean for three (or more) days while taking any medications, even simple antibiotics. The research shows that this is basically not true in most cases, and it is not hard to find this information through a simple google search. And remember, if it is a cold you have, then antibiotics aren't going to do anything for you anyway! If it is mastitis (a breast inflammation), it is crucial to continue nursing while taking the medications to avoid the risk of developing an abscess.

Think about the logistics and agony of weaning just for three days. During those three days, your breasts will become engorged and painful if you don't express your milk. Your milk supply will diminish if you don't express your milk regularly because of the "use it or lose it" prinicple. Your baby will need to be fed an alternative which is not without health risks. Most likely they will be fed by bottle, which they may not have experienced before...and without the built-in comfort of nursing directly, a normal part of life for your baby till now, your baby may also become quite stressed. This is not what you need while you are sick!

Your doctor may not have mentioned any of these things to you while handing you the medications. Is your doctor really supportive of breastfeeding? Did he/she mention that not continuing breastfeeding and substituing infant formula presents a greater risk to your baby's health than the risk of the transfer of a small amount of medication in your milk?

Dr Thomas Hale, pharmacologist and author of Medications and Mother's Milk (a book which all doctors should have on their shelves) tells us that in order for medications to transfer into human milk, they need to be highly lipid soluble, attain high concentrations in maternal plasma, be low in molecular weight, low in protein binding and pass into the brain easily. After those considereations, then we look at the bioavailability of the medication in the infant. He says :"numerous medications are either destroyed in the infant's gut, fail to be absorbed through the gut wall, or are rapidly picked up by the liver. Once in the liver they are either metabolized or stored". (p9) So factors like whether the medication passes freely into the mother's milk and the half life of the drug all need to be considered before we can really tell whether the dose the infant would receive via the milk is harmful to them. And we should not ignore that there are larger risks associated with formula use.

For more information see the articles on breastfeeding while mother is sick at kellymom. There are lots of references there for further reading too.

If you decide to use a herbal remedy, remember that just because it is herbal doesn't always mean it is safe while breastfeeding. This book has more information on herbs and nursing.

Note: Antihistamines or contraceptives containing estrogen have been linked to low milk supply.