048: Ask Dr. Nice: Safety of Medications While Breastfeeding

  Cathy, like so many other non-birthing parents wanting to induce lactation or relactate, is trying to unravel all of the varying information she has received.  So she emailed us for help.  When I suggested we might share her email on the podcast so that we could help others in her shoes, Cathy agreed.  This podcast episode is devoted to addressing Cathy's questions, concerns, and confusion around the basics of how to induce lactation/relactate -- and you might find it addresses some of yours as well!  Below is the email that is the inspiration for today's episode: I am 38 and have an almost 3-year-old son whom I nursed from birth-22 months. We are in the process of adoption.  We are in process of our homestudy and imagine we'll be bringing an infant home within 9-12 months.  I am eager to relactate for this baby.  I have spoken with two of our local IBCLC's.  One suggested the Newman-Goldfarb protocol, and the second suggested I contact you.  My GP suggested I talk to my ob/gyn for the prescriptions and my ob/gyn said the only way to relactate is via pumping.  As you can imagine, I am a bit frustrated.

For as long as I've known my podcast co-host Hope Lien, she has been my go-to person for questions about at-breast/chest supplementation.  When nursing her daughter by adoption (pictured here), at-breast supplementation was a key to her success - as it is for most parents who need to provide long-term supplementation.  She understands first-hand how frustrating at-breast/chest supplementation can be at the beginning and how invaluable it can be in the long run.  Getting from frustration to long-term success is the key and Hope tells us how!   View full show notes Here: http://sweetpeabreastfeeding.com/podcast/52-at-breastchest-supplementation-tips-and-more

It's a case study!  Something a little bit different in our discussion with Dr. Nice, our pharmacist expert.  Alyssa had connected with a mom-to-be Courtni who was inducing lactation with very quick and abundant milk production.  She wanted to figure out what Courtni was doing so that she could learn from Courtni's experience to help other parents.  (We at Sweet Pea are always trying to learn more about how to support the nursing success of non-birthing parents!)  ... but Alyssa could not find anything in Courtni's approach that was different than other parents she had worked with.  She did observe, however, that Courtni was taking several medications for her own health issues.  Alyssa wondered if these medications or the health conditions underlying them could be the secret to Courtni's outcomes.  She went to her friend, Dr. Nice for the answers... View full show notes here: http://sweetpeabreastfeeding.com/podcast/51-ask-dr-nice-a-case-study-on-the-impact-of-parents-medications-on-milk-production-when-inducing-lactation

As it turns out, breastfeeding is not just "A Womanly Art."  Steph shares an incredible story about a same-sex male couple she worked with who both nursed their baby, exclusively providing human milk for baby's first 6 months.  How does this work?  Creativity, support, milk expressed by baby's gestational carrier, and a tiny feeding tube at the father's nipple.  Steph gives us the details of this amazing nursing relationship and how to support any LGBTQIA family interested in breastfeeding/chestfeeding/nursing. Check out the full show notes here: http://sweetpeabreastfeeding.com/podcast/50-stephanie-wagner-ibclc-on-chestfeeding-and-supporting-the-lgbtqia-community

With the FDA warning against domperidone, we have noticed an increasing number of U.S. parents who choose to induce lactation or relactate without using the pharmaceutical medication domperidone.  While we have spent many episodes discussing the safety and effectiveness of domperidone, our ultimate goal is to  meet each parent with a plan for inducing lactation or relactation that is consistent with their preferences.  In this episode Alyssa and Hope discuss alternatives to domperidone and how milk production may be impacted by a lactation plan that does not include dom.   Full Shownotes available at: http://sweetpeabreastfeeding.com/podcast/49-ditching-the-dom-inducing-lactation-or-relactating-without-domperidone

For breastfeeding parents, safely taking medications - whether they are for the parent's health or for increasing milk production - can be complex.  It is a delicate balance between the parent's health, the safety of the milk for the baby, and the importance of breastfeeding.  It involves communication between the parent's health care providers, the baby's health care providers, and the pharmacist who can help to put it all together.  Here our friend and pharmacist with a ton of experience with lactation, Dr. Frank Nice has more answers.   ​On today's episode, we asked Dr. Nice questions such as: ​How to understand safety of medications when a parent is taking several of them.  Can we simply look at each one individually or is there a combined impact? ​What if both parent and baby are taking medications - do we need to consider the safety of how those medications interact in combination? ​When a parent is making less than a full milk supply, will the amount of the parent's medication in the milk be more concentrated or will the baby get less medication because there is less milk?​ ...and more!    

In the US, it is natural that we have a lot of concerns about the safety and side effects of domperidone.  Our Food & Drug Administration has not yet approved this medication (see episode #4 for more on that) so parents are generally obtaining it without a doctor's or certified nurse midwife's prescription*.  That also means that the pharmacist is not able to oversee use of domperidone and how it plays out with other medications that the nursing parent is taking.  That is our unfortunate reality today.  With this in mind, it is essential that parents and lactation professionals understand and take responsibility for possible contraindications and side effects associated with domperidone.  We are extremely fortunate once again to bend the hear of one of the most expert resources on safety and use of pharmaceuticals while breastfeeding, Dr. Frank Nice.

about their co-nursing experience, and with Katie about inducing lactation!  It has been a joy-filled road for them with a few bumps along the way ... including concerns with safety of medications, not always supportive healthcare providers, ​sore nipples, middle of the night challenges, and a bout of baby preferring one mom for bedtime nursing.  With creativity, communication and resourcefulness these two moms have navigated these challenges and now that baby is 10 months old they look back (and forward) to their nursing experiences with much gratitude.  

Dysphoric Milk Ejection Reflex, more commonly known as D-MER, is one of the most severe breastfeeding challenges yet also one of the least known or understood.  D-MER is a feeling of dysphoria caused by the hormonal shift that occurs when the milk releases during nursing, pumping, or any other time a let-down is triggered.  So if you or anyone you know experiences significant negative feelings when milk lets-down, you may want to hear what Alia Macrina Heise has to share.  Propelled by her personal experience with D-MER, Alia has become a clinical expert in the area of dysphoric milk ejection reflex.

Alyssa and Hope get real!  Being a new parent isn't always the blissful joy we might see on holiday cards.  It can be really tough times, as well as wonderful times.  We suggest that the balance lies in self-care.  It can be so difficult to care for ourselves as new parents, and we haven't always done the best job of it ourselves. We hope our stories and discussion will support you and propel you into a holiday season and new year of simple joys and caring for yourself just as well as you already do for your precious little ones.