When we are breastfeeding our baby, doubts may arise about the advisability of taking certain medications, vaccinating or undergoing some treatment, as we fear that they may be contraindicated with breastfeeding and harm our child.
There are really very few situations that contraindicate breastfeeding, but unfortunately it is still common to find outdated professionals who advise against it when starting a certain treatment that is compatible and safe.
With the help of e-lactancia we are going to clear up the main doubts that may arise when taking medications or undergoing treatments when we are breastfeeding our babies . Although it is important to remember that any medication, even those purchased without a prescription, should always be recommended by the doctor, especially when breastfeeding.
Imaging and ray tests
Given the suspicion of certain pathologies such as bone fractures, calculi, hernias, tumors, inflammatory processes … the doctor may indicate to carry out an imaging study, and in these cases doubts about its compatibility with breastfeeding are usually very frequent.
We have consulted in e-lactation the most common tests and this is what they tell us about it:
- X-rays, CT scans and other X-ray scans (such as mammography, CT scan) do not affect milk or lactation , since the X-rays used neither remain in the body, nor are they excreted through milk. They also do not alter prolactin levels.
- Iodinated radiographic contrast ” is considered compatible with breastfeeding because it is rapidly eliminated with little metabolization or release of iodine and is practically inabsorbable by the oral route .”
- Non-iodinated radiographic contrast such as barium sulfate and fluorescein are safe, compatible, and risk-free for breastfeeding.
- Ultrasound: “the high-frequency sound waves used in this technique are not radioactive, so they do not cause alterations in the production or composition of breast milk. “
- Nuclear magnetic resonance “does not affect milk or lactation” because “the electromagnetic field and radio frequency waves generated with this technique do not cause harmful alterations in the composition of the milk” . Therefore, after an MRI “you can breastfeed without problems” then.
Medications and antibiotics
No medications (not even those purchased without a prescription) should be taken on your own without first consulting your doctor. But this condition is even more essential if possible when we are pregnant or breastfeeding.
- Certain common analgesics and anti-inflammatory drugs to treat common ailments (back pain, headaches, toothache, catarrhal symptoms, joint inflammation …), such as paracetamol or ibuprofen are compatible with breastfeeding. The same is not the case with nolotil , which has not been considered safe during breastfeeding for a few months.
Regarding the use of aspirin during breastfeeding, it is considered “quite safe, with slight or unlikely risk” . But it must be taken into account that it is excreted in small amounts in breast milk, so we can always resort to safer alternatives such as paracetamol or ibuprofen .
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Some common antibiotics are also safe, such as amoxicillin, penicillin, amoxicillin with clavulanate, or azithromycin.
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In case of having to resort to corticosteroids for topical, inhaled, intra-articular or enema use, from e-lactation they inform us that their use is also safe. If this type of medication is required to treat eczema or dermatosis of the nipple, “it is advisable to choose the least powerful corticosteroid, apply it just at the end of the feeding so that it has been reabsorbed before the next one, and if necessary remove remains with a gauze and do not use for more than a week in a row . “
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Some of the antihistamines prescribed for allergies are compatible and safe while breastfeeding. Such is the case of loratadine or cetirizine, for example. But there are others whose risk is high and is not recommended . You can check very low, low and high risk antihistamines in this e-breastfeeding link.
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If the use of opioid analgesics is necessary, it is very important to consult with the doctor about the different options that there are, since some constitute a high risk for breastfeeding (see here).
Balms and decongestants
Special mention should be made of those products whose active ingredients are commonly used as decongestants or expectorants. Such would be the case of the well-known Vicks Vaporub, which has camphor, eucalyptus, lingroin and mint among its components.
- Camphor : it is a high risk for lactation, and in e-lactation we can read the following
“It is used as a local anti-inflammatory for the skin in creams and lotions. There is no evidence of its decongestant or expectorant effect in inhalation preparations and there is evidence of its toxicity. Camphor is a very lipophilic substance that is very well absorbed by any route of administration. (cutaneous, inhalational, oral …) crossing cell membranes well. Its pharmacokinetic data make it probable that it will pass to milk in a quantity that could be significant “.
” Camphor is very toxic in small doses , especially in children, causing headache, vomiting, seizures and coma. It should never be administered orally. It is not a suitable product to use during lactation and in any case it should not be applied on the maternal breast because serious poisonings have occurred in children with small amounts ingested or applied in the nostrils “.
- Eucalyptus : it is high risk for lactation, and in e-lactation we can read the following
“Due to the toxicity of its essential oil, it is not prudent to use it during lactation outside of very occasional and moderate use. It confers a characteristic smell and taste to the milk that could surprise the infant. Topical use is compatible with breastfeeding provided not to apply it on the chest “.
- Mint / Menthol: it is very low risk for lactation, and in e-lactation we can read the following
“Given its lack of toxicity at correct doses and the low demonstrated passage of its active product, menthol, into breast milk, moderate consumption would be compatible with breastfeeding .”
“Proven properties and indications: spasmolytic in dyspepsia, irritable colon and flatulence. It has been used in topical application to treat nipple cramps with better results than lanolin or placebo”.
“Traditional use without proven efficacy: topical or inhalation application for relief of coughs, colds, pain and itching”.
“Essential oil overdose can be dangerous. Prevent infants from inhaling peppermint vapors (respiratory irritant). If applied to the breast or nipple, do so after one feed and clean thoroughly with water before the next ” .
Anticonceptive pill
It is often mistakenly thought that while breastfeeding the mother cannot get pregnant because ovulation does not occur. But there are many nuances that must be taken into account, and that make the reappearance of the period after childbirth is not the same in all women.
If of all the contraceptive methods that exist you have decided to take the pill, first you must make sure of the different types that there are to choose the one compatible with breastfeeding:
- Combination pill based on progestin (derived from progesterone) and estrogens. During lactation it is not advisable to use contraceptives with estrogens as they lower milk production. As we read on e-lactancia.org, it is better to use contraceptives only with progestogens or, failing that, combined with the minimum amount of estrogens possible.
- Estrogen-free pill that only contains progesterone. Progesterone does not reduce milk production or affect lactation. Just look at the composition to confirm that the component they carry is only this and we will be sure that they will not affect our baby’s breastfeeding in any way.
Anxiolytics and antidepressants
When a mother has postpartum depression or suffers from a condition that makes the use of psychiatric medication advisable, it is inevitable that she considers its convenience and the risks that it may have for breastfeeding.
Although there are certain incompatible medications, in general you can always look for alternatives that do not affect breastfeeding, so that if the mother wishes, she can continue breastfeeding her baby while treating depression with medication .
For example, sertraline is usually the treatment of choice in these cases , and as we read in e-lactation “various medical societies and expert consensus consider its use safe .” Among the anxiolytics that are also recommended, some of the short half-life benzodiazepines can be used occasionally and at low doses, such as lorazepam , which is classified as a “very low risk for breastfeeding”:
“The occasional and low-dose use of benzodiazepines is compatible with breastfeeding.”
“It is advisable to choose benzodiazepines of short duration and to use the minimum effective dose , especially in the neonatal period and in case of prematurity because they can accumulate in the infant during chronic use” – we read in e-lactation.
Of course, the use of this type of medication has to be prescribed and controlled by the doctor , and never stop taking it or vary the doses on your own. In addition, while the treatment lasts, important aspects such as increased drowsiness in the patient must be taken into account. For this reason, from e-lactation they advise “not to share a bed with the baby if you are taking this medicine due to the increased risk of suffocation or sudden death of the infant”
As stated by the AEP in this article published by doctors Ibone Olza, Elena Serrano and Carmen Muñoz, unfortunately, the decision to start psychopharmacological treatment often leads to early weaning, depriving the mother and baby of the beneficial effects of the breastfeeding (which includes promoting the mother’s mental recovery). For this reason, it is essential to support women in these cases and to find up-to-date breastfeeding doctors who encourage the continuation of breastfeeding whenever possible.
Dental treatments
Pregnancy involves a series of changes for women that can affect the oral cavity , increasing the chances of suffering from cavities and periodontal diseases. The normal thing is that this type of ailments appear during pregnancy, but it can also happen that they show their faces later, when we have given birth and are breastfeeding.
In general, there is no contraindication when it comes to undergoing a regular dental treatment , such as fillings, extractions, root canals, bridges, brackets … If an X-ray is needed, it can be carried out with total safety (as we have mentioned more above), and the antibiotics and pain medications that are prescribed in these cases are also compatible with breastfeeding.
Regarding the local anesthesia that is applied in conventional treatments (such as lidocaine or articaine, for example), they are very low risk for lactation , and as we can read in e-lactation “its short elimination half-life and its large volume of distribution would prevent the excretion in breast milk of significant quantity “ , reason why ” it is not necessary to suspend the lactancia since clinically relevant levels do not appear in the breast milk “ .
Anesthesia
Certain medical interventions or surgical procedures require the use of general anesthetics whose risk is very low or low for breastfeeding (see all options here)
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Local and epidural anesthesia: its use is considered safe, compatible and without risks for breastfeeding .
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General anesthesia: “current anesthetics are very rapid elimination and allow breastfeeding as soon as the mother is awake and in conditions” . Therefore, its use is considered safe and compatible with breastfeeding.
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Anesthetic creams with lidocaine: “As a topical anesthetic (dermatological, stomatological-dental, ophthalmological and otological preparations) it has practically zero systemic absorption. Do not apply on the chest or, if necessary, apply after one feeding and clean well with water before the next “ . Its use is considered safe and compatible with breastfeeding .
Vaccines
Either because they correspond by age or due to certain personal or family circumstances (for example, having a child in a risk group), there may be vaccines that the woman needs to receive during breastfeeding . And faced with this situation, it is common to wonder: are the vaccines the mother receives safe for the breastfed baby, or can they affect the quality of her milk?
According to the CAV-AEP, “all the vaccines indicated in a woman, including those with live viruses, can be administered (and should not be delayed for this reason) while she is breastfeeding .” But we have to take into account a couple of vaccines that require special attention:
- The yellow fever vaccine , which must be administered when traveling to regions of the world where the disease is present. This vaccine contains live viruses that are transmitted through milk, so in general it would be advisable to avoid it during breastfeeding.
However, experts clarify that if the mother cannot avoid traveling to endemic areas, vaccination must be carried out, since the risk for the baby of being exposed to this vaccine virus is less than the one that the mother would assume when exposed to the disease. Another option to consider if the baby is less than nine months old, would be to express the milk and discard it during the 14 days after the vaccination , which is the time that the viral elimination lasts.
- The chickenpox vaccine is safe during breastfeeding, but it is rarely associated with the presence of a contagious rash at the puncture site. If this occurs, it is enough to cover the rash with a dressing or clothing to avoid direct contact with the baby.
In any case, if you have to receive a vaccine while you are breastfeeding your baby and you have any questions about it, it is recommended that you speak with your doctor or take a look at the e-lactation consultations website.
Vitamin complexes
Although by protocol it is usual to send vitamin complexes to the mother during breastfeeding, the truth is that in general terms, the only vitamin necessary during breastfeeding is iodine, since its deficit can affect the psychomotor and intellectual development of children.
As we read in e-lactation: “the daily needs of iodine are 100 to 150 micrograms per day and in pregnancy and lactation they rise to 250-300 micrograms, so most experts and health organizations recommend supplements of between 100 and 200 micrograms daily by region “ .
It’s important to consider…
This guide is intended to help clear up any initial doubts that may arise about whether or not to take any medication or undergo treatment. However, we remember the importance of never self-medicating , but especially during pregnancy and breastfeeding.
In this sense, the e-lactation website can be of great help in case of doubts , although it is essential to consult it whenever we are going to take a medicine, even if it is not the first time we use it, as it could have varied its safety recommendations.
Photos | iStock
In Babies and More | Antibiotics are not used to cure viruses, or treat colds or flu: bet on responsible use, “It is a myth to say that a woman who breastfeeds cannot take medicine.” Interview with José María Paricio (I), Breastfeeding and the flu: can I continue breastfeeding?
