Can I Relactate After 2 Weeks on Medications?

QUESTION

Dear Lactation Consultant,
Hi.I have to have a c-section and afterwards, due to a history of blood clots in my lungs, the doctor is putting me on Loveanox for two weeks. My question is, since the baby can not nurse due to this medication, can I pump for the first two weeks and then train him to nurse after the loveanox treatment is finished. I want more than anything to nurse my baby. Thanks for your input, nobody seems to know.Robin

ANSWER

Hi Robin,
Questions like this are by far the most frustrating aspect of being a lactation consultant.

The first question I have for you is who informed you so matter of factly that you can't nurse your baby while taking Lovenox, and why? I am not a doctor or a nurse, but all I have to do is pick up a copy of Dr. Thomas Hale's Medications and Mother's Milk (Tenth Edition, 2002) and look up enoxaprin (Trade name: Lovenox) and read the following:

"Enoxaparin is a low molecular weight fraction of heparin used clinically as an anticoagulant. Because it is a peptide fragment of heparin, its molecular weight is large. The size alone would largely preclude its entry into human milk at levels clinically relevant. Due to minimal oral bioavailability, any present in milk would not be orally absorbed by the infant. A simlar compound, dalteparin, has been studied and milk levels are extremely low as well."

In the book Clinical Therapy in Breastfeeding Patients (Dr. Hale, First Edition, 1999) states that

"anticoagulation therapy in breastfeeding mothers should always be approached cautiously, with close observation for abnormal bleeding".

What you have to realize is that there is no drug on the market that is not going to have this sort of disclaimer, due to concerns about liability among health care professionals. If there is even the slightest theoretical possibility that a drug might cause a medical problem, then doctors are legally required to let their patients know this. This is especially true when a patient is pregnant or lactating, and not only the mother but her infant is potentially affected. In the case of Lovenox, there have been no pediatric concerns reported via milk, and the molecular weight is too large to produce clinically relevant milk levels. In spite of this, your health care provider apparently told you point blank that you could not nurse your baby while taking this medication.

Research clearly indicates that many mothers have taken this medication without any adverse effects on their babies.I get very frustrated wtih doctors who aren't educated enough in lactation (or who don't take the time to do their research) to advise their breastfeeding patients about the actual clinical effects of taking a medication, and to discuss the options for providing the medical treatment the mother needs while still preserving the breastfeeding relationship if at all possible.

The fact is that in the vast majority of cases involving prescribing medication to nursing mothers, it is possible to continue nursing your baby without in any way endangering his health. In a risk/benefit situation, the small amount of the drug that actually transfers to the baby via breastmilk is seldom significant enough to justify advising the mother to wean (even temporarily), thereby denying the vulnerable infant with all the proven (not theoretical) benefits that human milk provides.

Advising a mother to "pump and dump" her milk while she is taking a medication is a pretty drastic step, especially when the mother in question is establishing her supply for a newborn infant. The first couple of weeks after your baby is born is considered a supply building period. The stimulation that you get during this early postpartum period, when your body is physically and hormonally "primed" to respond to this stimulation, is very important in establishing an adequate milk supply for your baby.

This is not to say that if you don't get to breastfeed your baby within a specific time frame, you are doomed to breastfeeding failure. Obviously, this isn't true because mothers of preemies who are in the hospital for extended periods of time after birth, as well as mothers who induce lactation for adopted babies are usually able to build up their supply by pumping, use of tube feeding devices, taking medications to boost their prolactin levels, etc.

By the same token, babies who aren't put to the breast for extended periods of time, (even weeks or months in some cases), are often able to be "retrained" to go on the breast, using techniques ranging from pure persistence to use of nipple shields, tube feeders, special bottles, etc. Just because these interventions exist does not justify their use unless it is absolutely medically necessary for the mother to be separated from or unable to breastfeed her infant.

I cannot give you medical advice, and would certainly not suggest that you go against your doctor's recommendations regarding the safety of taking Lovenox after your baby is born. However, I would strongly recommend getting at least a second opinion regarding this. Many health care providers who recommend weaning don't do it because they don't want their patients to breastfeed, but simply because they don't know that detailed information about the use of drugs during lactation is available.

Here is some information that you can share with your doctor that might be helpful:

  • You can visit Dr. Hale's website. Dr. Hale also offers a 24-hour Lactation Fax Hotline which can provide your doctor with up-to-date information about specific drugs. The system requires a password, so you register for a small fee, then pay a charge for each document sent. This is a great way to get information to your doctor quickly. For information, call 806-358-8138.
  • Another resource is the Lactation Study Center in Rochester, New York. Designed primarily for physicians, they will search their data bank for information and get back to you quickly. This includes drug information as well as information about any breastfeeding topic. Ruth Lawrence, Professor of Pediatrics and OB/GYN (and mother of 9) is probably the best known medical expert in the field of lactation, and is the author of another excellent resource book: Breastfeeding: A Guide for the Medical Profession (5th edition). The number for the Lactation Study Center is 716-275-0088.

Be assured that if you and your doctor decide after carefully reviewing the literature to delay putting your baby to breast for a period of time after birth, you certainly have lots of options as far as maintaining your milk supply and helping your baby latch on whenever you decide to start nursing. Make sure that you have good support from a lactation consultant after your baby is born, and she can advise you on how to maintain your supply by pumping and help you get your baby on the breast whenever you are ready. I wish you all the best.

-- Anne, IBCLC

Kathleen Tackett

Dr. Kendall-Tackett is a health psychologist, International Board Certified Lactation Consultant, and Research Associate Professor of Psychology specializing in women's health at the Family Research Lab, University of New Hampshire. She is a Fellow of the American Psychological Association in both the Divisions of Health Psychology and Trauma Psychology. Dr. Kendall-Tackett is a La Leche League leader, chair of the New Hampshire Breastfeeding Taskforce, and the Area Coordinator of Leaders for La Leche League of Maine and New Hampshire.

Dr. Kendall-Tackett is author of more than 140 journal articles, book chapters and other publications, and author or editor of 15 books including The Hidden Feelings of Motherhood (2005, Hale Publications), Depression in New Mothers (2005, Haworth), and Breastfeeding Made Simple, co-authored with Nancy Mohrbacher (2005, New Harbinger). She is on the editorial boards of the journals Child Abuse and Neglect, Journal of Child Sexual Abuse and the Journal of Human Lactation, and regularly reviews for 27 other journals in the fields of trauma, women's health, interpersonal violence, depression, and child development. Dr. Kendall-Tackett is the "Ask a Lactation Consultant" columnist on Pregnancy.org and serves on the Board of Directors of Attachment Parenting International.

Dr. Kendall-Tackett received a Bachelor's and Master's degree in psychology from California State University, Chico, and a Ph.D. from Brandeis University in social and developmental psychology. She has won several awards including the Outstanding Research Study Award from the American Professional Society on the Abuse of Children, and was named 2003 Distinguished Alumna, College of Behavioral and Social Sciences, California State University, Chico.