Prepare for crankiness, from which springs a professional query.
I get the Sunday night call from the mother of a two-weeker. She has a
fierce migraine (started getting them when she became pregnant with this,
her third child). Wants to know about taking Fioricet. She has called
another LC already, and has a call in to her own MD, and is leery about
taking it while nursing.
I read to her from Hale's 2002; this L3 drug has 325 mg aspirin, 40 mg
caffeine, and 50 mg butalbital, "a mild, short-acting barbiturate that
probably transfers into breastmilk to a limited degree, although it is
unreported." (Whenever I get these kinds of calls, I say to Mom, "I am not
a doctor, and I can't prescribe or advise about drugs. But I *can* read to
you from this resource [Hale's], so you can better educate yourself.")
After hearing what I've read, Mom decides out loud that she can probably
"risk it."
Then the details start to unfold as we chat. Mom was prescribed this drug
-- and took it -- while pregnant. Mom is an RN. Mom is "exclusively
breastfeeding," although she goes on to say that baby got formula in the
hospital ("when she didn't start out well"), and "I gave her three ounces
last night because she still seemed hungry after I fed her." And, in the
course of our phone call, she puts me on hold to answer an in-coming call
from her MD. MD tells Mom to take the drug with caution .... because of the
caffeine content. (Mind you: one good cup of coffee has 100-150 mg of
caffeine.)
So here is the cranky part: where the heck is the concern about the
*formula?* I do NOT blame this Mom (or sadly, even the MD) -- because we
lactation advocates are all painfully aware that the risk of formula-use is
the great untold story.
Which brings me to the professional query: have any of you, given a
circumstance like this, ever offered up information about the risks of
formula use? Clearly this mom was greatly concerned about her baby's
health: she'd made a least three phone calls with a migraine, for cryin'
out loud. But how to open the door, when she didn't ask? ("Now, allow me
to read to you from this other resource entitled 'Just One Bottle Won't
Hurt.'")
Liz Brooks, JD, IBCLC
Wyndmoor, PA, USA
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