“The mistake many doctors make is in thinking that formula is neutral. It’s not.”
I am fairly certain that those were Dr. Christina Smillie‘s exact words when she began to explain to me (and my husband) the benefits of breastfeeding and why they could outweigh the risks my medication might pose. I came to her because I wanted to breastfeed my baby, at least during our hospital stay. She wasn’t trying to change my mind or convert me. The appointment lasted over two hours. It was pretty amazing! She was able to give me exactly what I wanted: a scientific explanation for abandoning the fear I carried that my milk would hurt my child.
Dr. Smillie recommended breastfeeding because, from her perspective, the benefits of breastfeeding a baby make even less-than-perfect breastmilk healthier than formula. I am not saying that formula is bad. I already wrote that we use formula. But breastmilk is pretty amazing stuff, and nothing we manufacture can measure up to it.
I didn’t just take the doctor’s word for it; I read the article she gave us from the journal Pediatrics, published by the American Academy of Pediatrics called “Breastfeeding and the Use of Human Milk.” This is a ten-page academic article, not including notes and citations, so I’ve included the link. The article addresses both the benefits of breastfeeding and the risks of taking meds while nursing, go and check it out if you want to read the benefits. Basically, breastmilk is good for babies in every possible way, from supporting the immune system to lowering an infant’s risk of contracting a respiratory infection.
But what about those risks because of my medication? There’s a whole section on “Maternal Medications,” and they state first that there are very few medicines that are “contraindicated” (the AAP recommends that you not breastfeed because of them). There are many, and they specifically mention psych meds, that we just know very little about, especially when it comes to how much medicine is in a mom’s blood stream or milk supply. But then, there’s what we do know: of the drugs that we do have data on, Zoloft is one of the most-studied and “least problematic.” Effexor and Zoloft are not the same. They are similar enough for me to feel ok about taking that risk. Klonopin? We just don’t know enough to say that it is probably not problematic. The combination of the two? No data.
That’s kind of scary, I admit. But the same article offers some perspective by listing the classes of drugs that are dangerous enough for the AAP to recommend formula over breastmilk. There are four: amphetamines, chemotherapy agents, ergotamines, and statins. Why does this offer perspective? Because these drugs have extremely intense side effects, unlike the anti-anxiety meds and anti-depressants that I take. They also directly effect basic body functions, unlike my meds.
Speaking of basics, Dr. Smillie offered some perspective in the midst of all this science by explaining the way that alcohol enters breastmilk as a point of comparison. Alcohol enters everyone’s blood stream and every lactating woman’s milk supply at exactly the same rate (unlike antidepressants). A great resource for breastfeeding moms is the website Kelly Mom, which supports Dr. Smillie’s assertion that “less than 2% of the alcohol consumed by the mother reaches her blood and milk.” The example the doctor used was that of a mother who is legally drunk here in Connecticut, with a blood alcohol level of .08. If she nurses her baby at that blood alcohol concentration (BAC), her baby will end up consuming 2% of the alcohol in her blood and will have a BAC of less than 2% of .08. While a fetus shares his mother’s blood stream and would also share her BAC, a baby is just taking a drink of a liquid that contains less than 2% of the alcohol in his mother’s blood stream. That baby would then have a negligible amount of alcohol in his blood stream, even though his mom was very drunk when she fed him.
My medication is metabolized differently than alcohol, but even if my baby got 2% of it at its peak concentration in my body, he would still be getting a tiny amount. In fact, one study that did look at breastfed infants whose mothers took Klonopin found that “ten of eleven … had no detectable” levels of the medication. Studying eleven infants is not exactly conclusive. But in the database Lactmed’s summary of research on Klonopin and breastfeeding, only one infant seemed to show any side effects from Mom’s meds. There’s more research on Effexor, but Dr. Smillie’s point was clear: it’s probably safe, watch the baby for side effects, don’t worry too much.
We supplemented with donor milk to reduce the amount of medication Walt got in the early days for our own peace of mind, because as his body gets bigger, the same amount of medicine has a smaller impact on that body. It also gave me time to see whether or not Walter was exhibiting any symptoms after consuming my milk. By the time we ran out of donor milk, I had watched him and couldn’t find any sign of any symptom.
Please, ask questions. It took me a long time to absorb all of this information, and I’m really not sure I have reached the point where I can explain it to other people.