Mother’s Medication and Breastfeeding
It's obvious that a mother taking medication for her illness is concerned about possible side effect of these drugs upon her child through breast milk. She seeks information from doctors and health workers. The main issue of discussion is whether the drug(s) she is taking could harm her baby with toxic components transmitted to breast milk. Details have been discussed in our national breast feeding guideline and the prime message is to continue or encourage breastfeeding rather than withdrawing it in 'almost every' condition.
There are certain medications which can be transmitted through breast milk. Again some organisms responsible for disease causation could transmit disease through breast milk. Drugs which can be excreted to breast milk are mainly anti-cancer drugs, anti-thyroid drugs, some psychiatric drugs, some antibiotics and some hormone replacement therapies etc.
Breast feeding is contraindicated if a mother is taking anti-cancer drugs, anti-thyroid drugs and any medications containing radioactive components. Even in these conditions emphasis should be given in collecting another mother's milk rather than starting formula or cow's milk. If a mother is taking anti-psychotic drugs or even anti-convulsants she must continue her breast feeding. It's a major issue as the 'postpartum depression' is an increasing problem in some mothers; they have to take anti-psychotic drugs. Some health workers and even doctors fail to deliver the information that very negligible amount of drug product is transmitted to breast milk and withdrawing breast feeding could even be more harmful. Mother just has to observe some possible effects in her baby like excessive drowsiness etc.
Same thing is applicable to some antibiotics like sulphonamides, cotrimoxazole, fansidar (anti-malarial drug) and dapsone (used in leprosy and lupus). Possible side effect in baby is jaundice which should be observed carefully. Mother must consult with physician in taking alternative drugs (as there might be scope of another safer drug) if she is taking some other antibiotics like chloramphenicol, tetracycline's, metronidazole, quinolone (ciprofloxacin etc). Estrogen containing contraceptive and thiazide diuretics (used in hypertension) decrease breast milk supply. Alternative drugs should be prescribed in these conditions.
Last but not the least, some information must be delivered regarding HIV AIDS. Although HIV is transmitted through breast milk, withdrawing it and giving formula or cow's milk can result in repeated infections, malnutrition, poor health and ultimately mortality. Our national strategy is to treating the HIV infected mother with antiretroviral therapy (ART) during pregnancy. The baby should be bathed immediately after birth followed by ART start. Both mother and baby will get ART for one year while exclusive breast feeding for first six months must be ensured. Proper ART along with exclusive breast feeding is an established tool to decrease morbidity and mortality in HIV infected mother's offspring.
Counseling and support might help in motivating diseased mother to continue breast feeding even in taking medication. Nothing is a substitute or better than breast milk. Our national agenda is to promote breastfeeding and improve exclusive breastfeeding rate so that we can decrease morbidity and mortality in infants and children stepping toward a healthier and better future.