Recommendations regarding breastfeeding in situations in which the mother is undergoing pharmacologic therapy must balance the benefits to the infant and the mother against the potential risk of drug exposure to the infant.
Pain management during breastfeeding illustrates some of the medication and breastfeeding considerations. It is undeniable that labor and delivery is a major event with the potential to inflict trauma on the mother’s body. Following delivery, particularly a cesarean, pain medication is often used. Additionally, mothers who have existing conditions involving pain will still need pain relief while nursing.36 Babies who are unusually sleepy and poor feeders may be associated with moms who are using narcotics chronically and many days after delivery.
Non-steroidal Anti-inflammatory Drugs (NSAIDs):
Narcotic pain relievers:
If a mother must take a medication while breastfeeding, there are several ways to minimize her infant’s exposure to that medication. These recommendations include the following:
Hale’s Medications and Mother’s Milk Lactation Risk Categories:
|L1 – Safest||These drugs have been taken by a large number of breastfeeding mothers without any observed increase in adverse effects in the infant. Controlled studies in breastfeeding women fail to demonstrate a risk to the infant and the possibility of harm to the breastfeeding infant is remote; or the product is not orally bioavailable in an infant.|
|L2 – Safer||These drugs have been studied in a limited number of breastfeeding women without an increase in adverse effects in the infant, and/or, the evidence of a demonstrated risk which is likely to follow use of this medication in a breastfeeding woman is remote.|
|L3 – Moderately Safe||There are no controlled studies researching the use of these medications in breastfeeding women; however, the risk of untoward effects to a breastfed infant is possible, or controlled studies show only minimal non-threatening adverse effects. These drugs should be given only if the potential benefit justifies the potential risk to the infant. New medications that have absolutely no published data are automatically categorized in this category, regardless of how safe they may be.|
|L4 – Possibly Hazardous||There is positive evidence of risk to a breastfed infant or to breast milk production, but the benefits from use of these drugs in breastfeeding mothers may be acceptable despite the risk to the infant (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).|
|L5 – Contraindicated||Studies in breastfeeding mothers have demonstrated that there is significant and documented risk to the infant based on human experience, or it is a medication that has a high risk of causing significant damage to an infant. The risk of using these drugs in breastfeeding women clearly outweighs any possible benefit from breastfeeding. The drug is contraindicated in women who are breastfeeding an infant.|