I read a magazine for NPs called "The Clinical Advisor for Nurse
Practitioners". e-mail address <[log in to unmask]> They have a Q this
mo (March 2000) that I thought may be answered by someone in our collective
1600+ membership. Please answer them directly and cc to Lactnet. I'm
typing in their Q & A and my answer.
Lacation Issues in Peripartum Cardiomyopathy
Q.
Although peripartum cardiomyopathy is a rather unusual condition, Colleen
Balch, NP, Clay NY, recently has cared for a young woman with this
diagnosis. "I find scarce information to guide me on lactation issues.
One must worry about drugs crossing into the milk as well as increased
fluid intake needs for breast-feeding in patients with congestive heart
failure. I wonder what experiences others have had with such patients."
A.
Peripartum cardiomyopathy affects an estimated 250-1350 women in the United
States per year. It is a type of dilated cardiomyopathy causing symptoms
typical of heart fatigue: fatigue, shortness of breath, chest pain, and
edema. It can occur late in pregnancy and after delivery. Patients with
this condition are often treated with medications to improve cardiac
function and alleviate symptoms, e.g., digoxin, alpha and beta blockers (Am
J Obstet Gynecol 178:409, 1998). You are correct in that there is limited
literature on issues of lactation and medications used in peripartum
cardiomyopathy.
The patient's condition dictates whether she can breast-feed, considering
that breast-feeding can increase demands on the heart. If a woman chooses
to breast-feed, the risks and benefits, especially in light of medication
use, need to be discussed with her. Other readers who've had experience
with this condition should write to the Clinical Advisor to share their
findings. - AL (23-30)
My answer:
Dear Clinical Advisor, AL and Ms. Balch,
Any HCP who sees mothers or babies on a regular basis needs to own a
current copy of "Medications and Mothers' Milk", by Thomas Hale, Ph.D. My
current copy is the 8th ed., 1999-2000. It is available from: Pharmasoft
Medical Publishing, 21 Tascocita Circle, Amarillo TX 79124-7301.
<www.perinatalpub.com> Dr. Hale has also written a new book called
"Clinical Therapy in Breastfeeding Patients", 1st. ed., 1999.
Both books are modest in price and extremely valuable additions to any
HCP's office and a neccessity on OB & Ped hospital units.
Dr. Hale discusses how drugs enter mother's milk and the properties of the
drugs themselves and how this contributes to the amount in mother's milk.
I have not personally ever had a patient with this problem. However,
mothers can relax and lie down to nurse. In fact, stopping periodically
during the day and nursing in bed at night give mom extra rest that she
wouldn't have if formula feeding. We know that the breastfed infant is a
healthier infant, with less feeding problems and colic than the formula fed
infant. A healthier, happy baby is easier to care for than one who gets
otitis and GI upsets. Breastfeeding has health implications for mother
too. In the long term, breast is best for the health of mother and
baby.
Sincerely, Patricia Young (New Jersey)
RN, MSN, CPNP, IBCLC
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