Pain Meds and Breastfeeding

  1. I am just a student nurse doing my childbearing rotation but I am just wondering if anybody knows the percentage of pain meds (Motrin and Percocet in particular) that are excreted in breastmilk?

    Is there any harm to the baby if the mother is taking these medications and breastfeeding? I think it is really important to be liberal with pain medications for postpartum pain management but I was just wondering if there are any possible side effects for the baby.
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  2. 36 Comments

  3. by   z's playa
    I'm not doing a rotation yet but side effects...I would imagine would be one groggy baby!
  4. by   Spidey's mom
    Check out Dr. Thomas Hale's book, Medications and Mother's Milk.

    Here is his website:

    http://neonatal.ttuhsc.edu/lact/

    steph
  5. by   prmenrs
    Great site!!
  6. by   Fiona59
    Our unit used mainly T3s and the excretion rate was not felt to be a factor worth worrying about. Didn't see any groggy babies. Better a comfortable mother than a woman in pain and miserable.
  7. by   klone
    Ibuprofen is an L1 Lactation risk drug (safest) and approved by the AAP for use in nursing moms. It has protein binding of >99% (which means that less than 1% is actually available to enter the breastmilk), and an oral absorption of 80%. It's believed that breastmilk levels are less than 1mg/L.

    Oxycodone is an L3 Lactation risk (moderately safe). It's believed that the amount excreted in milk is less than 2% that of the maternal dose at highest concentration. It has 50% oral bioavailability.

    Hope that helps.
  8. by   BETSRN
    Quote from celle507
    I am just a student nurse doing my childbearing rotation but I am just wondering if anybody knows the percentage of pain meds (Motrin and Percocet in particular) that are excreted in breastmilk?

    Is there any harm to the baby if the mother is taking these medications and breastfeeding? I think it is really important to be liberal with pain medications for postpartum pain management but I was just wondering if there are any possible side effects for the baby.
    These meds are both deemed safe. Two books you may want to reference are DRUGS IN PREGNANCY AND LACTATION by Briggs et al, and MEDICATIONS AND MOTHER'S MILK BY Thomas Hale. These two books are considered the gold standard in lactation. Hale is a very good speaker, by the way.
  9. by   SmilingBluEyes
    Steph's site is GREAT. Anecdotally, I see NO difference in behavior of babies breastfeeding habits between moms who take narcotics post partum and those who do not. Check out that site; the books recommended there should be STANDARD issue on all post partum floors (we have several of them in our nursery and LDRP unit). Thanks steph, mind If I put it in the "recommended reading area"?
  10. by   FrumDoula
    Whatever you do, DON'T turn to the PDR to get breastfeeding info! It's a horrible resource because it's written more to cover the butts of the pharm companies than to assess risk for the mother/baby diad.

    Does your hospital have an IBCLC on staff (a lactation consultant)? These ladies (sorry for being sexist) are worth their weight in GOLD. They can not only help the PP mamas, they are wonderful resources for staff members who want to help with breastfeeding but don't have all the knowledge they need. I think they're terrific! Even contacting a local La Leche League leader can be a positive experience.

    Of course, YMMV with some IBCLC's, but in general, I can't say enough about them. Very few medications call for weaning, by the way. What a great question!!!

    Alison
  11. by   Spidey's mom
    Quote from SmilingBluEyes
    Steph's site is GREAT. Anecdotally, I see NO difference in behavior of babies breastfeeding habits between moms who take narcotics post partum and those who do not. Check out that site; the books recommended there should be STANDARD issue on all post partum floors (we have several of them in our nursery and LDRP unit). Thanks steph, mind If I put it in the "recommended reading area"?
    Nope - great idea.

    When we (breastfeeding advocates) approached some of our OB docs with more detailed info they point to the PDR as their bible.

    We bought them each Dr. Hale's book.

    I have spoken to him - very nice man. And the site is extremely helpful in that you can post questions.

    steph
  12. by   SmilingBluEyes
    Quote from FrumDoula
    Whatever you do, DON'T turn to the PDR to get breastfeeding info! It's a horrible resource because it's written more to cover the butts of the pharm companies than to assess risk for the mother/baby diad.

    Does your hospital have an IBCLC on staff (a lactation consultant)? These ladies (sorry for being sexist) are worth their weight in GOLD. They can not only help the PP mamas, they are wonderful resources for staff members who want to help with breastfeeding but don't have all the knowledge they need. I think they're terrific! Even contacting a local La Leche League leader can be a positive experience.

    Of course, YMMV with some IBCLC's, but in general, I can't say enough about them. Very few medications call for weaning, by the way. What a great question!!!

    Alison
    we have an IBCLC and a couple of LC's and the knowledge these folks possess is amazing in deed. they are wonderful resources.
  13. by   FrumDoula
    Quote from SmilingBluEyes
    we have an IBCLC and a couple of LC's and the knowledge these folks possess is amazing in deed. they are wonderful resources.
    If you've ever seen the requirements to become an IBCLC, you know that it's basically a degree in breasts and breastfeeding. For someone with an ADN, it requires 45 additional hours of lactation classes, PLUS 4000 hours of work as a breastfeeding consultant.

    Alison
  14. by   SmilingBluEyes
    I know all that Alison. I was planning on studying for mine. Decided against it, as my chances of finding a position as an IBCLC that make it worth all those hoops to jump and money spent to do it, not worth it. And my heart is in L and D, not in fulltime LC work. So I am pursuing certification in inpatient OB nursing, which in itself is not a cakewalk, either. I hope I do pass, as it's 300.00 to take it!

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