The Secret to Pain Free Breastfeeding

Breastfeeding Help And Baby Care For New Parents

The Breastfeeding Help Video Compilation By Australian International Board Certified Lactation Consultant Kate Hale is full of useful information about breastfeeding and how to manage low supply. It is very clear and concise in its content. It also has a lot handy tips for new mothers, including how to bath, massage and dress an infant. Learn how to care for a new-born, including how to deeply latch your baby and breastfeed without pain within minutes for a contented baby and an end to sore nipples. It is the only Dvd of which I am aware that is readily available to new mothers with an actual demonstration on how to correctly latch a baby on and off the breast using a couple of alternative feeding positions. Reading about breastfeeding in a book is nowhere near as useful as watching the Dvd. Continue reading...

Breastfeeding Help And Baby Care For New Parents Overview

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The author has done a thorough research even about the obscure and minor details related to the subject area. And also facts weren’t just dumped, but presented in an interesting manner.

This ebook does what it says, and you can read all the claims at his official website. I highly recommend getting this book.

Breast Feeding and Drugs

Between 1930 and the late 1960s, there was a dramatic decline in the percentage of American mothers who breast-fed their babies. This was also accompanied by a reduction in the length of breast feeding for those who did nurse. The incidence of breast feeding declined from approximately 80 of the children born between 1926 and 1930 to 49 of children born some 25 years later. For children born between 1966 and 1970, 28 were breast-fed. Indeed, in 1972 only 20 of newborns were breast-fed. As data have become available for the following years, it is clear the decline has been reversed. By 1975, the percentage of first-born babies who were breast-fed rose to 37 . At the present time in the United States, a number of surveys indicate that more than 50 of babies discharged from the hospital are breast-fed, and the number is increasing. Breast feeding is difficult to contemplate, since more than 50 of mothers work and return to work soon after delivery. New solutions must be found by...

Breast Feedinq Summary

The Breast Feeding Summary is a brief review of the literature concerning the passage of the drug into human breast milk and the effects, if any, on the nursing infant. In many studies of drugs in breast milk, infants were not allowed to breast feed. Readers should pay close attention to this distinction (i.e., excretion into milk vs. effects on the nursing infant) when using a Summary. Those who require more details than are presented should refer to the specific references listed at the end of the monograph.

Breast Feeding Summary

Reports on the use of abacavir during human lactation are unlikely because the drug is used in the treatment of HIV-1 infections. HIV-1 is transmitted in milk, and in developed countries, breast feeding is not recommended (4,5,7,8 and 9). In developing countries, breast feeding is undertaken, despite the risk, because there are no affordable milk substitutes available. Until 1999, no studies had been published that examined the effect of any antiretroviral therapy on HIV-1 transmission in milk. In that year, a study involving zidovudine was published that measured a 38 reduction in vertical transmission of HIV-1 infection in spite of breast feeding when compared to controls (see Zidovudine).

6 Use Of Psychiatric Medications During Breastfeeding

The decision to use psychiatric medications in new mothers should take into consideration whether the patient will be breast-feeding. If so, it is best to prescribe a medication for which safety data exist in breastfeeding and to use the lowest effective dose. Before the mother begins the medication, the infant's behavior and sleep and feeding patterns should be established. Changes in these patterns may reflect a side effect of the medication in the infant. For medications that lack safety data in breast-feeding, the medication's pharmacokinetic parameters can provide useful information about its likely passage into breast milk. High protein-binding and short half-lives are associated with lower concentrations of the medication in milk and therefore less infant exposure. The medication's potency is another consideration for example, fluoxetine has approximately one-sixth and one-fifteenth the serotonergic potency ofsertraline and paroxetine, respectively. Therefore, a serum...

Will Breast Feeding Help You Lose Weight

Breast-feeding burns calories, so you may lose weight without cutting back on calories. It also shrinks the uterus, which can make you look more svelte (if that word can be used without irony for the mother of a newborn). On the other hand, bottle-feeding mothers can try some exercises and weight-loss diets that are not advisable when you're starting to breast-feed. Either way, it's wise to assume that it will take you nine months to a year to get back to your prepregnancy weight. While breastfeeding, a woman of normal weight should lose no more than one to two pounds a month. But compared to all the life-altering changes that come along with any baby, the extra limitations on nursing mothers are relatively minor and last only a few months. For most women, no dietary changes are needed, for instance. Leaving a newborn home requires planning, no matter how you feed her, and breast milk can be saved in bottles to allow Mom time away from the baby for work or play. Besides,...

Tides in Breastfeeding Practice

Throughout the world today, an infant is apt to receive less breastmilk than at any time in the past. Until the 1940s, the prevalence of breastfeeding was high in nearly all societies. Although the feeding of manufactured milks and baby milks had begun before the turn of the century in parts of Europe and North America, the practice spread slowly during the next decades. It was still generally limited to segments of population elites, and it involved only a small percentage of the world's people. During the post-World War II era, however, the way in which most mothers in industrialized regions fed their infants began to change, and the export of these new practices to developing nations was underway. Evidence About Breastfeeding Practices How do we know what we know about the prevalence of breastfeeding (The word prevalence is used here to mean the combined effect of breastfeeding initiation rates and breastfeeding continuance rates.) Before attempting to trace trends in infant...

Preparing for breastfeeding

If you plan on breastfeeding, you may want to take steps to toughen the skin around your nipples, which can help prevent them from cracking and becoming sore when you're breastfeeding. Because cracked nipples can be painful, preparing them helps reduce any discomfort you may have. You can try very gently rubbing or massaging your nipples between your fingers, exposing them to air, rubbing them gently with a wash cloth, or wearing a nursing bra with the flaps down so that your nipples rub against your clothes. Creams and oils work against toughening, so don't use them on your nipples. Some women worry that they don't have the right type of breasts for breastfeeding, but no breast type is right or wrong. Breasts both large and small can produce adequate milk. Some women with retracted or inverted nipples can make breastfeeding easier by massaging their nipples so that they protrude more. (See Chapter 14.) Some maternity or baby stores sell special breast shells that use suction to help...

The Unique Characteristics of Counseling Breastfeeding Women

There are unique aspects of working with breastfeeding women that differ from other aspects of health care. Breastfeeding is an emotion-laden subject that may be viewed as an integral part of human sexuality, not just an infant feeding method. It touches deep-seated feelings that people have about themselves and their bodies that reach back to childhood. This emotional content makes breastfeeding counseling, like sex counseling or childbirth education, unusually sensitive. Health-care workers assisting breastfeeding families must be especially intuitive, caring listeners and advisors. Working with new mothers and babies is a popular and thus, competitive, activity. Not only are newborns adorable, but the mothers and fathers are (generally) healthy and happy. By working on the hospital maternity unit or in a birth center, the nurse gets to play a paid, starring, ongoing role in the usually joyous family dramas of birthing and early breastfeeding. As a result, nurses compete to work...

Sizing up the advantages of breastfeeding

Breast-feeding gives your baby a tailor-made formula for good nutrition and a whole lot more. The following are some advantages to breast-feeding Breast-feeding is emotionally rewarding. Many women feel that they develop a special bond with their baby when they breast-feed, and they enjoy the closeness surrounding the whole experience. Breast-feeding is convenient. You can't leave home without it. You never have to carry bottles or formula with you. Breast-feeding provides some degree of birth control (although it's not totally reliable see the section Looking at birth control options). Some studies suggest that women who breast-feed may reduce their lifetime risk of breast cancer.

Latching onto Breast Feeding

Pregnancy goes a long way toward preparing your body for breast-feeding. The key pregnancy hormones cause the breasts to enlarge and prepare the glands inside the breasts to lactate. But you can prepare yourself for day-to-day nursing. You can, for example, toughen your nipples a bit and thus minimize soreness later on in a few different ways Some women have inverted nipples and worry during pregnancy that their nipples will make breast-feeding difficult. Usually, the problem corrects itself before the baby is born, but a few techniques can help things along

Checking out breastfeeding positions

You can breast-feed in one of three basic positions, as shown in Figure 14-3. Use whichever position works and is comfortable for you and your baby. Most women alternate among the positions. Lying down Lie on your side in bed with the baby next to you. Support the baby with your lower arm or pillows so that his mouth is next to your lower breast, and use your other arm to guide your baby's mouth to the nipple. This position is best for late-night feedings or after a cesarean delivery when sitting up is still uncomfortable. (See Figure 14-3b.) One concern about breast-feeding while in bed is that you may fall asleep and unknowingly roll over your baby. You may decide to keep a cradle or crib next to your bed so you can put your baby back to sleep right after you finish feeding, without disrupting your night's sleep too much. The three basic positions for breastfeeding.

31 The advantages of breastfeeding versus the risks of maternal medication

No discussion of the risks of maternal medications can be undertaken without an understanding of the benefits of being breastfed for the child. Advantages to breastfeeding have been recognized in general terms for decades. However, new information and evidence-based studies following breastfed infants for months and even years have identified many additional advantages and protections provided by human milk and the process of breastfeeding. There are many advantages to breastfeeding for the mother herself The process facilitates the rapid recovery postpartum, with a reduccd loss of blood and the prompt involution of the uterus to its pre-pregnant state (Labbok 2001). Further breastfeeding prevents post-partal depression (Groer 2005), and reduces the long-term risk of obesity and osteoporosis for the nursing mother. Studies of specific diseases show that there is a reduced risk of breast cancer and ovarian cancer for women who breastfeed (Lawrence 2005, Collaborative Group 2002)....

63 Cocaine and Breast Feeding

Women using cocaine should be advised not to breast-feed because of the risk of passive intoxication of the infant, and ideally these infants should be cared for outside of the home until the mother is able to obtain treatment. Seizures can result from infant cocaine intoxication. However, maternal cocaine use is generally not reported, so that cocaine intoxication is usually unsuspected when an infant is brought in for a medical evaluation of a seizure. Another danger is if the mother smokes crack cocaine, neonates and infants in the area are at risk of intoxication because of passive inhalation (59).

Breastfeeding and maternal diabetes

Fifteen observational studies have been written about the role of breastfeeding in IDM and IGDM.54 There is no contraindication to breastfeeding in these infants, and diabetic women should have the same opportunity to breastfeed as women without diabetes. Higher rates of pregnancy and neonatal complications among diabetic women can pose significant challenges to breastfeeding. Thus, women with diabetes should be strongly encouraged to breastfeed because of maternal and childhood benefits specific to diabetes that are above and beyond other known benefits of breastfeeding.54 Although maternal hypoglycemia does not cause a reduction in breast milk lactose level, it does lead to increased secretion of epinephrine, which inhibits milk production and the ejection reflex. In addition, elevated acetone levels can be expressed in breast milk, placing stress on the newborn liver.55 As a result, the diabetic mother should be well instructed in order to achieve the right adjustment of diabetes...

Breastfeeding care preventive measures and treatment for the newborn

COUNSEL ON BREASTFEEDING (1) Counsel on importance of exclusive breast feeding Help the mother to initiate breastfeeding COUNSEL ON BREASTFEEDING (2) Support exclusive breastfeeding breastfeeding OTHER BREASTFEEDING SUPPORT Give special support to the mother who is not yet breastfeeding Advise the mother who is not breastfeeding at all on how to relieve engorgement If the baby does not have a mother COUNSEL ON BREASTFEEDING (3) Give special support to breastfeed the small baby (preterm and or low birth weight) Give special support to breastfeed twins COUNSEL ON BREASTFEEDING (3) Give special support to breastfeed the small baby (preterm and or low birth weight) Give special support to breastfeed twins This section has details on breastfeeding, care of the baby, treatments, immunization, routine and follow-up visits and urgent referral to hospital.

Breast Feeding Difficulties

If your baby cannot nurse or if you are having troubles with breast-feeding, it is important that you call your doctor as soon as possible. Refusal to breast-feed may be a sign of sickness that needs prompt attention. Try to avoid caffeine while you are breast-feeding, or at least reduce your intake. Caffeine tends to build up in babies because their bodies cannot get rid of it very easily. A morning cup of coffee is not likely to harm your baby, but too much caffeine can cause problems such as poor sleeping, nervousness, irritability, and poor feeding. Try using decaffeinated coffee and tea, and avoid colas and other carbonated drinks that have added caffeine. Sometimes breast-feeding babies react to certain foods eaten by their mothers. You may notice after you eat spicy or gas-producing foods that your baby cries, fusses, or nurses more often. Babies with colic often have similar symptoms. The best way to tell the difference between a food reaction and colic is by how long the...

Pharmacologic Treatment Options for Unipolar Depression and Bipolar Disorder in Breast Feeding

A MEDLINE search identified 148 original research reports for the use of antidepressants or mood stabilizers during breastfeeding. With few exceptions, the parent compound and or metabolites were found in human breast milk thus, the nursing infant is always exposed to medication. To afford a detailed characterization of infant exposure and provide a basis for comparing individual medications, investigators have typically emphasized either breast milk concentration or the nursing infant's serum concentration. Historically, the de facto standard for breast-feeding safety has been defined as an estimated infant daily dose (estimated from the milk plasma M P ratio and infant weight) of less than 10 of the maternal daily dose. This standard has essentially no scientific justification. Conclusions based on such measures are

1915antidepressants and breastfeeding

The clinicians of breastfeeding women diagnosed with postpartum depression must consider the different treatment options for their patients including antidepressants, hormonal therapy, or psychotherapy. In situations where the postpartum depression requires antidepressants, the safety of the nursing infant must be considered. Antidepressants taken during breastfeeding can induce adverse symptoms in the infant. The antidepressants that have been particularly problematic are nefazodone 102 , citalo-pram 103 , doxepin 104, 105 , and fluoxetine 106, 107 . Given the negative infant outcomes associated with maternal antidepressant therapies, the US Food and Drug Administration (FDA) has not approved any antidepressant for use during lactation 49 . Alternatively, depression during the postpartum period can impair maternal-infant interactions 108 , which in turn negatively affect infant cognitive development 109 , emotional development 109 , anxiety, and self-esteem 110 . In some cases, the...

102 Breast Feeding and Feeding Issues

As the new mother struggles in her efforts to lose weight, she may also have difficulties in feeding her baby. To date, there are seven studies of four samples of eating-disordered mothers and their offspring (45-51). In summary, these studies find that, compared with controls, the children of women with eating disorders weigh less at infancy and at 1 yr, have more difficulty with breast-feeding and bottle-weaning, and have more emotional difficulties and eating behavior disturbances (inhibited, secretive, or overeating). During mealtime, interactions are characterized by more conflict in eating-disorder dyads, and mothers were found to make fewer positive comments during mealtimes. One study (49) found that 20 of the variance in weight at 1 yr was accounted for by conflict during mealtime. The eating-disordered mothers reported more negative affectivity in their children and more concern for their daughter's weight and preferred thinner babies. A recent review ofthis literature...

1916effect of postpartum depression on breastfeeding success

Given the benefits of breastfeeding for both mother and infant, breastfeeding mothers with postpartum depression may benefit from this choice of feeding. However, the additional demands of breastfeeding could also be overwhelming for women experiencing postpartum depression, and care should be taken to support mothers deciding to formula feed. Those women who decide to breastfeed will likely need additional support to foster the continuation of breastfeeding during this difficult time. Although breastfeeding may reduce depressive symptoms during the postpartum period, mothers with depressive symptoms are more likely to discontinue breastfeeding 111-115 . Referrals to area lactation consultants and breastfeeding support groups such as La Leche League can be extremely helpful to mothers with PPD who are interested in continuing breastfeeding.

Antidepressants in Breast Feeding The Data

As a class, antidepressants have been the focus of more published data on breast-feeding than any other class of medications. This database (summarized in Table 5-1) includes 687 separate measures of breast milk concentrations with more than 400 nursing infant serum measures. It is noteworthy that the lactation categories for SSRI antidepressants listed in the PDR and AAP guidelines (i.e., unknown, but may be of concern) do not reflect the extant literature. The best example of the limitation of the PDR in this area is the statement regarding sertraline (it is not known whether and if so to what amount sertraline and its metabolites are excreted into human milk) a medication with the greatest amount of data on breast milk excretion of any medication in the PDR. Antidepres-sant use during lactation warrants continued concern however, the failure of the AAP to cite the extant data set in its latest report is inexplicable. A literature review identified 11 publications, comprising 40...

Management after the birth Breastfeeding and its problems

Correct positioning of the baby on the breast is one of the most important factors in successful breastfeeding. The baby has a natural sucking reflex, which in turn stimulates the mother's milk production. For this to be effective, the baby has to 'latch on' correctly, sucking on the whole nipple and surrounding areola, pulling it in towards the back of the mouth. The mother should support her back with pillows and lift the baby to the breast rather than bending over, putting a cushion under the baby if that helps. This will help to prevent sore nipples as well as upper back, neck and shoulder problems.

Cracked and sore nipples

The nipples may well feel tender during the first few days of breastfeeding but this does improve as time goes on. The mother should be closely supervised during the early days to ensure that the baby is properly 'latched on'. A comfortable nursing bra is important, though sore nipples heal quicker if exposed to the air. Creams such as Camillosan, calendula or Bach Rescue Remedy cream can be applied, though it is important to wash or wipe these off the nipples before the baby sucks. However, too much washing of the nipples, particularly using soap, is counterproductive as it will dry the nipples out further. You could suggest steeping two camomile tea bags in boiling water, cooling them and applying them to the nipples inside a bra.

The Breastfeeding Connection

I underst an d absolutely th at not every woman can or wants to breastfeed, but there is no better way of conti nuin g the physic al con necti on between you and your b aby. Sh e may be breathing on her own, but sh e is sti ll reli ant on you for food through th e bre ast r ath er th an th e placent a .

Mood Stabilizers in Breast Feeding Infant Monitoring

In contrast to antidepressants, mood stabilizers might directly affect laboratory indices in the breast-feeding infant. There is no consensus with respect to infant monitoring, although a conservative approach warrants monitoring of those indices that are potentially affected by the individual medications. It would be prudent to establish a baseline and to periodically repeat such measures. Like the antidepressants, all mood stabilizers studied to date cross the placental barrier. Typically, anticonvulsant and lithium exposure in pregnancy is greater than 80 and breast-feeding exposure is considerably less.

Breast Engorgement Really Sucks and Breastfeeding Can Be a Production

Of course you know your breasts fill up with milk after you deliver your baby. But what you may not have heard is how painful and cumbersome this engorgement can be if you aren't breast-feeding, or when you decide to stop breast-feeding. Your breasts may become rock hard, tender, and warm, and they sometimes seem to grow to the size of blimps. Fortunately, the discomfort is temporary this intense period of engorgement lasts only a couple of days. We encourage all of our patients to breast-feed due to the benefits for the baby, but keep in mind it may be harder than you think. Needing some extra help and assistance is very natural. Fortunately, most hospitals have lactation specialists that can help you milk the process along.

4186 Breastfeeding despite environmental contaminants

Persistent organochlorine compounds are stored in the fatty tissue for life, and are only mobilized by losing weight and breastfeeding. For this reason, a low-calorie diet should be avoided while breastfeeding. Apart from a marked intake of animal fat and contaminated seafood (especially shellfish), the current dietary habits of the mother have little influence on the contamination levels in the milk. However, a primarily vegetarian diet of products having low pesticide residues does lead to a lower level of contaminants in the mother's milk. Every breastfed child reduces the contaminant load in the fatty tissue of the mother and in the milk by about 10-20 . It could be said, somewhat cynically, that breastfeeding is the most effective detoxification technique for the mother. There is speculation as to whether so-calicd endocrine disruptors, i.e. contaminants with estrogenic properties (some PCBs, dioxins, phthalatcs), taken in via the mother's milk, may impair an infant's development...

4187 Breastfeeding and the workplace

The motto for the World Breastfeeding Week 2000 (Breastfeeding It's Your Right''), coined by the World Alliance for Breastfeeding Action (WABA), raised awareness that it is the responsibility of both political bodies and society at large to make it possible for women to breastfeed. Part of this responsibility is creating conditions that permit a mother to breastfeed for as long as she and her baby want to, despite her being employed outside the home. At the same time, the motto emphasized the right of the child to be nourished optimally - and that means the right to be breastfed. The revised International Labor Organization Convention (ILO Convention No. 183), passed in June 2000, codifies the mother's right to retain her job, protection from being dismissed, and the adaptation of both the work and the working hours to suit the situation of the pregnant or breastfeeding mother. Some countries have gone beyond the convention and passed legislation which provides that pregnant or...

Breast Feeding During Illness

Many parents are concerned that breast-feeding has to stop if the mother gets ill. During most illnesses, including colds, flu, bacterial infections, and even surgical conditions, breast-feeding can and should continue. By the time you show symptoms of an illness, your baby has already been exposed to it. The best thing to do is to keep breast-feeding, because you have already started to produce antibodies. The baby will receive these antibodies through your milk, preventing infection of the baby. If you stop breast-feeding when cold or flu symptoms first appear, you actually reduce your baby's protection and increase the chance of the baby's getting sick. If you are unable to breast-feed your baby while you are ill, keep up your milk supply by expressing milk for your baby either by hand or using a pump. The milk can then be fed to the baby. You will usually need to stop breast-feeding only for a short period of time, even with serious illnesses. There are several infectious...

84 Methadone and Breast Feeding

Mothers who are treated with methadone and are abstinent from substance use should not be discouraged from breast-feeding. Negligible amounts of methadone appear to be transmitted in breast milk (80), and recent guidelines have maintained that, regardless of the mother's dose, nursing is unlikely to adversely affect the infant. The amount of metha-done transmitted to an infant from breast milk is not enough to prevent NAS. Breast-feeding fosters maternal attachment and is valuable for both the mother and infant. However, mothers may become discouraged as they try to nurse an infant undergoing NAS because the infant's symptoms may interfere with nursing. These problems can be addressed by a lactation consultant working with the substance abuse and medical treatment staff (80).

Organizations And Events That Promote Breastfeeding

1995 World Alliance for Breastfeeding Action 1998 United States Breastfeeding Committee of breastfeeding. Guidelines and Recommendations for Breastfeeding US National Breastfeeding Policy Conference United States Breastfeeding Committee, 2001 The Right to Breastfeed Act passed to ensure a woman's right to breastfeed on federal property Expert Panel on Breastfeeding Breastfeeding Blueprint century or so, as breastfeeding became associated with more restrictive aspects of women's lives, as breastmilk was thought by some to be inferior to increasingly available manufactured infant milks, and as use of manufactured milks became a hallmark of privileged segments of society, large portions of both lay and health-care populations came to be lieve that there was little reason to persist in traditional breastfeeding practices. Since the early 1990s, however, it has become increasingly clear that breastfeeding confers health and psychological advantages on the breastfeeding infant and also...

Breastfeeding

In most cases, the midwife should promote and support breast-feeding even if concern may arise over drugs passing to the baby in breast milk. Here the midwife should confer with the physician, paediatrician and pharmacist as to the best course of action. In some cases the mother may need to express and dispose of breast milk until certain drugs have 'cleared' and she is able to breast-feed as normal. Alternatively she may have to continue with her 'pregnancy drugs' and delay a return to the former treatment regimen until breast-feeding has ceased. The midwife should address practical aspects, such as equipment for expressing breast milk, cleaning and sterilisation of that equipment and storage of the milk, which will require refrigeration and labelling to comply with food handling requirements of the individual institution. Arrangements should be made to take the milk over to the neonatal unit if the mother is unable to go in person. Personal issues must not be forgotten, such as...

Breast Feeding

There are many advantages to breast-feeding your premature infant. In addition to all the advantages breast milk can give any baby (see Chapter 8, Breast or Bottle, and Chapter 9, Breast-Feeding, for more details), it contains higher amounts of certain nutrients that premature infants need. The early breast milk, called colostrum, is especially rich in antibodies and cells that help fight infection. Mother's milk is better tolerated by the premature baby and may reduce the risk for necrotizing enterocolitis, a serious disorder of the immature bowel. Even small amounts of mother's milk in the early days or weeks after birth can provide premature babies with health benefits. So if you are uncertain about breast-feeding, you may want to consider providing breast milk for your infant for just a few weeks or while he is in the hospital. In the beginning, breast-feeding your premature infant will take patience, time, and some equipment. Many premature babies are not able to feed at the...

128breastfeeding

De Martino et al. 83 report that the risk of mother to child transmission (MTCT) of HIV through breastfeeding ranges from 4 to 14 , depending upon geographic location and whether feeding was sustained for greater than 1 year. Some risk factors for MTCT through breastfeeding include viral load in the blood 84 , viral load in breast milk 85 , the mother's immune status 86 , the breast health of the mother 87 , and the mother's nutritional status, including hemoglobin and serum retinol levels. 58, 88-89 . Mothers who are HIV-positive should be educated regarding the risks and benefits of different feeding options, including the risk of transmitting HIV through breastfeeding 1 as well as an increased mortality rate among HIV-infected pregnant women who breastfeed 90 . The metabolic demands of lactation as well as the metabolic demands of HIV infection are thought to lead to nutritional impairment and subsequently, an increased risk of infant mortality 90 . It is recommended that mothers...

137breastfeeding

Although pregnancy is a time when women should be discouraged from caloric restriction, concerns regarding weight gain provide an excellent opportunity to promote breastfeeding. Women concerned about weight gain may be particularly interested in learning how breastfeeding can help shed pounds gained during pregnancy 52 . Dewey and colleagues 53 found that weight loss is enhanced in the postpartum period if lactation is continued beyond 6 months. Rather than pursue weight loss by restricting calorie, and consequently nutrient, intake, women should be educated regarding energy balance in the context of breastfeeding. Specifically, by understanding the high-energy demands of lactation, women can apply the concept of negative energy balance subsequent to breastfeeding to potential weight loss during the postnatal period. The needs for successful lacatation are discussed further in Chap. 18, (Nutrition Issues during Lactation).

10 Breastfeeding

Postpartum, the doses of antipsychotics generally need to be raised in order to prevent postpartum exacerbation ofillness. Antipsychotic drugs are lipid soluble but highly protein-bound, so that plasma milk ratios are high. The amount of antipsychotics found in breast milk is usually less than 30 ofthat found in maternal plasma. Nonetheless, because infants have little body fat, reduced protein binding, and lower excretion rates, the effects of drugs absorbed through breast-feeding can affect the infant's central nervous system. Delayed development at 12-18 mo of age has been reported for three infants exposed to a combination of the first-generation antipsychotics, haloperidol and chlorpromazine. Because only one of the three infants had detectable serum levels of the drug, this finding is hard to interpret (50). One report indicates a low level of olanzapine in infant plasma (compared with mother) and a level during breast-feeding that was undetectable (51). No adverse effects...

Assess breastfeeding

Assess breastfeeding in every baby as part of the examination. How is the breastfeeding going Observe a breastfeed. If the baby has not fed in the previous hour, ask the mother to put the baby on her breasts and observe breastfeeding for about 5 minutes. Breastfeeding 8 times in 24 hours on demand day and night Encourage the mother to continue breastfeeding on demand K3. Breastfeeding less than 8 times per 24 hours. Support exclusive breastfeeding gJQS. Help the mother to initiate breastfeeding K3.

Breastfeeding twins

It may seem daunting, but some women with twins successfully breast-feed. Your body can make enough milk for two babies at once, especially if you're persistent and work up your milk production to a high level. Even so, arriving at a system that works for you takes some experimentation. You may breastfeed both babies at once or each one separately. The advantage to the first alternative is that you don't spend all your time breast-feeding, but the second method is easier. You don't have to deal with one baby finishing first and needing to be burped while the other one is still sucking. (Holding one baby over your shoulder and keeping another one at your breast can be very tricky, no matter how many pillows and props you use.) You may breast-feed one baby, bottle-feed the other, and then alternate at the next feeding. You may breast-feed each baby a little at each feeding and then supplement with the bottle. Or you may breast-feed both babies for most of the day and then supplement...

1914breastfeeding

Breastfeeding is known to be very beneficial to both mother and infant, and recent reports suggest that it may reduce risk for postpartum depression in women by reducing stress 92-97 . Although the majority of investigations point to breastfeeding as protective in postpartum depression, results are equivocal, as other investigations have reported no relationship between depressive symptoms and breastfeeding 98-100 . As earlier described, Infants of mothers with postpartum depression are at risk for cognitive and emotional impairments 37-41 , and breastfeeding can help protect infants against these negative outcomes. Breastfed infants of depressed mothers exhibited decreased depressive symptoms compared to those who were bottle fed 101 .

Fetal Risk Summary

A woman with glaucoma was treated throughout pregnancy with acetazolamide, 250 mg twice daily, and topical pilocarpine and timolol (8). Within 48 hours of birth at 36 weeks' gestation, the infant's condition was complicated by hyperbilirubinemia and asymptomatic hypocalcemia, hypomagnesemia, and metabolic acidosis. The deficiencies of calcium and magnesium resolved quickly after treatment, as did the acidosis, even though the mother continued her medications while breast feeding the infant. Mild hypertonicity of the lower limbs requiring physiotherapy was observed at 1-, 3-, and 8-month examinations (8). Two other healthy infants of an epileptic mother, treated throughout two pregnancies with acetazolamide 250 mg day and carbamazepine, were delivered at term and showed no effects of exposure to the drugs (8).

35 Amount of medication in the milk and relative dose

Sometimes there is also information about how much medication a child takes in with each meal. This method of calculating can make sense in the case of a single dosage of a drug with a short half-life. Based on the assumption of five breastfeeds a day, a child would drink 150 5 30 ml kg per breastfeed ( 0.031 kg per breastfeed). (50 ig l x 0.15 I kg dailyJ 5 1.5 ig kg per breastfeed.

36 Toxicity of medications in the mothers milk

Of a group of 838 mothers who had drug therapy while breastfeeding, about 11 reported symptoms in their infants that were possibly caused by the medication. In no case did this involve serious symptoms needing therapeutic intervention. The following associations were observed by the mothers (Ito 1993 B) In some cases, an interruption of breastfeeding following the administration of medication may make sense. This may be easier to adhere to if the mother chooses, for instance, to take the medication in the evening after the last breastfeed. By avoiding the peak plasma times, the maternal drug levels that reach the milk can be minimized. In the case of paracetamol, it was even demonstrated that there was a higher concentration of medication if the breast had been frequently pumped (Notarianni 1987). The following exposures are known to be problematic in breastfeeding When administration cannot be avoided in an individual case, it must be decided whether to abandon breastfeeding...

37 Medications that affect lactation

Medications with an antidopamine effect, such as phenothiazine, haloperidol, and other neuroleptics, such as sulpiride and risperidone, as well as the antihypertensive a-methyldopa, and medications used to stimulate intestinal peristalsis, domperidone and metoclopramide, can, as a result of increasing the secretion of prolactin, stimulate milk production. The sympathicoiytic action of reserpine can have the same effect. Growth hormone and thyrotrophin-releasing hormone can also enhance milk production. Domperidone and metoclopramide are occasionally used for this purpose - for example. 10 mg metoclopramid three times a day (for a maximum of 7-10 days) and then tapering off the dosage for 2-5 days is sometimes recommended. Domperidone (not available in the USA) is less capable of crossing the blood-brain barrier, and therefore the risk of extrapyramidal symptoms is remote. Due to a molecular mass of 426, protein binding > 90 , and poor oral bioavailability, the relative dose for a...

412 Acetylsalicylic acid

The half-life of salicylates in mother's milk is more than 7 hours, which is decidedly longer than in plasma. The highest values are reached in just about 3 hours. Following a single dose of 500 mg acetylsalicylic acid, a maximum of 7.8 mg was measured in the milk after 1000 mg this rose to 21 mg I, and after 1500 mg it was 48mg l (Jamali 1981). If these high concentrations apply, an infant can consume between 0.2 and 1.4 mg acetylsalicylic acid per kg bodyweight at each breastfeed. This represents 2-14 of an antipyretic infant dosage of lOmg kg. There is very little experience for long-term antiphlogistic therapy with a daily dosage of up to 5g. In one case, a near-therapeutic concentration of 65mg l was found in the infant's plasma despite supplementary feeding (Unsworth 1987). The 16-day-old infant of another mother who took 4g of acetylsalicylic acid daily, as antiphlogistic therapy, showed toxic symptoms with a salicylate concentration of 240mg l in the plasma (Clark 1981)....

416 Pyrazolone and phenylbutazone derivatives

There is very little experience of using these medications during breastfeeding. Taking its four main metabolites into consideration, an M P ratio of about 1 was calculated for metamizol. In one case, very similar serum concentrations were found in both mother and child (Zylber-Katz 1986). Another report describes cyanotic attacks in an infant after his mother took metamizol (Rizzoni 1984). Phenylbutazone has a half-life of 30-170 hours and an M P ratio of 0.1-0.3. There have been no toxic effects reported, as yet, in breastfed infants. The American Academy of Pediatrics does not object to its occasional use during breastfeeding. Recommendation. Famprofazone, kebuzone, metamizol, mofebutazone, phenazone, phenylbutazone, and propyphenazone should be avoided. Accidental intake does not require any limitations on breastfeeding, but the medication should be changed. Ibuprofen and paracetamol are the anal-gesics antiphlogistics of choice.

417 Other antirheumatics

Bccause of tlieir risk-benefit ratio. Passage into the mother's milk and tolerability during breastfeeding have not been studied sufficiently to assess risk. A case report describes two healthy babies who were breastfed for 3 months during maternal penicillamine therapy for Wilson's disease (Messner 1998). Recommendation. Among the basic antirheumatics, sulfasalazine and glucocorticoids and, in some instances, hydroxychloroquine are acceptable during breastfeeding. The American Academy of Pediatrics considers taking gold preparations while breastfeeding to be acceptable. This should be looked at critically because of the above pharmacokinetic data. Single doses of the other medications do not require any limitation of breastfeeding.

419 Local anesthetics

For normal use (dental treatment or minor surgery), local anesthesia may also be used during breastfeeding. This also applies to combinations with adrenaline. Prilocaine should be avoided, but if it is used accidentally there is no need to interrupt breastfeeding.

424 Anticholinergics for asthma treatment

The anticholinergic effect of ipratropium bromide and oxitropium bromide also causcs bronchodilatation and can lead to a considerable reduction in the necessary -sympathomimetic dosage. Documented experience on its use during breastfeeding is limited. However, good tolerance can be assumed with the well-tried ipratropium bromide. Recommendation. Ipratropium bromide is acceptable for treating asthma while breastfeeding, and should be used in preference to oxitropium bromide.

429 Acetylcysteine and other mucolytics

Acetylcysteine, ambroxol, and bromhexine are widely used and well-tolerated during breastfeeding. There are no details available on their kinetics. Carbocisteine, guaiacol, guaifenesin, mesna, and preparations with essential oils such as cineol, myrtle, lime, and eucalyptus are probably also well-tolerated during breastfeeding, but here too there are no systematic studies to date. Essential oils can change the taste of the milk and lead to feeding problems. Recommendation. Acetylcysteine, ambroxol, and bromhexine are the mucolytics of choice during breastfeeding when non-drug procedures such as abundant fluid and inhalation are not really effective. Carbocisteine, guaiacol, guaifenesin, and mesna should be avoided. Potassium iodate as an expectorant is absolutely contraindicated during breastfeeding.

432 H2receptor blockers and other ulcer therapeutics

H2-blockers may be given during lactation. Those with low concentration in breast milk should be preferred - for example, famotidine or nizatidine. If proton-pump blockers are indicated, omeprazole or pantoprazole should be chosen. Single doses of other medications do not require any limitation of breastfeeding, but a change in therapy is desirable.

433 Peristaltic stimulators

Hansen (2005), in a randomized double-blind study, investigated more than 60 mothers of preterm newborns, who received either metoclopramid or placebo. There were no significant differences with respect to the amount of milk and duration of lactation period. Other reports observed its successful use in, for example, the context of lactation stimulation in a woman with agenesis of the uterus. Although her pregnancy was carried by another woman, she wanted to breastfeed her child. Therefore, she started with 3 x 10 mg metoclopramide from week 28 until delivery (of the host-mother), and stimulated the nipples with an electric milk pump. The effect of this method was confirmed by serum prolactin and estradiol measures. She was ultimately able to breastfeed her child until 3 months of age however formula was used as a supplement because of insufficient milk production (Biervliet 2001). Recommendation. Domperidone, metoclopramide, and cisapride may be used for appropriate indications. The...

435 Anticholinergic spasmolytics

Atropine-Wke preparations are considered to be contraindicated due to tbe extreme sensitivity of the infant to this group of substances. However, there have been no publications, as yet, in which negative effects on the baby have been described as a result of giving atropine-like drugs to a breastfeeding mother. Experience with other anticholinergics such as butinolin, denaverin, glycopyrrolate bromide, hymecromon, mebeverine, methanthelinium, oxybutynin, phenamazide, pipenzolate, pipoxolan, tiropramide, toltero-dine, trospium chloride, and valethamate bromide is insufficient with respect to breastfeeding. Recommendation. Butylscopolamine may be administered for appropriate indications. In the case of bladder incontinence, oxybutynin, which is equally widely used, also seems to be acceptable. Single administration of the other drugs mentioned does not require any limitation of breastfeeding. However, a critical look at the indications, and in some cases a change in therapy, should be...

437 Agents used for chronic inflammatory bowel diseases

Mesalazine consists of 5-aminosalicylic acid, the anti-inflammatory portion of sulfasalazine. With a daily intake of 1500mg, 0.015 mg kg daily was calculated for the infant. This is less than 0.1 of the maternal weight-related dosage (Klotz 1993, Jenss 1990). However, taking into consideration the metabolite, acetyl-5-aminosaIicylic acid (about 12 mg 1 of milk), it would be 7.5 . A further publication also reports 15 mg active ingredient per liter (Christensen 1994). Silverman (2005) found very low levels of 5-aminosalicylic acid in the milk of four lactating mothers however, the content of the relatively inactive metabolite N-acetyl-5-aminosalicylic acid was 1000-fold higher. A case report described an infant who developed diarrhea following repeated rectal administration of mesalazine to his mother. The diarrhea ceased when therapy was ended (Nelis 1989). In a further group of eight breastfeeding women, there was also a report of a child with diarrhea (Ito 1993). However, the...

4311 Chenodeoxycholic acid and ursodeoxycholic acid

There is no documented experience on the tolerance of chenodeoxycholic acid and ursodeoxycholic acid during breastfeeding. Only limited amounts of ursodeoxycholic acid appear in the blood circulation, where they are overwhelmingly bound to albumin. Thus, a quantitative transfer into the milk is unlikely. Recommendation. Chenodeoxycholic acid and ursodeoxycholic acid should not be used while breastfeeding. The exception is therapy for primary biliary cirrhosis with ursodeoxycholic acid. In such a case, breastfeeding does not necessarily need to be limited.

442 Penicillins cephalosporins and other f3lactam antibiotics

In the case of aztreonam, a 0,2 relative dosage was reported for the baby in the next breastfeed after the mother had taken a single dose (Ito 1990), Recommendation. Penicillin derivatives and cephalosporins are the antibiotics of choice during breastfeeding. As far as possible, substances that have been in use for a long time (e.g. second-generation cephalosporins) are preferable. When necessary, other -(-lactam antibiotics and davulanic acid can also be used.

443 Erythromycin and other macrolides

There are no reports of specific intolerance during breastfeeding to any of the macrolides mentioned here. This also applies to josamycin. Recommendation. In addition to penicillin derivatives and cephalosporins, erythromycin and roxithromycin are the antibiotics of choice during breastfeeding. The macrolidic antibiotics, azithromycin, clarithromycin, josamycin, and spiramycin, are second-choice medications. Where there is already a noteworthy icterus in the first days of life, caution should be exercised if the mother receives high dosages of parenteral macrolides.

445 Dapsone nitrofurantoin and other drugs for urinary tract infections

Cotrimoxazole or trimethoprim alone (which is mostly just as effective as cotrimoxazole as monotherapy for urinary tract infections) can be used for appropriate indications. If actually indicated, nitrofurantoin and sulfonamides can also be prescribed. In the case of necessary treatment with dapsone, an individual decision must be made about limiting breastfeeding.

4410 Tuberculostatics

Tuberculostatics of choice during breastfeeding are isoniazid (in combination with 0.5-1 mg vitamin B6 prophylaxis per day for the infant), rifampicin, and pyrazinamide. Ethambutol is also acceptable. Streptomycin is a second-choice drug. If possible, it should not be used in the newborn period. Protionamide should be avoided.

4412 Local antimycotics

Local antimycotics of choice during breastfeeding are nystatin and clotrimazole. Miconazole is also acceptable. These three drugs are preferable to the other abovementioned locally effective antimycotics. if one of the other medications is urgently indicated, breastfeeding can continue with no limitation if its use is only temporary or if only small areas are being treated. In the case of fluconazole, following a single dosage of 150 mg orally, a maximum of 2.9 ig ml was measured in the milk. Based on this, a fully breastfed infant would receive over 15 of the maternal weight-related dosage. A half-life of 30 hours was calculated for fluconazole in the milk (Force 1995). The good tolerance in infancy for fluconazole administered intravenously for therapeutic purposes was cited by many authors as grounds for clearing it for usage during breastfeeding. Recommendation. When systemic therapy is unavoidable, fluconazole should be selected over ketoconazole because It is...

4415 Acyclovir antiretroviral drugs and other virustatics

No statements regarding kinetics or tolerance during breastfeeding can be made for the other virustatics, adefovir, amantadine, atazanavir brivudine, cidofovir, famciclovir, fosamprenavir, sodium foscarnet, ganciclovir, ribavirin, valaciclovir, and zanamivir, nor for the antiretroviral substances abacavir, delavirdin, didanosine, efavirenz, indinavir, lopinavir, nelfinavir, ritonavir, saquinavir, stavudine, tipranavir, and zalcitabine. Recommendation. Breastfeeding may continue when acyclovir or valaciclovir are administered externally or systemically. The other virustatics and antiretroviral substances, if really indicated, require an individual decision about continuing breastfeeding. In the case of drugs developed for HIV infection, an additional consideration is the risk of virus transmission via the mother's milk (see Chapter 4.15) here, guidelines only clearly recommend exclusive breastfeeding in those regions where lack of clean water for preparing infant formula and feeding...

451 Maternal immunization

A woman who has not received all the recommended immunizations before or during pregnancy may be immunized in the postpartum period even though she is breastfeeding. The presence of live viruses in the milk does not present a problem because the viruses have been attenuated. According to the statement of the American Academy of Pediatrics Committee on Infectious Diseases (2006), breastfeeding women may be immunized with both killed and live vaccines. All vaccines and immunoglobulins used for mothers are considered safe for the infant during breastfeeding. Lactating women can be

Cup feeding expressed breast milk

Feed for a longer time or feed more often Teach the mother to measure the baby's intake over 24 hours, not just at each feed, i If mother does not express enough milk in the first few days, or if the mother cannot breastfeed at all, use one of the following feeding options donated heat-treated breast milk home-made or commercial formula, i Feed the baby by cup if the mother is not available to do so.

461 preceptor blockers

The following i-receptor blockers are preferred meto-prolol, Oxprenolol, propranolol (mostly used for tachycardlal arrhythmia), timolol (as eye drops), and labetalol. If another d-receptor blocker has been taken, there is no need to limit the breastfeeding, but the medication should be changed.

464 Calcium antagonists

With nifedipine and its active pyridine metabolites, a maximum of 2-10 ig kg daily is transmitted to the infant when the mother takes 30-90 mg a day. That is less than 5 of a weight-related child's dose. Average values of 2 and less are probably even more realistic (Murray 1992, Manninen 1991, Ehrenkranz 1989, Penny 1989). Nifedipin is also used successfully to treat Raynaud phenomenon of the breast nipple. Anderson (2004) reports on 12 breastfeeding women complaining of pain in the nipple, which was finally diagnosed as Raynaud phenomenon. Those choosing nifedipin therapy instantly improved. Of the 12 women, 8 had been treated with antimycotics previously because of suspected mycosis. Recommendation. Diltiazem, nifedipine, nitrendipine, and verapamil are the calcium antagonists of choice during breastfeeding. The results with nicardipine and nimodipine do not suggest any risk. Individual doses of other calcium antagonists do not require limitation of breastfeeding, but therapy should...

4612 Circulatory drugs and vasodilators

There is no information on the passage into the milk of buflomedil, gingko biloba, and other drugs which are said to promote circulation. On the other hand, we have observed no toxic symptoms in the infant as a result of ginglto biloba - a medication that is not infrequently also used during breastfeeding. Isosorbide mononitrates, isosorbide dinitrate, and glyceryl trinitrate have been insufficiently studied with respect to breastfeeding. The short half-lives and the usually brief use argue against a toxic risk for the breastfed infant.

473 Other anticoagulants

Low-dose acetylsalicylic acid (80-300 mg daily) is widely used to inhibit thrombocyte aggregation, and is well-tolerated during breastfeeding. There is a case study on lepirudine in which a breastfeeding mother who could not tolerate heparin received 50 mg of this hirudin derivative subcutaneously, twice a day, for 3 months. The maternal plasma showed 0.73 mg 1, a therapeutic concentration, and virtually no hirudin was detected in the milk < 0.1 mg 1). The breastfed child had no symptoms (Lindhoff-Last 2000). There is insufficient experience for argatroban, clopidogrel, and ticlopidine during breastfeeding. Recommendation. Breastfeeding may continue after using fibrinolytics. Lindhoff-Last E, Willeke A. Thalhammer C et al. Hirudin treatment in a breastfeeding woman. Lancet 2000 355 467. von Kries R. N cker D, Schmitz-Kummer E et al. Transfer of phenprocoumon in breast milk. Is oral anticoagulation with phenprocoumon a contraindication for breastfeeding in German , Monatsschr...

487 Recommendations classical anticonvulsants

Monotherapy with phenytoin, valproate or carbamazepine is compatible with breastfeeding. With carbamazepine, however, the baby should be observed for symptoms such as weak suck, vomiting, and tiredness. If these symptoms occur, the concentration of carbamazepine in the infant's serum should be measured. In suspicious cases, liver values should also be measured. Antiepileptic therapy with the barbiturates, clonazepam and ethosux-imide should be considered problematic during breastfeeding. If treatment is unavoidable, the decision to breastfeed should be made individually, and the infant should be observed for symptoms such as weak suck, vomiting, and tiredness. Where there is a suspicion of side effects, the concentration in the infant's serum should be determined and a decision taken regarding whether formula should be added to reduce drug transfer via mother's milk, or the baby should be weaned. Anticonvulsive combination therapy with barbiturates, clonazepam or...

4815Recommendations newer antiepileptics

As monotherapy, new antiepileptics are compatible with breastfeeding. However, close observation of the infant is recommended regarding drugs where there has been little experience or where substantial transfer has been documented. If there are any symptoms that could be associated with maternal drug therapy, the serum concentration in the child should be measured. To limit exposure, it may be necessary to supplement with formula or cease breastfeeding. In cases of prematurity, other risks and or antiepileptic combination therapy, an individual decision on breastfeeding must be taken.

491 Antidepressants in general

With SSRIs in particular, the highest drug concentration in the milk can be expected up to 8 hours after intake - and thus brief interruptions of breastfeeding for a few hours do not necessarily limit the baby's exposure. However, it might be advisable to take the medication after the last feed at night. Combination therapy using several psychoactive drugs should be viewed very critically while breastfeeding. When combination therapy is unavoidable, decisions about possible limitations on breastfeeding need to be made on a case-by-case basis. Basically, accumulation in young infants under 8 weeks of age, especially in those born prematurely, cannot be ruled out under long-term medication. Long-term effects of antidepressants used during breastfeeding have barely been studied. The WHO Working Group on Drugs and Human Lactation (Bennett 1996) classifies most of the tricyclic antidepressants and some of the SSRI as probably safe, as does the American Academy of Pediatrics (2001).

493 Selective serotonin reuptake inhibitors

Escitalopram is an active isomer of citalopram with a molecular mass of 414. At 56 , the protein binding is lower than that of citalopram (80 ) and could facilitate a transfer to the milk. Data are insufficient with respect to lactation. A case report describes a child aged 3 weeks, whose weight gain was insufficient from the beginning of the maternal therapy and up to the age of 4 months. In addition, slightly elevated liver enzymes, moderate muscle hypertonia of the upper extremities, irritability, and frequent crying were observed. The symptoms resolved after adding formula feeding in the fifth month (Mcrlob 2005). A similar observation was documented by the currcnt author and colleagues. A hypcrirritable newborn started high-pitched crying 2 hours after breastfeeding (5-6 hours after escitalopram intake by the mother), every afternoon. When the mother took her tablet in the morning instead, her child's symptoms appeared at the same time interval after breastfeeding. After adding...

494 Other antidepressants

There are either no or insufficient data on the use of amineptine, amoxapine, atomoxetine, duloxetine, iprindole, medifoxamine, oxitrip-tan, reboxetine, tranylcypromine, I,-tryptophan, and viloxazine during breastfeeding. Recommendation. Due to the quantity and the results of documented experience, St. John's wort or hypericin preparations and mirtazapine are acceptable during breastfeeding. If compellingly indicated, moclobemid, venlafaxine, and bupropion are also tolerable. Whenever possible, the drugs of choice among tricyclic antidepressants or SSRIs are preferable. In general, monotherapy should be the goal. In cases of symptoms potentially associated with the drug therapy, a pediatrician and a teratology information center should be contacted to decide individually upon measuring drug values in the infant's serum, supplementary formula feeding, weaning, and or changing the therapy. As with all psychoactive drugs, there is insufficient experience on the long-term effects on...

497 Atypical neuroleptics

Olanzapine has a rather long half-life of up to 54 hours. Based on the data of seven mothcr-child pairs, the median infant dose of olanzapine ingested via milk was 1 of the maternal dose the median milk plasma ratio was 0.4 for the six patients with data collected over the dose interval. Corresponding values in the patient with single-point data were 1.1 and 0.8. Olanzapine was not detected in the plasma of the six infants with an evaluable plasma sample. All the infants were healthy and experienced no side effects (Gardiner 2003). In another child whose mother has already been treated during pregnancy with lOmg d, after delivery the plasma level of olanzapine in the infant was one-third of the maternal plasma level, and during breastfeeding it decreased to an undetectable limit (Kirchheiner 2000). In a study with five mother-child pairs, the median relative infant dose was 1.6 (range 0-2.5 ) of the weight-adjusted maternal dose. During the study period, there were no apparent ill...

4101 Immunosuppressive and immune antineoplastic agents

Cyclosporins use in lactating women has been reported in several studies. Levels in maternal plasma studied in 15 mother-child pairs (Moretti 2003, Munoz-Flores-Thiagarajan 2001, Merlob 2000, Nyberg 1998. Thiru 1997) varied from 55 to 903 ng ml. Corresponding milk levels were 14-1016 ng ml. which works out at (at maximum) 2 of the weight-adjusted maternal dose, In another case, where the mother received 3 mg kg per day, milk levels averaged 596 ig l but infant trough blood levels remained under 3ng l when mother's were 260 ig l. In a series of five patients receiving cyclosporine. however, one clinically unremarkable infant had trough blood levels (131pg l) near therapeutic levels (Moretti 2003). The other four infants had levels below 25 j,g l. Another 17 unremarkable breastfed infants were reported by Armenti (2003). The peak time for maternal blood level is 3.5 hours post-dose, so this would mean not breastfeeding for at least 4 hours to avoid peak milk levels. It is poorly...

4113 Bromocriptine and other prolactin inhibitors

The effect of breastfeeding on the growth of the prolactinoma appears to be more limited than that of the pregnancy, so an interruption of dopamine agonist treatment with bromocriptine during breastfeeding can be considered (Rau 1996). Cabergoline is taken less often (e.g. once a week) because of its considerably longer half-life and period of effectiveness. In addition. there seem to be fewer side effects. With respect to the other prolactin inhibitors, lisuride, metergoline, and qiunagolide, experience during breastfeeding is insufficient. Recommendation. Because of maternal risks, routine prescription of bromocriptine to stop lactation is not indicated. If physical measures (and, in cases of mastitis, antibiotic treatment) are insufficient cabergoline should be preferred (see also Chapter 3.7). If therapy with prolactin inhibitors for mastitis is unavoidable, the briefest and lowest dosage should be used so that milk production will not diminish. As long as milk is being produced,...

4114 Thyroid hormones and thyroid receptor antibodies

Thyroid receptor antibodies (TRAb) can result in transient neonatal thyroid disease by transfer through milk from mothers treated for thyrotoxicosis, Serum TRAb concentration in neonates decrease continuously with time after birth. The calculated half-life for offspring-serum and breast-milk TRAb was calculated as approximately 3 weeks and 2 months, respectively. Transient neonatal thyroid disease may be worse and more prolonged during breastfeeding as a consequence of TRAb in breast milk flomhage 2006). Recommendation. Substitution of thyroid and parathyroid hormones establishes a physiological state, and, thus should be continued during breastfeeding if necessary. Thyroid hormones should not be given together with thyrostatics, because higher dosages of thyrostatics would then be necessary.

4119 Insulin and oral antidiabetics

Insulin and metformin are not problems during breastfeeding. Glibenclamide may also be taken however, the infant should be observed for symptoms of hypoglycemia after the start of therapy. Other oral antidiabetic should not be taken, but single doses do not require any limitation of breastfeeding.

41112 Cyproterone acetate and other sexhormone inhibitors

Other antiandrogens, such as bicalutamide and flutamide, and antiestrogen-acting substances, such as aminoglutethimide, anas-trozole, formestan, raloxifene, and tamoxifen, as well as the sexhormone inhibitors danazol and tibolone, have practically no role during breastfeeding and have also not been studied. There are also no data on clomiphene and the progesterone antagonist mifepristone. In so far as its (accidental) use during breastfeeding happens at all, a toxic effect on the infant should not be expected due to the brief exposure. Recommendation. Antiandrogens and antiestrogens are contraindi-cated during breastfeeding. Accidental intake of a single dose does not require an interruption of breastfeeding. However, treatment should not be continued.

4123 Treatments for acne and psoriasis

Minocycline, now available in an extended-release oral preparation (Saladyn), is effective in moderate to severe acne (Shalita 2006). The extended-release form reduces the incidence of vestibular side effects and allows the lowest possible effective dose (1 mg kg). Minocycline is a broad-spectrum tetracycline antibiotic capable of causing dental staining and reduced bone growth in children, though. It binds to milk calcium and is more effectively absorbed than previous tetracyclines. In the short term (less than 2 weeks) it is probably tolerable, but chronic use would be contraindicated during lactation. Minocycline has been measured in human milk, although it was not found in the plasma of breastfeeding infants whose mothers took 500 mg orally four times a day. For other anti-infectives, see Chapter 4.4. Recommendation. Systemic therapy with retinoids should not be undertaken during breastfeeding because of the toxic potential and the long halflife. This also applies to external use...

Visit the health worker during pregnancy

I If at any time you have any concerns about your or your baby's health, go to the health centre. I During your visits to the health centre, the health worker will Check your health and the progress of the pregnancy Help you make a birth plan Answer questions or concerns you may have Provide treatment for malaria and anaemia Give you a tetanus toxoid immunization Advise and counsel on breastfeeding birthspacing after delivery nutrition

4125 Eye ear and nose drops

The safest therapy for an acute upper respiratory infection (URI or cold) is not with systemic vasoconstrictors or decongestants, which can decrease milk production, but with local treatment. Nose drops which shrink mucous membranes (pseudoephedrine) are given in small doses and provide relief locally, and do not interrupt breastfeeding. Recommendation. Medication by drops in the eye, ear, and nose are usually compatible with breastfeeding. Ophthalmic atropine can be an issue if used chronically, as it may decrease milk production. Preparations for the eyes or ears that contain chloramphenicol, quinolines, and streptomycin should be avoided.

4127 Vein therapeutics and other local therapeutics

Hemorrhoid medications commonly contain local analgesics or anesthetics, and anti-inflammatory agents. To relieve local pain, lido-caine 1-2 is often used. Lidocaine has been measured in human milk, where it is calculated to be 40 of the maternal plasma level. When lidocainc was given intravenously for maternal ventricular arrhythmia, the breastfeeding infant rcceivcd an estimated 2mg day. Lidocaine is poorly absorbed orally (35 ), so little would be absorbed via the milk. Thus the local use of preparation by the lactating women would have negligible effect on the infant (Giuliani 2001). When used for dental block and other local procedures, the dose is usually less than a total of 40 mg. On the other hand, the dose used for local liposuction is quite large. Genital or veneral warts are condylomata acuminata caused by the human papilloma virus (HPV) of several types, especially 6 and 11. Treatment is usually by electrocautery, laser, cryotherapy, or surgical excision. Chemical...

4134 Vitamins minerals and trace elements

Vitamins, minerals, and trace elements can and should be used when the mother has real deficiencies. This also applies to iron and to vitamin D preparations. Such usage - and this also applies to fluoride for dental prophylaxis (Koparal 2000) - does not require lowering the infant's dosage in cases where he or she is also being treated directly, However, routine prescription of vitamin and mineral preparations during breastfeeding is not necessary if nutrition Is balanced. In the interest of the future diet of the child who Is still being breastfed, the mother should be made aware of the special Importance of healthy nutrition, which, in the long run, can prevent the need for both her and her child to take not only substitutes but also therapeutic tablets. For iodine, see Chapter 4.11. Postpartum hair loss, which is frequently bemoaned and can be observed for many months, Is physiologic and almost always improves spontaneously. The effectiveness of using mineral...

4144 Magnetic resonance contrast agents

They are non-tonic, non-iodinated, water-soluble compounds. Gadolinium compounds peak in the blood immediately, and their half-life values are an hour to an hour and a half. Total clearance is calculated to be less than 8 hours. The estimated total dose of drug absorbed from 24 hours of breastfeeding would be less than 1 of intravenous dose (Kubik-Huch 2000, Rofsky 1993). Due to insufficient experience, no risk assessment is possible with the manganese-containing mangajodipir. On the other hand, the advice of the manufacturer to interrupt breastfeeding for 14 days does not seem to make sense. Recommendation. There is no indication to interrupt breastfeeding when gadolinium compounds or ferristen are used. Mangafodipir should be avoided.

4151 Simple infections

The most common questions arise because the mother has developed a fever of unknown origin in the immediate postpartum period. The most likely is a urinary tract infection, an upper respiratory infection or a wound infection. Modest engorgement also may cause a fever. Breastfeeding docs not need to be interrupted while the work-up is completed. Treatment may be initiated or found unnecessary. An infection with rt-hemolytic strep requires aggressive therapy for both mother and infant, interrupting breastfeeding until the mother has received 24 hours of antibiotics. Illness in the infant requires neither interruption of breastfeeding, nor separation of mother and infant. For viral infections, breastfeeding is not interrupted and can be therapeutic, as mother provides her antibodies through the milk to her infant.

4185 Other contaminants

A case report describes obstructive icteric liver disease in a breastfed baby after exposure to the volatile organochlorine tetrachloroethene (PER), which is used as a cleaning agent. The mother had visited her husband every day at his workplace, which was apparently strongly contaminated. This also ted to neurological symptoms in the mother (Bagneli 1977). A milk sample given an hour after maternal exposure had 10 mg tetrachloroethene . After 24 hours, the level was still 3 mg l. The baby's condition returned to normal after weaning. A follow-up examination aL 10 years of age showed nothing remarkable. Other groups of authors have demonstrated volatile chlorhydrocar-bons - on average 6.2 jig 1 - in the milk of mothers whose exposure was not occupational. It can be 4-8 weeks after exposure before the concentration in milk of the lipophilic tetrachloroethene normalizes (Schreiber 1993). However, this should in no way be a basis for recommending weaning after trivial exposure. Ongoing...

North American Teratology Information Services collaborating in the Organisation of Teratogen Information Specialists

Tel. (905) 521 2100 ext. 76788 serves Ontario open M-F 8-4 EST accepts calls from health care providers by referral only. Does not handle breastfeeding. Tel. (800) 322 5014 or (781) 466 8474 serves Massachusetts and surrounding areas open M-F 9-4 EST accepts calls from both public and health care providers. Does not handle breastfeeding. Tel. (800) 532 6302 serves North Carolina only open M-F 8 30-4 30 EST accepts calls from both public and health care providers. Does not handle breastfeeding. Tel. (585) 275 3638 serves New York only open M-F 8-4 EST accepts calls from both public and health care providers. Does not handle breastfeeding.

4112 Methylergometrine methylergonovine

Single parenteral administration of methylergometrine in the delivery room is apparently unproblematic for the breastfed infant, and may be used if it is really indicated. Postpartum oral treatment with methylergometrine over several days, or even weeks, is rarely indicated in modern obstetrics. It should be considered that this agent counteracts the natural uterine involution, which normally occurs during breastfeeding via prolactin secretion. Oxytocin, which promotes the milk ejection reflex. Is preferable as a medical support for uterine involution. If, however, there are sound grounds to use methylergometrine for a protracted time, there is no need for breastfeeding to be limited.

452Efficacy of immunization in breastfed infants

Many myths have circulated regarding the efficacy of immunization of the infant during breastfeeding. Actually, the immunogenicity of some vaccines is increased by breastfeeding, but long-range enhancement of efficacy has not been studied. In any case the response to vaccines while breastfeeding is not diminished, and the usual vaccination schedules should be followed. Hepatitis A vaccine is available in two preparations which are prepared from cell culture-adapted hepatitis A virus which has in turn been cultured in human fibroblasts and inactivated. It has not been studied in breastfeeding or in children under 2 years of age.

421 Antihistamines Hrblockers

In connection with the use of brompheniramine plus d-isoephedrine during breastfeeding, a hyperexcitable infant was described (Mortimer 1977). There are no published data on the passage of cetirizine into mother's milk, but the experience to date indicates no noteworthy symptoms during breastfeeding. The half-life of 9 hours is quite short, and the medication has scarcely any sedative or atropine-like action. There are, as yet, no data available on dimetindene during breastfeeding. This common H -blocker has a short half-life of 5-7 hours, and there are recommended doses for children beginning at 1 year. Dimetindene has relatively little sedative action, but has an atropine-like effect that should not be overlooked. Diphenhydramine was recommended by the American Academy of Pediatrics for the breastfeeding period. However, because of the strong sedative effect, its use as an antiallergic can no longer be justified. This also applies to doxylamine. There is no information on...

41110 Estrogens gestagens and hormonal contraceptives

The amount of milk produced can decrease as a result of the Influence of estrogen. With the older, higher-dosage contraceptives, a reduction of up to 40 was described. Changes in the caloric, protein, nitrogen, and lipid content were also observed, and arc apparently dependent on the starting point. With normally nourished women, the alterations slay within the physiological bounds. However, when there is a prior milk-supply problem, the influence on the milk production can be unfortunate when the mother is poorly nourished, it can be dramatic. In follow-up studies, including those on the new low-dosage preparations, the slight reductions observed in the average length of breastfeeding and in milk production, as well as the temporarily slightly reduced weight gain of the infants, did not have any effcct on the physical or cognitive development (survey in Bennett 1996). Gestagens (norethisterone, levonorgestrel, medroxyprogesterone) as an ingredient of a mini- or combination pill or as...

449 Aminoglycoside antibiotics

When aminoglycosides are strongly indicated, they may be used during breastfeeding. Restricted use is particularly applicable to the early postnatal period, since both quantitative absorption and accumulation by the infant must be reckoned with and, at least in the case of streptomycin, an ototoxic effect cannot be ruled out.

72 Personal Hygiene During Pregnancy

It is important to begin preparing the breast for breastfeeding during the prenatal period. (3) The breasts should be washed daily (without soap) to remove dried colostrum and to prevent irritation to the nipples. Lanolin may be applied to the nipples to prevent evaporation of perspiration, thereby softening the skin. Wet tea bags may be placed on the nipples, as the tea will release tannic acid, which will toughen the skin. The nipples should be air dried or blow dried after washing to help toughen them, especially if the patient plans to breastfeed.

447 Other antibiotics and urinary tract antiseptics

With clindamycin, a maximum of 3.1 mg 1 milk was measured. For the infant, this represents about 6 of the maternal weight-related dosage, or 15 of the daily dosage for an infant. In a ease report, hemorrhagic enteritis was described in an infant whose mother had taken clindamycin and gentamicin. The symptoms improved spontaneously after breastfeeding was interrupted (survey by Bennett 1996). There are no data on the use of colistin and polymyxin B during breastfeeding. Recommendation. When it is unavoidable, clindamycin, vancomycin, and lincomycin, as well as colistin and polymyxin B, may be prescribed. However, clindamycin should not be routinely used after dental procedures. Chloramphenicol is contraindicated. Generally, an antibiotic with a lower risk potential can easily be substituted for it. Administration of a single dose does not require any limitation of breastfeeding. This also applies following short-term usage of the urinary tract antiseptic discussed.

495 Phenothiazine and thioxanthene neuroleptics

Regarding therapy during breastfeeding. In none of these reports, which have been published over a period of 40 years, is there any mention of serious or permanent effects on the child breastfed while his mother was being treated with this group of drugs (McElhatton 1992). The American Academy of Pediatrics considers phenoth-iazines compatible with breastfeeding because only very limited concentrations have been found in all the mothers' milk samples measured up to now, due to the high plasma protein binding. At the same time, however, it has been pointed out that long-term effects cannot be judged definitively. This, of course, also applies to all the other drugs with a central nervous system action. There was speculation recently that sudden infant death syndrome (SIDS) and sleep apnea could be induced by phenothiazines. Atypical neuroleptics were discussed as a therapeutic alternative (Hale 2004). Chlorpromazine, with a half-life of 30 hours, is absorbed at a very individual rate...

468 Dihydroergotamine and other antihypotensives

The use of dihydroergotamine during breastfeeding is considered safe. However, non-drug measures (sports, the use of cold water and brushes, moderate coffee consumption) should be the first choice for the treatment of hypotonia. Etilefrine and norfenefrine, as well as amezinium, gepefrin, midodrin, and pholedrin, should be avoided. However, accidental intake does not require interruption of breastfeeding.

4158 Herpes zoster shingles chickenpox

Varicella zoster virus (VZV) has not been cultured from the milk with either herpes zoster or chickenpox (Frederick 1986), but VZV-DNA has been identified in breast milk (Yoshida 1992). One case of suspected transfer of VZV to an infant via breastfeeding has been reported, but the virus may have been transmitted by droplet or exposure to the rash. The overwhelming majority of HIV-positive children arc infected during the birth. Postpartum infection via breastfeeding has also been described. The virus has been delected in the mother's milk, especially among women with mastitis and infected infants (Pillay 2000. Semba 1999). On the other hand, the protective effect of substances in the mother's milk, such as maternal anti-HIV antibodies, lactoferrin, and secretory leukocyte protease inhibitors on a vertical transmission, has been discussed for a long time (Becquart 2000, van de Perre 1999). A South African study of 549 HIV-1 infected women showed that babies who were exclusively...

Hormones and hormone antagonists

There are only a few publications that discuss tolerance of hypothalamic and pituitary hormones during breastfeeding. There are no data on the use during breastfeeding of the other hypothalamic and pituitary hormones, or their synthetic analogs cor-ticorelin, sermorelin, somatorelin, cetrorelix, chorionic gonadotrophin, gonadorelin, goserelin, leuprolide acetate, menotropin, nafarelin, trip-torelin, urogonadotropin, octreotide, somatostatin, tetracosactid, somatropin (growth hormone), follitrophin-a, follitrophin-3, urofol-litrophin, argipressin, lypressin, ornipressin, lanreotide, and terli pressin. This also holds true for the oxytocin-antagonist atosiban and the somatropin-receptor antagonist pegvisomant. Recommendation. With the exception of oxytocin, hypothalamic and pituitary hormones are seldom indicated during breastfeeding. No toxic effect on the infant has been demonstrated as yet, nor, due to its limited oral bioavailability, is this to be expected. Usage for appropriate...

472 Vitamin K antagonists coumarin derivatives and indanediones

During treatment with the oral anticoagulants acenocoumarol, phenprocoumon, and warfarin, breastfeeding may continue. To be on the safe side, the infant should receive 1 mg vitamin K orally, two to three times a week, in the first 4 weeks of life. To avoid any possible complications, the coagulation status should be determined after about 10-14 days, at least with premature infants. Fluindone and phenidone are contraindicated.

492 Tri and tetracyclic antidepressants

Breastfeeding women taking 75-175 mg amitriptyline a day were studied (survey in Weissman 2004). The M P ratio was 1 the relative dosage for a fully breastfed baby, including the active metabolites, should not, in light of current experience, exceed 2.5 . Amitriptyline and nortriptyline could not be dctccted in the infants' serum. The children had no acute clinical symptoms. Among the 10 infants breastfed while their mothers were taking tricyclic antidepressants, development in the first year of life did not differ from that of the artificially fed infants in a control group (Yoshida 1997A). Galactorrhea was reported with a daily intake of 250 mg amoxap ine. The patient was neither pregnant nor breastfeeding. Less than 20jig l amoxapine plus 140 ig i of the metabolite 8-hydroxy-amoxapine were excreted in the milk. An M P ratio of about 0.3 and a relative dosage of 0.7 can be calculated with the available data (cited in Spigsct 1998). Dosutepine ( dothiepin), half-life 9 hours, is...

Conclusions

The obvious solution to fetal and nursing infant risk avoidance is maternal abstinence. However, from a pragmatic standpoint, that would be impossible to implement. Another solution is to disseminate knowledge, in an authoritative manner, to all those involved in the pregnancy and breast feeding processes physician, mother, midwife, nurse, father, and pharmacist. BreastFeedng_Symma Y Risk.FactP.tS. Breast Feeding Summary

New Mothers Guide to Breast Feeding

New Mothers Guide to Breast Feeding

For many years, scientists have been playing out the ingredients that make breast milk the perfect food for babies. They've discovered to day over 200 close compounds to fight infection, help the immune system mature, aid in digestion, and support brain growth - nature made properties that science simply cannot copy. The important long term benefits of breast feeding include reduced risk of asthma, allergies, obesity, and some forms of childhood cancer. The more that scientists continue to learn, the better breast milk looks.

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