Hi Sharon,  

Congratulations on your IBCLC!  I'm glad this mom has you to care for her.

 

I am concerned that this baby is drowsy.  The mom is sometimes taking twice the recommended dose of hydrocodone for a breastfeeding mom and her baby is symptomatic.  I am also concerned that this mom may have difficulty monitoring her baby due to her pain and the narcotic use.  I am also extremely concerned about this mom.  Does she anyone who can help her with the baby?  This may be the most single important part to help her through this and maintain her milk supply until she can fully breastfeed. 

 

I would recommend that mom pump and feed the baby formula until the baby is alert.  Mom may be able to partially breastfeed until her pain gets under control.  Has mom ever attended a pain clinic?  Maybe they could provide more comprehensive care than an individual practitioner.  I have worked with moms who have used methadone for chronic pain problems and have breastfed.  

 

Do you think that her back problems have worsened and she is not getting enough medical help?  Do you think that she is depressed?  Is she still getting chiropractic and/or massage?  This would really help too.

  

I'm sorry that I am giving you more questions than answers.  I don't have my Hale's at home, so I can't give you the answer to your question about the half-life of hydrocodone.  I hope that you can help this mom through this difficult time by telling her that the most important thing is for mom to return to feeling better so that she can be there for her baby and be comfortable.

 

I hope one of the MDs or pharmacists can comment.  Dr Hale also has a website that HCP can ask questions and he will give answers.  Sincerely,  Rachel Wahl RN IBCLC  
 
> Date: Sat, 17 Oct 2009 22:08:56 -0700
> From: Sharon Craig Economides <[log in to unmask]>
> Subject: Hydrocodone and breastfeeding
> 
> I have permission from this client to share this case.
> 
> I have a client who was a midwifery client through her pregnancy and birth
> and early postpartum. She had a back injury years ago and has always had
> moderate, but manageable back pain. The pain was managed through the
> pregnancy with massage and chiropractic care. After we ended midwifery
> postpartum care at 6 weeks, her back pain increased. She called in tears at
> 2.5 months postpartum and could not tolerate the pain any longer. She had
> already started taking ibuprofen, which was not enough. She saw a primary
> care physician, who prescribed Vidocin (the 5-500 formulation) as well as a
> steroid. She discontinued the steroid after 2 weeks, and continued the
> Vicodin. The pain has become even more unbearable and her prescription was
> changed to Norco 10 (10-325, so twice as much hydrocodone) and takes it
> every 4-6 hours. She notices that her daughter (who is 4 months old now)
> does get drowsy. She wants to continue exclusively breastfeeding, but is
> uncertain if she should pump and dump etc. She is devastated that she is in
> such pain, and that when she gets relief from the pain by taking the
> medication her infant is drowsy and may have other unseen side effects.
> Lactmed (http://toxnet.nlm.nih.gov/cgi-bin/sis/search/f?./temp/~Kf2Y8R:1)
> does mention infant drowsiness and recommends daily dosage be limited to
> 30mg per day (which the client is taking 40-60 per day at this point). Does
> anyone have a suggestion of a good alternative medication without the side
> effects for the infant? I could not find information on Lactmed about the
> half-live of the medication. Should the mother pump and dump initially?
> Any other suggestions?
> 
> Many thanks in advance for your wisdom, as I am a Lactation Consultant
> "newbie" (just heard yesterday that I passed the exam).
> 
> -- 
> Sharon Craig Economides, LM, CPM, MMid, IBCLC
 		 	   		  
             ***********************************************

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