In today’s blog, I wanted to address a question from a mother that I’ve recently been supporting. She asked if I had written a blog on paracetamol and breastfeeding, specifically about whether it could impact her milk supply. I realised this question has come up with other mothers too, so I thought it would be a great idea to cover it here as a resource for the breastfeeding community. Finding science-based information online can be challenging, so hopefully, this blog can help clarify things.
First thing to consider is that breastfeeding mothers can still take medications when they’re sick—they don’t have to suffer needlessly because they’re breastfeeding. Unfortunately, some healthcare providers may not be fully up to date, and might still recommend stopping breastfeeding when prescribing certain medications. Sometimes, the information provided with a medicine warns against breastfeeding, but this doesn’t always mean it’s unsafe. Often, it’s because the medicine hasn’t been tested in enough breastfeeding mothers to confirm its safety, or it’s because pharmaceutical companies have to cover their backs, therefore they write to the leaflet for legal reasons to speak with your doctor before taking meds.
Let’s delve a bit deeper into medications and milk supply, review some common and safe medications for breastfeeding, and, as usual, I’ll share my top 5 tips for maintaining your milk supply while taking medications.
Understanding Milk Supply
For breastfeeding mothers, concerns about milk supply and the effects of medications are very common, especially when managing minor ailments like headaches, colds, or muscle aches due to fever. You may wonder if taking a pain reliever like paracetamol or ibuprofen could impact your milk supply or if it’s safe for your baby.
It helps to remember that milk supply is primarily a supply-demand process: the more often you breastfeed your baby, the more milk your body produces in response to this stimulation. This means that most medications won’t interfere with your milk supply. However, some medicines, such as birth control pills containing hormones like oestrogen, can affect prolactin and oxytocin—the two key hormones for breastfeeding—and may reduce supply.
Safe Medications While Breastfeeding
Several factors determine if a medication passes into breast milk, including molecular weight, bioavailability, milk/plasma ratio, liposolubility, dosage, and the medicine’s half-life in the bloodstream. The baby’s age is also an essential factor; medications impact a newborn differently than a 3-month-old or a 2-year-old. Many common medicines, such as painkillers, antibiotics, antihistaminics or decongestant nasal sprays, have breastfeeding-friendly options. Here are the most common and safe medications that won’t affect your baby or milk supply:
- Paracetamol: It’s the most common fever reducer and pain reliever. Only small amounts can pass into breastmilk, making it entirely safe for your baby. It’s an ideal choice if you’re dealing with a mild headache that won’t compromise your milk supply.
- Ibuprofen: A non-steroidal anti-inflammatory drug (NSAID) commonly used for inflammation, swelling, and fever. Ibuprofen transfers minimally into breast milk, with no observed issues in infants of mothers taking it. It’s not known to reduce milk supply and can actually help mothers feel comfortable enough to breastfeed when engorged, supporting milk production.
- Antibiotics: While it’s best to avoid antibiotics when possible, they are sometimes necessary for bacterial infections like mastitis, post-C section wound infections, or lung infections. Common antibiotics like amoxicillin or penicillin are excreted in breast milk in insignificant amounts and no problems have been observed in the majority of infants of mothers who took them, except for occasional episodes of mild diarrhoea due to an altered intestinal flora, rash or drowsiness that did not require medical attention. It’s essential to complete the full prescription (usually 7-10 days) to prevent antibiotic resistance or infection recurrence.
- Antihistamines: Some antihistamines, like diphenhydramine are totally save and no problems have been observed in infants whose mothers took it for a long time. Neither a decrease or milk production nor alteration of prolactin release have been shown with using this first-generation antihistamine drug. Other second generation antihistamine like loratadine or cetirizine, are generally considered safe choices as well with insignificant amounts passing into the breast milk.
- Decongestant nasal sprays: Decongestants like pseudoephedrine may decrease the milk production, especially in high doses or over long periods. Studies show, pseudoephedrine produces a variable and non-significant decrease on prolactin levels, along with a variable decrease on milk production in some women. The safer option in case you need to use a decongestant it’s triprolidine hydrochloride.
My Top 5 Tips for Maintaining your Milk Supply While Using Medications
If you’re concerned about how a medication might affect your baby or your milk supply, here are my top 5 tips to ensure breastfeeding is minimally impacted:
1. Nurse frequently: When mothers feel unwell, they may breastfeed less often, which can sometimes cause a dip in supply. Try to breastfeed as frequently as possible, and if you’re too unwell to nurse, pumping can help maintain production.
2. Stay hydrated: Some decongestants can have a drying effect on the body, so be sure to drink plenty of water, especially if you’re fighting a cold.
3. Monitor your baby’s behaviour: When starting a new medication, watch your baby for any changes, such as increased gassiness, fussiness, or drowsiness. Consult your healthcare provider if you notice anything unusual.
4. Use evidence-based resources: For more information on medication safety while breastfeeding, you can consult a database created by doctors specialising in breastfeeding, where you can consult and check the risk of the medicine you need to take. Here is the link:
5. Seek professional guidance: Don’t hesitate to reach out to an IBCLC lactation consultant if you have concerns about a medication or your milk supply. Sometimes supply issues may not be related to the medication, and a consultant can help identify any other factors.
To conclude, as a breastfeeding mother, you don’t have to choose between managing your health or your baby’s health. Most over-the-counter medications for common ailments are safe and will not impact your baby nor your milk supply. However, always check with a healthcare provider if you’re concerned. And if you’re advised to stop breastfeeding but are unsure, consider consulting an IBCLC lactation consultant for guidance tailored to your individual circumstances.
