The late, great Dr. Audrey Naylor authored six principles to reduce or eliminate risk from drugs and other substances while lactating. Published in Lactation management curriculum: A faculty guide for schools of medicine, nursing, and nutrition, (edited by Woodward-Lopez and Creer in 1994) it now appears to be out of print. Based on what I learned from Dr. Naylor more than 25 years ago, I converted those principles into six questions, and here I provide my short take on how to use them in real life.
1. Is the medication essential?
Instead of getting stuck on the process, consider the outcome. Here’s what I mean:
- Might a non-pharmacologic therapy yield the same (or sometimes better) result?
- How about using a steam vaporizer to relieve a stuffy nose?
- Might a chiropractic treatment help a neck ache?
- How about hypnosis for labor?
2. Can we delay using medical therapy to reduce or eliminate risk?
I cringe when I see how many women receive prescriptions for Depo-Provera® before they leave the hospital a few days after birth. I’ve heard hundreds of verbal anecdotal reports that the Depo-Provera® reduces milk supply. Whether that’s true or not is another matter. But the manufacturer’s directions call for delaying use until 6 weeks after birth in the breastfeeding mother. Further, research shows that if the woman is exclusively breastfeeding, the likelihood of her conceiving is very, very small before 6 weeks.
Here’s another question: Can a painful procedure be delayed? Maybe a cesarean delivery needs to be done now. But delaying something like a complicated dental procedure might be possible.
3. Should breastfeeding be temporarily delayed?
There are very few medications that are incompatible with breastfeeding. But if a medication must truly be taken at this time, is it feasible to delay breastfeeding until the medication is no longer needed?
Similarly, if a drug’s effects peak in a few hours, can a mother delay breastfeeding for a few hours?
4. Can we use only medications with established history?
Sometimes, the effects on the mother or infant — especially with new medications — may be unknown. If possible, persuade the mother and her physicians to explore other choices that will almost certainly reduce or eliminate risk from drugs known to be compatible with breastfeeding, and achieve the desired health outcome.
5. Can we use only medications that do not pass into milk readily?
Whether or not a drug easily passes into the milk depends on several factors. Obviously, it’s better for the mother to take a drug that does not readily pass into her milk. Try to generate a list of medications that could accomplish the desired outcome. Then, separate them into two columns: those that easily pass into milk, and those that do not. While this should not be the sole criteria for whether a medication can be prescribed or consumed, it certainly helps to achieve a win-win situation.
6. Can alternative routes reduce or eliminate risk?
Using a different route of administration may decrease the amount of medication in the milk.
- How about a topical product rather than a systemic product to relieve a symptom? For example, Afrin Nasal Spray nose drops are a better choice that pseudoephedrine tablets.
- An inhaled bronchodilator would be better than an oral agent for asthma because the inhaled medication would minimize the amount of medication that gets into the milk.
Sure, there are still some thorny issues that crop up, no matter what.
I feel badly that these principles on how to reduce or eliminate risk have somehow gotten lost as we’ve all moved into a more complicated medical world. Hopefully, I have revived these with examples of which the original author would approve.
I had a profound respect for Dr. Audrey Naylor as a physician, but also as a master educator. While nothing compares to what I learned in my everyday work at the bedside and through hallway conversations with renowned giant, Dr. Ruth Lawrence, what I learned from Audrey was more structured and formal. I miss her, and I’m glad I snapped a photo of her shortly before she passed away.
Like what I’ve written elsewhere on this blog, this is only for information, not advice!
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