Hi Margaret,
That seems a very difficult situation all around. I think I would approach
this by validating with mom how she is feeling, explore more with her what
she would want to do. If she would really want to continue breastfeeding,
does she want or is able to do the work of increasing her milk supply and
her baby's ability to transfer milk at breast?  Does she want to do short
term partial bf and supplement liberally, however she should have realistic
expectations that her milk supply will very likely downregulate fairly
soon, and it would be unlikely that she would bf for 6-9 mos for example.
Maybe 1 or 2 months.

Once you have an idea of what she really wants to do or feels able to do
with her health issues, then you can explore further the issue of the meds.
At the starting point, it seems she is within the realm of acceptable
doses, and the milk transfer being low, the baby appears to be safe. The
baby can be monitored by the pediatrician with health and growth checks and
drug levels, and mother should be taught what side effects to watch for. I
would have a candid discussion with her about her ability to be awake and
alert, and hope that is not a problem for her due to her long term use.

Even though we know the decision is ultimately the mother's to make, it
would behoove you (as you stated) to have the OB and pedi doctors agree on
the course of action, with guidance from Infant Risk Center info.

Laurie Wheeler RN MN IBCLC
Mississippi USA

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