Chapter 7.docx

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10 Apr 2012
Department
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Chapter 7 -
Low milk supply:
- Most common reason to stop breastfeeding
- Usually caused by the mother not pumping or breastfeeding enough or a poor latch while pumping
- Fenugreek, goat’s rue and milk thistle are common herbal Galactogogues which can increase milk supply but they are not
FDA approved and studies have not been done on the effectiveness
- Oral contraceptives with estrogen may decrease milk supply
- Metoclopramide is the most commonly used drug to increase milk supply, may cause side effects such as fatigue, drowsiness
and diarrhea, can also increase depression, anxiety, confusion and dizziness or headache
- Domperidone is commonly used outside of the U.S., it is not approved by the FDA
Maternal Medications:
- 90-99% of breastfeeding women receive some type of medication in the first week postpartum, most medications are excreted in
the breast milk
Important to consider:
- Pharmacokinetic properties of the drug
- Milk/plasma ratio of the drug
- Drug exposure index
- Infant’s ability to absorb, detoxify, and excrete the agent
- Dose, strength and duration
- Infant’s age, feeding pattern, total diet and health
Seven categories in risk factors:
1. Cytotoxic drugs that may interfere with cellular metabolism of the infant
2. Drug abuse has adverse effects on the breastfeeding infant
3. Radioactive compounds require cessation of breastfeeding at least temporarily
4. Drugs which have unknown effects
5. Drugs that do have effects on the infant should be given with caution to the mother
6. Maternal medications usually compatible with breastfeeding
7. Food and environmental agents having no effect on breastfeeding
The Breastfeeding and Human Lactation study Center at the University of Rochester always updates its knowledge of more than 3000
drugs. There is also TOXNET lactmed database and textbooks such as ‘Medications and mother’s milk’.
Physician’s Desk Reference (PDR) is not a good source because the info comes from pharmaceutical companies.
Antihistamines, cold remedies and decongestants are said to be compatible with breastfeeding but they may suppress lactation.
Oral contraceptives and lactation:
- No evidence of harm but not many studies available
- World health organization recommend not using during the first 6 weeks
- WHO does not recommend using oral contraceptives from 6 weeks to 6 months unless there is no other forms of birth control
available
- Implants, progesterone only pill and Depo-Provera shot is also recommended at 6 weeks post-partum
Prescriptive drugs and cancer treatments:
- Alternative procedures should be recommended
- Inhalants and topical applications are less transferable than oral medicine
- The mother can stop breastfeeding temporarily if she is taking radioactive compounds
- As a last resort cessation of breastfeeding is required for chemo and radioactive treatment
Herbal Remedies:
- Not many studies on herbal remedies
- Could cause harm
- Herbs that affect the central nervous system, , destroy cells, or herbs that are laxatives, hepatotoxic, carcinogenic, mutagenic or
contain toxic oils are not recommended during lactation
- Toxic effects of herbs are not due to the herb but by products containing misidentified plants or contaminants
- Medicinal herbs in the US are not tested for safety or efficacy
- some herbal teas are safe during lactation such as chicory, orange spice, peppermint, raspberry, red bush tea and rose hips
- sage, fresh parsley and peppermint may lower lactation if consumed a lot
- the use of herbal oils on nipples can be ingested by the infant
- Echinacea is used for common colds and is not recommended during lactation
- Ginseng root(believed to increase mental capacity and physical activity and reduce stress) could have estrogen and other steroids
so it is not recommended during lactation
- St John’s Wort used as a mood stabilizer and antidepressant, large doses can reduce lactation; studies did not find any effects on
infants. This could be helpful in treating post-partum depression
- Fenugreek a spice used in cooking, teas and maple syrup. It is also used in an herbal galactogogue. One study found that it did
increase milk production, but it is transferred to infants. Dose is 2-3 capsules per day.
- Goat’s rue is a commonly used galactogogue. One side effect is drowsiness, hypotonia, lethargy, and poor suckling. Dose is 1
teaspoon stepped in 8 ounces of water 3 times a day.
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