Whenever someone suggests that something is contraindicated during lactation,
the position deserves discussion - for e.g. the recent rehash of alcohol.  I
think we can all agree that alcohol is very psychoactive, as anyone who has
taken it knows.

Kava is always called unsafe during lactation although there is little
evidence one way or the other.  Most of the alternative drugs for anxiety or
sedation have documented  adverse effects ( sedation for e.g.) especially with
younger infants (and for mom: potentially addictive/impairing driving ).  Yet,
these drugs are not absolutely contraindicated, nor should be.  So I would ask
the question, kava is unsafe compared to what?

At this point the contraindication found in herb texts was made without
evidence of documented adverse effects on the infant ( or adults in most
settings ). For e.g. Commission E's decision was based on lack of information
(few studies done at that time).  Kava is not a traditional herb of Germany,
so no surprise if 10+ years ago, the Commission E felt on unfamiliar
terrritory ( unlike St. John's Wort or Valerian - also psychoactive but
familiar, and not contraindicated for lactation by same group).

In traditional use (e.g. Hawaii), medicinal or ceremonial use of kava is
absolutely avoided as soon as a woman is pregnant (uterorelaxant),  yet I have
read of no such restriction while breastfeeding.

If anyone would like some insight into herbal sedatives, go to your local drug
store and buy a variety of herbal products ( for e.g. Valerian, kava,
chamomile, hops, skullcap) and in the safety of your home give them a try and
see for yourself what each do or don't do to you.  Compare to your experiences
with alcohol or prescription anxiolytics/sedatives, if applicable.  I find
skullcap gives a hangover similar to alcohol but valerian or kava do not.  Not
objective science but may be thought-provoking.

Sheila Humphrey
BSc  RN IBCLC
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