There are 3 questions you should ask when considering taking ANY medication while nursing:
1. Do you need the drug? (Need is different than really want)
2. How does the drug affect baby?
3. Can the drug affect my milk supply?
First, talk to your doctor about any medications you need to take while breastfeeding. Ask a pharmacist too because many drug labels state, "do not take if pregnant or breastfeeding" because they would rather be safe than sued, but a pharmacist can tell you what the drug manufacturing company recommends such as when to take certain drugs to minimize their risk or alternative drugs that are safer. Some drugs go through the system quickly (like alcohol takes about 3 hours to digest) so if you have to take medication while nursing, you might be able to take it just after nursing, and wait till your body digests it or pump before nursing again.
The problem with most medications is that they simply haven't been tested with breastfeeding women, because no nursing mom would volunteer to see how X medication affects her baby.
There are SOME medications that are considered safe to take while nursing as well as others that probably safe but haven't been around long enough or been tested enough. Check out the list of drugs that are not safe to take while nursing too at Baby Center's Drug Safety Charts.
Personally, I have had to take a wide variety of drugs while pregnant and nursing (from Tylenol, Motrin, Percocet, Antibiotics, Benedril, Zofran, Immodium, Monostat, Robitussin, Tums, as well as several types of medicated creams, ointments, eye drops, etc) but took ALL of these while under my doctor's care. ALWAYS check with your doctor before you assume any drug is safe, because every body is different, every baby can respond differently, and some drugs become "safer" the older your nursing baby is (ex: a baby's liver isn't developed until they are 3 months old so digesting any alcohol before that time can potentially put your baby in danger).
Also, my "boobie Bible" (So That's What They're For!) was a great resource when it came to looking up certain drugs because an extensive list of charts (roughly 8 pages long) are listed. In this book several phone numbers are listed as well in case you actually want to call an expert and have any questions about drugs and their affects on breastmilk:
Phillip Anderson, a pharmacist and the director of the Drug Information Service at the University of California, San Diego Medical Center, compiles research on drugs and breastmilk interaction. You can call the UCSD information service at (900) 226-7539, 9:00am to 5:00pm Monday through Friday ($4 for the first minute, $2.50 for every additional minute).
The Lactation Study Center: free information on drugs in breastmilk: 8:00am to 5:00pm Monday through Friday (716) 275-0088.
The La Leche League: 800-LA LECHE or (847) 519-7730. In Canada? Try (800) 65-4234 or (514)LA LECHE for a French speaker (page 328-331).
EDIT: I just came across a very helpful site called Kellymom. On her site she has a wonderful index of medications and their levels of safety while breastfeeding or pregnant.
Sunday, January 9, 2011
Thursday, January 6, 2011
Nursing Strike!
Before we had Ben we had two little yorkies that were our babies. Missy and Fufu were not exactly friendly towards children. They'd growl, bark, and the boy (yes Fufu was the boy yorkie) would try and bite / attack little kids. So when I told my husband Nick we'd have to find them a new home before the baby came home, he very sternly told me that these dogs are part of the family. He went on to say that Fufu is going to be like Ben's brother and that he plans to give the dog more attention than the baby to ensure the dog that he isn't being replaced. Ha! Can I just throw in that the day Nick walked through the front door with our screaming baby (after 3 days of labor and 5 days in the hospital without sleep) that he kicked the dog out of his way when Fufu met him at the door! Nick still refused to give the dogs to a better home even though they mostly lived in the backyard or in their crates when in the house, were often neglected and forgotten unless they barked and woke the baby - then I gave them some attention.
When Ben was about 11 months old, Fufu snuck into the house and within a minute I heard the yelp, growl from the dog and a cry from my baby. I'm assuming Ben tried to pet Fufu or grabbed his ear or something and Fufu bit his face. His tooth punctured his skin and made a blood blister under his right eye. I was beyond furious and the neighbors probably thought I was insane. I called Nick, made him come home, and give the dogs away - even innocent Missy b/c I wasn't going to wait for her to one day get a hold of him, and the next time I might not be so lucky. What if he lost an eye or a finger?
Whenever we went on vacations Nick's boss (known as "the dog whisperer" at his office) would watch our dogs, and he offered to take them. I tried to nurse Ben to sleep to calm him down and I was sobbing, shaking with my anger and stupidity for allow this to happen, b/c I knew an accident like this was inevitable. I stared and stared at his cheek, burning the image in my mind to serve as a reminder that I would never go against my gut when it came to my baby's safety again. I didn't realize that Ben's eyes were wide with alert and probably filled with worry over why I was so upset. I remember him reaching for my face, and thinking he's trying to calm me down. You know, the way people always say, "They're fine" when they're not just to make you feel better. Well eventually he fell asleep but he hadn't really nursed which was kinda odd.
When he woke up from his nap I assumed he'd want to nurse really hard because he must be hungry but he refused to latch on. Sometimes he'd wake up from a nap and just want to play so I didn't think much of it. When he refused to nurse before his afternoon nap, and after he woke from that nap I started to worry. I tried to nurse him to sleep before bedtime but he screamed and cried and wouldn't even attempt to latch. It was like he wanted nothing to do with me, pushing against my hold and turning his head away. I made my husband rock him to sleep that night with a plan in mind. As soon as he was asleep I planned to sneak back into his room and "dream nurse" him in his sleep. When I gently picked him up and placed his cheek against me, instinctually he opened his mouth but then it occurred to him that he was about to nurse and his eyes snapped open and he began to cry. I began to cry too! What a horrible day! First my baby gets bitten by our dog, then he refuses to nurse! I put the two together and thought maybe he's just been traumatized by the whole thing and will wake up hungry in the night and eventually nurse.
Even though we spent days doing the cry it out method to make him sleep through the night, I snuck back into his room and tried to nurse him in the middle of the night. My breasts were nearly as engorged as when my milk first came in. I was extremely scared when he started to cry when he realized what I was trying to make him do. I called the pediatrician the next morning and told him all that had happened leading up to his refusal to nurse.
The doctor told me a few things...
1. Babies can go on a nursing strike for several reasons:
- If you're eating something that is causing their belly to hurt.
- If you change your deodorant, soap, perfume, etc and you smell different.
- If they've had a negative association with the breast (ex: If you scream or yell when they accidentally bite you when they are teething. In my case, the crying fest I had while nursing him probably did it.)
3. It's easier on the baby to decide when to stop nursing then to force him to stop when he still wants to - so look at this as a blessing.
I went for a quick run (maybe I needed to run away from my baby that I felt was rejecting me) and thought things over. No more worrying about being away from my baby for too long, or my diet or not being able to take medicine. It's true that I wanted to be the one to decide when it was over, but at least I never had to go through the transition of getting him off me. No more pumping, nursing pads, nursing bras. It was a bittersweet moment to realize I had my body back, but with that meant I'd never breastfeed my son again. Oh had I only known the last time I nursed him, would be the last time I'd ever nurse him, I would have enjoyed it more! I told myself at least I'll get to nurse again, one day, when I have my next baby...little did I know I'd be pregnant again three months later!
Wednesday, January 5, 2011
Breastfeeding 101
Want to breastfeed? Here's what you need to know:
1. Do the research and make a commitment. If you go in with the attitude that you're going to "try to breastfeed" it's like going into a marathon saying you're going to "try to run" but in order to do either successfully you have to really commit to doing it, and that means preparation. Biggest Tip: Know that it might be uncomfortable or even painful at times while you and baby learn how to latch properly, but don't give up! Give your body the chance to get familiar with the feeling of having let downs, and as your breasts get used to constantly being nursed on, in most cases after TWO WEEKS it will be pain free and easy as pie! Get through that two week hump and you'll enjoy one of the greatest blessings ever :)
2. Make this experience as easy as possibly by taking advantage of all the products available for nursing moms.
3. Now that you've purchased some basic nursing supplies let's get down to nursing! When baby is born as soon as possible try and nurse. When my first son was born I was afraid to try and nurse because I was in so much pain I didn't want him to feel my anxiety. I wanted our first nursing experience to be beautiful. When I had my second son Jonathan, I had a Cesarean delivery and as soon as I was wheeled into the recovery room (about 40 minutes after he was born) I tried to nurse him and I am AMAZED at how well he did. He latched right away and nursed for 11 minutes! So basically the first time I held him he was nursing and THAT was beautiful :)
4. Time to get baby to latch on! The sooner you try to do this after birth the better. If the room isn't too cold you might want to undress baby (this helps baby wake up too) and nurse him skin to skin. If you touch baby's lips with your nipple the scent and sensation should make baby open his/her mouth. Don't just let baby suck on the very tip of your nipple, you want to wait till baby opens his mouth as big as possible and then in one swift motion push the baby's head into your breast. You want the nipple to be as far into the back of the throat as possible b/c this will prevent nipple damage. You also don't want to start bad latching habits so if you feel the baby isn't on right use the tip of your finger and slide it into the side of baby's mouth. This will break the suction without hurting you. Then try again. My nurse told me you want the baby to look like he's biting down on a burger, the way you open your mouth to a big tall sandwhich is the way you want baby to latch on. Once the baby learns how to nurse correctly you won't have to work so hard to get them on right...After a couple weeks you'll be able to get baby to latch on in the dark, half asleep, without any thought at all.
5. Now that baby is latching on correctly, you want to help baby nurse for 10-15 minutes on each side every hour or two. This can be tricky because the breast is so warm and cozy and mommy's scent and heartbeat puts baby in a calm happy place so most babies pass out as soon as they latch on. You might have to keep bugging baby to stay away and suck suck suck. My pediatrician showed me how to "pump" their arm to stimulate sucking. You just flap their little arm up and down like you are pumping them! You can undress them, tickle their feet stroke their hair, etc. I personally noticed that when you stroke their cheek this was a distraction and they turn their head and open their mouth looking for a nipple and breaking the latch, so see what works best for you.
6. How do you know if they are getting anything? The lactation consultant showed me that if they are sucking and swallowing you'll see this pulsing near their temples and right under their ear along their cheek. As your milk comes in you can actually hear them swallowing harder. Remember the diagram in Breastmilk 101? Newborn babies have tiny tummies (about the size of a marble) so don't think they need a 4 oz bottle right away!
7. Alternate the breast you fed on last and nurse every hour or two. The more often you nurse, the sooner your milk will come in and the faster your milk supply will increase. Think of Dori from Finding Nemo. She sang in encouragement to Nemo's dad, "Just keep swimming, just keep swimming" but change it to, "Just keep nursing, just keep nursing."
8. Even if you think you're doing fine, meet with the lactation consultant (they are only there certain times of the day so tell your nurse that as soon as one gets to the hospital you want to meet with her) just to get any extra tips, pointers or suggestions on your latching and nursing positions.
9. Some women nurse without any pain, but most will feel some discomfort and a large part of that can be because of damaged nipples (from either bad latches or b/c they are getting dried out). Before they get too sore, apply a thin layer of nipple cream (I prefer Medela sold at Target) after each nursing. You don't have to scrub and clean this off before nursing again. Think of it as chapstick for your breasts. This "chapstick" moisturizes and creates a barrier of protection. Nursing removes natural oils so the skin gets dried out and this is when your nipples can become very tender, crack or even bleed. (If they get too damaged or sore you might have to pump and either bottle feed or "finger feed" - I'll go over that in another blog)
10. For first time moms, anticipate it taking up to 4 or 5 days for your milk to come in and try not to use bottles, formula or pacifiers for the first couple weeks to avoid nipple confusion and delay milk production. Don't beat yourself up though if you have to use any of these things, I had to use all three. I had blisters the first time and just needed a 4 hour break to allow some recovery time so I pumped and the second time I had to pump and use a bottle for 2 days b/c of nipple damage due to a bad latch. I also had to allow my son to try and use a paci b/c his screaming was unbearable (my uncle and I joked that the neighbors probably thought I was illegally harboring and torturing some rare exotic bird) and I tried to formula feed thinking that might put an end to his cries.
11. Breastfeeding can be a form of contraceptive (not full proof!) because the body might not regulate back to your normal cycle during part or the entire time you are nursing. Do not think you can't get pregnant when nursing b/c I know two moms that did, but don't be surprised if you don't get your period for 11 months after birth either (my friend didn't get hers for 11.5 months and I didn't get mine for the first 7 with Ben...my second son Jonathan is almost 6 months old and I still haven't started my period yet). I also know moms that exclusively breastfeed and started their period 2 months after giving birth. Every body is different but just be aware that nursing can shift / alter your menstrual cycle.
12. Benefits for Mom! "Breastfeeding lowers your risk of getting breast cancer. A woman who breastfeeds for twenty-four months of her life drops her risk in half"(p 27 STWTF!). "It lowers your risk of endometrial cancer, ovarian cancer, and osteoporosis. It helps your uterus shrink after childbirth. Studies show that nonbreastfeeding women's uterus never shrinks backs to prepregnancy size. It helps you loose weight because breastfeeding burns off 500 - 1,000 extra calories a day"(p 28 STWTF!). Nursing releases endorphins that make you feel happy and help you better bond with baby. These are only SOME of the benefits for mom.
13. Benefits for Baby! Babies that are breastfed have fewer cases of ear infections, are four times less likely to be hospitalized for bacterial infections, less likely to suffer from Crohn's disease, dermatitis, diarrhea, diabetes, liver diseases, and other afflictions. Breastfeeding may help your child avoid a weigh problem later in life, are 40% less likely to have misaligned teeth, and have better eyesight. Studies have shown that formula feeding may increase a baby girl's risk of developing breast cancer later in life. Babies use as much as sixty times more energy to get breastfed than to get formula from a bottle.(p16-28 STWTF!) Again these are only a FEW of the benefits for baby to breastfeed.
1. Do the research and make a commitment. If you go in with the attitude that you're going to "try to breastfeed" it's like going into a marathon saying you're going to "try to run" but in order to do either successfully you have to really commit to doing it, and that means preparation. Biggest Tip: Know that it might be uncomfortable or even painful at times while you and baby learn how to latch properly, but don't give up! Give your body the chance to get familiar with the feeling of having let downs, and as your breasts get used to constantly being nursed on, in most cases after TWO WEEKS it will be pain free and easy as pie! Get through that two week hump and you'll enjoy one of the greatest blessings ever :)
2. Make this experience as easy as possibly by taking advantage of all the products available for nursing moms.
- If you have large breasts invest in supportive nursing bras (I actually found a few at Target that I liked better then two I bought at motherhood maternity, and they were less than half the price!).
- Back to those heavy and engorged breasts, check out a nursing wedge to help lift those natural bottles into an easier nursing position!
- Pick out a button down shirt/ top style or nightgown that allows you to nurse comfortably.(I like stretchy spaghetti straps with a v neck overlay so that I can pull fabric down on one side at a time rather than lift my shirt up and have my whole torso exposed). Gray is probably the worse color for showing milk and black isn't great either. White is probably best b/c it hides spit up, milk, baby powder, desitin, etc!
- You will probably have to nurse in public (whether in your car, at a friends house, or maybe even in a restaurant) so check out some type of Udder Cover - one of my girlfriends cannot live without hers!
- Buy at least one type of nipple cream either lansinoh, medela or some of the other natural products for soothing cracked dry sore nipples.
- Consider either renting or purchasing a double electric pump.
- Unless you are very comfortable holding very new newborn babies I'd suggest the "my breast friend pillow" over a boppy - but some moms use those too for back support behind them in bed or for baby to rest on under kick and play mats, etc.
- Buy a box of nursing pads to place in your bra to collect any leaking milk to avoid embarrassment!
- Buy and read So That's What They're For! a breastfeeding guide by Janet Tamaro. This book is a good start for the research you'll want to do and it's filled with cartoon women nursing so you dont have to look at the real pictures if that makes you feel any better. The book shows you different nursing positions as well as phone numbers for lactation consultants and doctors in case you need to make a call for some support or have questions about nursing while taking meds, etc. There are SO MANY resources in this book it's crazy!
- Go online and look for an "ItzBeen" either from their website, ebay, or babysrus. When you are beyond sleep deprived 3 minutes will feel like 30 minutes, but it's so important to make sure you are actually nursing for at least 15 minutes on both sides so this handy dandy little stop watch keeps track of the time for you (as well as which side you nursed on last, and you can track when you last changed the diaper, how long baby's been sleeping, or when you last took your pain meds).
3. Now that you've purchased some basic nursing supplies let's get down to nursing! When baby is born as soon as possible try and nurse. When my first son was born I was afraid to try and nurse because I was in so much pain I didn't want him to feel my anxiety. I wanted our first nursing experience to be beautiful. When I had my second son Jonathan, I had a Cesarean delivery and as soon as I was wheeled into the recovery room (about 40 minutes after he was born) I tried to nurse him and I am AMAZED at how well he did. He latched right away and nursed for 11 minutes! So basically the first time I held him he was nursing and THAT was beautiful :)
4. Time to get baby to latch on! The sooner you try to do this after birth the better. If the room isn't too cold you might want to undress baby (this helps baby wake up too) and nurse him skin to skin. If you touch baby's lips with your nipple the scent and sensation should make baby open his/her mouth. Don't just let baby suck on the very tip of your nipple, you want to wait till baby opens his mouth as big as possible and then in one swift motion push the baby's head into your breast. You want the nipple to be as far into the back of the throat as possible b/c this will prevent nipple damage. You also don't want to start bad latching habits so if you feel the baby isn't on right use the tip of your finger and slide it into the side of baby's mouth. This will break the suction without hurting you. Then try again. My nurse told me you want the baby to look like he's biting down on a burger, the way you open your mouth to a big tall sandwhich is the way you want baby to latch on. Once the baby learns how to nurse correctly you won't have to work so hard to get them on right...After a couple weeks you'll be able to get baby to latch on in the dark, half asleep, without any thought at all.
5. Now that baby is latching on correctly, you want to help baby nurse for 10-15 minutes on each side every hour or two. This can be tricky because the breast is so warm and cozy and mommy's scent and heartbeat puts baby in a calm happy place so most babies pass out as soon as they latch on. You might have to keep bugging baby to stay away and suck suck suck. My pediatrician showed me how to "pump" their arm to stimulate sucking. You just flap their little arm up and down like you are pumping them! You can undress them, tickle their feet stroke their hair, etc. I personally noticed that when you stroke their cheek this was a distraction and they turn their head and open their mouth looking for a nipple and breaking the latch, so see what works best for you.
6. How do you know if they are getting anything? The lactation consultant showed me that if they are sucking and swallowing you'll see this pulsing near their temples and right under their ear along their cheek. As your milk comes in you can actually hear them swallowing harder. Remember the diagram in Breastmilk 101? Newborn babies have tiny tummies (about the size of a marble) so don't think they need a 4 oz bottle right away!
7. Alternate the breast you fed on last and nurse every hour or two. The more often you nurse, the sooner your milk will come in and the faster your milk supply will increase. Think of Dori from Finding Nemo. She sang in encouragement to Nemo's dad, "Just keep swimming, just keep swimming" but change it to, "Just keep nursing, just keep nursing."
8. Even if you think you're doing fine, meet with the lactation consultant (they are only there certain times of the day so tell your nurse that as soon as one gets to the hospital you want to meet with her) just to get any extra tips, pointers or suggestions on your latching and nursing positions.
9. Some women nurse without any pain, but most will feel some discomfort and a large part of that can be because of damaged nipples (from either bad latches or b/c they are getting dried out). Before they get too sore, apply a thin layer of nipple cream (I prefer Medela sold at Target) after each nursing. You don't have to scrub and clean this off before nursing again. Think of it as chapstick for your breasts. This "chapstick" moisturizes and creates a barrier of protection. Nursing removes natural oils so the skin gets dried out and this is when your nipples can become very tender, crack or even bleed. (If they get too damaged or sore you might have to pump and either bottle feed or "finger feed" - I'll go over that in another blog)
10. For first time moms, anticipate it taking up to 4 or 5 days for your milk to come in and try not to use bottles, formula or pacifiers for the first couple weeks to avoid nipple confusion and delay milk production. Don't beat yourself up though if you have to use any of these things, I had to use all three. I had blisters the first time and just needed a 4 hour break to allow some recovery time so I pumped and the second time I had to pump and use a bottle for 2 days b/c of nipple damage due to a bad latch. I also had to allow my son to try and use a paci b/c his screaming was unbearable (my uncle and I joked that the neighbors probably thought I was illegally harboring and torturing some rare exotic bird) and I tried to formula feed thinking that might put an end to his cries.
11. Breastfeeding can be a form of contraceptive (not full proof!) because the body might not regulate back to your normal cycle during part or the entire time you are nursing. Do not think you can't get pregnant when nursing b/c I know two moms that did, but don't be surprised if you don't get your period for 11 months after birth either (my friend didn't get hers for 11.5 months and I didn't get mine for the first 7 with Ben...my second son Jonathan is almost 6 months old and I still haven't started my period yet). I also know moms that exclusively breastfeed and started their period 2 months after giving birth. Every body is different but just be aware that nursing can shift / alter your menstrual cycle.
12. Benefits for Mom! "Breastfeeding lowers your risk of getting breast cancer. A woman who breastfeeds for twenty-four months of her life drops her risk in half"(p 27 STWTF!). "It lowers your risk of endometrial cancer, ovarian cancer, and osteoporosis. It helps your uterus shrink after childbirth. Studies show that nonbreastfeeding women's uterus never shrinks backs to prepregnancy size. It helps you loose weight because breastfeeding burns off 500 - 1,000 extra calories a day"(p 28 STWTF!). Nursing releases endorphins that make you feel happy and help you better bond with baby. These are only SOME of the benefits for mom.
13. Benefits for Baby! Babies that are breastfed have fewer cases of ear infections, are four times less likely to be hospitalized for bacterial infections, less likely to suffer from Crohn's disease, dermatitis, diarrhea, diabetes, liver diseases, and other afflictions. Breastfeeding may help your child avoid a weigh problem later in life, are 40% less likely to have misaligned teeth, and have better eyesight. Studies have shown that formula feeding may increase a baby girl's risk of developing breast cancer later in life. Babies use as much as sixty times more energy to get breastfed than to get formula from a bottle.(p16-28 STWTF!) Again these are only a FEW of the benefits for baby to breastfeed.
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