> I got this information from the Breastfeeding Answer Book.

Rather than make a list of contraindicated drugs, why not teach staff
how to evaluate any particular drug according to any particular
lactating mother-baby couple at any particular point in time of the
breastfeeding experience? As you know, what may be significant
information for a 1 week old infant may have no meaning for the 3 year
old.

You did not say what kind of staff you will be writing this for, but I
can anticipate some problems should you use the list as written:

L&D and PP staff might challenge the OB's orders for ergotrate which
would be necessary to treat pp hemorrhage - but used only for a very
short time. It seems to me, this would be very important to the mom's
health & well-being, and thus, probably not a major problem for
breastfeeding.

On the other hand, if your staff are out-patient peds nurses, they will
rarely encounter a mom on ergotrate for pp hemorrhage. Yet they may get
a call from a mom experiencing migraines who uses ergot preparations.
Even then, if it is the only drug that works for her, I'd rather teach
her to anticipate a transient drop in supply and how to work with that
instead of denying her the Rx.

Nursery & NICU staff might disallow BFing from the list with drugs of
substance abuse, yet I've worked in NICUs where the neonatologists allow
expressed breast milk with all the abuse drugs in this list except
heroin and its counterpart which was not in the list: methadone. Even
then, the amount used is evaluated and the mother's current situation is
also evaluated.

I think there is a different responsibility requirement in printing
contraindications to BFing (as the publisher of any book does not know
how, when, or by whom the information will be used; the "safe" mode for
the printed medium is the most conservative mode) versus teaching about
Drugs in Breastmilk in a specific setting to a specific group of
healthcare providers.

Teaching your staff how to evaluate a mother-baby couple is much more
difficult and time-consuming than simply reaching for a "no-brainer"
list and applying the information arbitrarily. I think any course such
as you propose would greatly benefit from a hands-on activity learning
how to use standard medical texts and Drugs/BF resources such as Drugs
in Pregnancy and Lactation or Tom Hale's Drugs in Breastmilk. Since you
said it was a self-study module, simply include an exercise or two
leading the learner through the evaluation process using one of the
professional pharmacology references. They would be better served to
learn how to use available resources anyway. In other words, teach your
staff "how to fish" rather than simply "giving them a fish."

Good luck - your staff will be very fortunate to have this class.

Sincerely,
Katharine West, BSN, MPH
Sherman Oaks, CA