Hello Chayn,

I will defer to inpatient clinicians to best answer your question, but in the meantime, these are two common resources here in the U.S. for drugs in human milk:

From the InfantRisk Center website:  "The InfantRisk Center (IRC) is a world-wide call center presently in the Texas Tech University Health Sciences Center, School of Medicine, Department of Pediatrics, in Amarillo. The InfantRisk Center is used by physicians, nurses, lactation consultants, and mothers in every part of the world. Virtually all calls are about multiple drugs, averaging 3-4 individual drugs. We do our best to help moms, lactation consultants, and doctors evaluate the risk to the infant from exposure to multiple drugs, and keep the mom breastfeeding."  Dr. Thomas Hale is the executive director of the InfantRisk Center and well-known author of the text, Hale's Medications & Mothers' Milk 2021: A Manual of Lactational Pharmacology – An Essential Reference Manual on the Transmission of Medicine into Breast MilkMedications & Mothers' Milk.  Users of the InfantRisk Center website can log in to post comments.  This is some of their content on caffeine:  

Re: migraines and caffeine:  "Caffeine can make a big difference in the effectiveness of migraine treatments. It is generally safe to use in low doses."
https://www.infantrisk.com/migraine-headaches

Re: caffeine and breastfeeding:  "Medical studies have so far failed to provide strong evidence that caffeine increases the risk for adverse pregnancy or breastfeeding outcomes in otherwise healthy mothers and babies. Specifically, reviews of the available literature suggest that caffeine does NOT increase the risk of birth defects, pre-term birth, low birth weight, stillbirth, or learning disabilities. In breastfeeding infants, there was no observed effect on sleeping patterns or heart rate. https://www.infantrisk.com/caffeine-intake-pregnant-and-breastfeeding-women

This next page on caffeine is from the Drugs and Lactation Database (LactMed) at the U.S. National Institutes of Health.  Their summary:  "Caffeine appears in breastmilk rapidly after maternal ingestion. Insufficient high-quality data are available to make good evidence-based recommendations on safe maternal caffeine consumption. Fussiness, jitteriness and poor sleep patterns have been reported in the infants of mothers with very high caffeine intakes equivalent to about 10 or more cups of coffee daily. Studies in mothers taking 5 cups of coffee daily found no stimulation in breastfed infants 3 weeks of age and older. A maternal intake limit of 300 to 500 mg daily might be a safe level of intake for most mothers. However, preterm and younger newborn infants metabolize caffeine very slowly and may have serum levels of caffeine and other active caffeine metabolites similar to their mothers' levels, so a lower intake level preferable in the mothers of these infants. Other sources of caffeine, such as cola and energy drinks, yerba mate or guarana, will have similar dose-related effects on the breastfed infant. Coffee intake of more than 450 mL daily may decrease breastmilk iron concentrations and result in mild iron deficiency anemia in some breastfed infants."  

https://www.ncbi.nlm.nih.gov/books/NBK501467/

With kind regards,

Debbie

Debra Swank, RN BSN IBCLC
Program Director
More Than Reflexes Education
Elkins, West Virginia USA
http://www.MoreThanReflexes.org




Original Post: 
"I am a nurse and LC in a maternity ward. We have a protocol for treating women with post spinal headaches which includes 200 mg caffeine at least twice a day. The caffeine is very helpful for treating these poor suffering women. Recently we had a patient receive caffeine IV though generally they receive it in pills.

"It had recently come to my attention that the official stance in the hospital is to tell women receiving caffeine that they are not allowed to breastfeed until 15 hours after the last dose.  I have looked it up on
e-lactancia which says that doses greater than 300 - 500 mg a day can cause irritability and insomnia in the infant while pointing out another study that found no problems in infants whose mothers consumed 500 mg of caffeine daily for 5 days.

"I would like to know what the protocol is other hospitals regarding caffeine and breastfeeding."

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