Happy New Year to all.

        Since it is a new year, it is time perhaps to take stock.  Drugs and
breastfeeding seem to be a recurrent big issue on Lactnet, and it is
certainly something we have to deal with repeatedly here in Toronto.
Would not a few basic principles and approaches avoid some of the
recurrent questions that come up?

1. Not all problems need medications.  I realize that the lactation
consultant may find it difficult to suggest this approach once the
physician, in his/her wisdom, has decided to pharmaceuticalize, but it
is best to avoid drugs when they can be avoided.  They can be avoided
much of the time.  The same is true of certain tests such as the
thyroid scan.  Most of the time, the test is *not* necessary, and
diagnosis and treatment can be done without it.

2. If there is a question or lack of information about a particular
drug, is it *that* drug which must be used?  This is rarely true
these days.  Here is where the lactation consultant can be
particularly useful.  Physicians often prescribe without considering
breastfeeding.  But the time is over when this can be tolerated.
There was a time when we thought it okay to prescribe tetracycline for
children.  Now we must take into consideration the fact that children
may get unacceptable side effects from tetracycline (though
tetracycline is *not* contraindicated during breastfeeding).

3. If there does not seem to be an alternative to stopping, sometimes
there is still an alternative.  Thus, if the physician or mother
cannot be convinced that warfarin is acceptable (which it is), the
baby can be given vitamin K to placate everyone's concerns.  If the
only drugs available for a urinary tract infection are gentamicin and
ciproflaxin, the mother might opt for getting injections three times a
day rather than take ciproflaxin (which is *not*, by the way
contraindicated for breastfeeding). Mothers or their partners can
learn to give injections themselves.  This is true of postpartum
diabetes--why not continue insulin, since it is necessary usually only
for a relatively short time?

4. Breastfeeding might have to be interrupted as in the case of the
mother taking chemotherapy, but she does not have to stop completely
if the chemotherapy is intermittent.

Jack Newman, MD, FRCPC