i have had several people ask why i said lithium is okay for use during
breastfeeding, especially when the aap says it is not. i have noticed there
are several drugs that are contraindicated during breastfeeding which we
nevertheless encourage mothers to use, with adequate monitoring.
there have been several comments from dr. hale and dr. newman in the past
about lithium, and having had a client/acquaintance on this drug this year, i
am now very knowledgeable about it. to briefly summarize; monitoring of the
blood lithium levels of the baby and educating the mother about what signs to
watch for in the baby constitutes adequate management of lithium use during
breastfeeding. my client breastfed her baby from his birth (after a few hours
of shoddy hospital intereferences and completely indefensible actions)
because i presented the information to the neonatologist. this baby was born
36 SGA because of oligohydramnios, and is now 7 months old, and just about
perfect (well, i can say that, since i get to keep him once in a while).
that is despite his small size at birth he has done well on breastmilk with
lithium and has never shown clinical signs of a problem, and his blood tests
have all been within allowable limits. these limits were decided upon by myla
moretti in toronto, at the special needs clinic (or maybe it is called
something else), where they have followed several women (six when i last
spoke to her, last january) breastfeeding while taking lithium. none of the
babies have had problems.
sure, its a serious drug. so is formula. and a mother whose illness is not
controlled is a serious problem. i would have to say that the worst parts of
this mother's situation were the hostile and uneducated attitude of the
nursing staff in the nicu at this hospital, who were not only unsupportive
but actively trying to undermine the breastfeeding relationship, which caused
much difficulty for this mother, whose confidence level was extremely low to
begin with. also, there were a couple instances of neonatologists and other
physician staff members who, despite not being caregivers for this mother or
baby, and not having read any of the information i had provided, and not
having spoken to the neonatologist who made the decision to "allow" (grrrr,
you know what jack says) this mother to breastfeed, still felt they had the
right to tell this mother that "they" would "never consider risking their own
baby's life" by doing what she was doing.
some other points about lithium: it is not advised for use during early
pregnancy because of the increased risk of serious problems for the baby.
there are other drugs much less potentially hazardous to mother and baby, but
there is often the problem of taking a chance by changing a drug that works
well and finding that the new drug doesn't control the illness as well. there
are also the important elements of breastfeeding for a mother who has a
serious illness such as bipolar disorder, which include feeling emotionally
devastated by the idea that she cannot breastfeed her child because of her
illness, feeling "responsible" for her illness in a way that our society
encourages (mental illness still being heavily stigmatized), and the
knowledge that if she is unable to breastfeed, her baby may well suffer
unnecessarily.
so don't let anyone be "forced" to wean because they need to treat bipolar
disorder. it just takes a lot of information for everyone involved (the
mother must decide she wishes to take one set of risks with the lithium in
exchange for the known risks of not breastfeeding), including clear
guidelines for monitoring the condition of both baby and mother. i must say
that after the initial uproar, this mother and baby were discharged, the baby
has not been tested often enough (in my opinion), the hcps are still not
clear about what values they should really be looking for and how they should
be measured, etc. however, i am doing my part as a professional and as a
friend by keeping close tabs on behavior and state of both mother and baby.
and she is a classic case of someone who has found that motherhood and
especially successful breastfeeding, has helped her improve her mental state
more than anything.
so let them have lithium.
carol brussel IBCLC
laura nevada lactation
denver co
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