Mom told to wean, question re: med & breastfeeding

[mountainborn]

I'm working on helping a mother who has been told that she can only breastfeed "as long as she can stand the pain" of her rheumatoid arthritis. Prior to pregnancy she was prescribed Enbrel, and when she became pregnant she was told not to take it. Then the decision was recanted because, "studies were done" and they decided it was safe for pregnant women. However, no studies have been done (according to her/ her doc) re: it's use during breastfeeding, so they intended on taking her off of the med a month prior to the birth.

Long story short, preeclamptic (?), baby delivered by c-section 6 weeks early. Mother was told to pump and dump for a week to avoid harmful effects of the drug on the baby. (Did I mention that hospital staff never even showed her how to use the pump until two full days after the birth?) : She did, and is now being told that the baby needs half formula for the first month after discharge because she is a preemie. This is 2007, right? Am I in a time warp?

But I digress. The main point of this post is that I'm wondering if anyone has super recent copy of Hale's Meds & Mother's Milk or other publication with info on Enbrel and/or alternatives. Or any experience with severe rheumatoid arthritis and breastfeeding!

I'm not as optimistic as perhaps I should be, as in all the above mentioned situations mom has not been informed of her rights and when she is she is very reluctant to contradict the doctor. BUT, if she is able to clear the hurdles before her thus far it sure would be nice for her to be able to maintain that breastfeeding relationship for more than a few months.

I have pointed out that most (all?) drugs that are safe for extended use during pregnancy should also be safe for nursing. My logic may be flawed, I'm not an LC. Would it be possible for a drug to transfer in milk but not cross the placental barrier?

[Meredith&Alexander]

Dr. Hale has some good info on Enbrel:

http://66.230.33.248/discus/messages/48/295.html

I've looked into it (for psoriasis, not RA) and my dermatologist did a phone consult with Dr. Hale. After they talked, my derm was very reassured, and would have had no problem prescribing it to me.

[miche28]

I would also strongly recommend that she give a call to Motherisk at Toronto's Hospital for Sick Children (http://www.motherisk.org) They are among the best experts in the field of drugs in lactation and are well-regarded in the scientific community, which helps both mom and medical staff.

Based on what I've read, there is NO reason to pump and dump for the commonly administered medications for pre-e (mag sulfate, labetalol, niphedrine, etc...). Preemies need breastmilk MORE than other babies, not less.

Baby's crying, gotta run, but keep providing support - sounds like she and her baby need it!

[Tendaironi]

Some preemies need additional fat and vitamins and minerals that they can get from preemie formula but usually it is because they missed the third trimester where they would have received it or because they are very underweight. However it doesn't replace bm you just fortify the breastmilk. But really the baby is only 6 weeks early and probably doesn't need fortification even if the baby is small. But to exclusively breastfeed an underweight baby you have to assert yourself with any doctor. So wish you well.

[veganone]

I've read that preemie mommas produce bm that is specially formulated for preemie babies (different composition than regular bm). So, she should bf for sure!!! No experience with fortifying, but that's an option too.

I have no expertise on RA or that med, but I'm on several medications and am bfing dd, who was 5 weeks early.

I agree that they need to check the Hale's guide. If that says it's okay she should definitely bf.

You might ask around in the preemie forum, too. Lots of experience there...

[J2]

Hale's book says it is okay to have that drug while breastfeeding. He is the medical expert on medications while lactating.

She really needs to nurse as often as possible to help her milk supply come in fully (I didn't catch how old the baby is now). Do lots of skin to skin contact to aid in making milk. As long as the baby is gaining weight and is having several stools per day (at least 4) and several wet diapers in a day then she should not need to supplement with formula. Breastmilk is best for ALL babies, especially preemies. And her milk is specially made for a preemie - it is different than if she were making milk for a full term infant.

[mountainborn]

thanks

Thank you to everyone for your responses - especially the Dr. Hale forum. Unfortunately this looks like a situation where the family does not want to pursue breastfeeding if there are any difficulties (there are many).

The ped has lifted the ban on exclusive breastfeeding, stating that they can continue to supplement if they want, "whatever". What's being communicated from doctors is that this will have no effect on the breastfeeding relationship. I didn't mention that baby is not on the breast, mom is pumping. The family returned from this ped appt stating that they prefer to supplement for a "while longer". I have continued to offer support if the mother wants to wean from bottles, but I don't think that support is wanted at this point. I have provided lots of info re: maintaining milk supply, antibodies in breastmilk, etc. along with my own experience in transitioning from bottle to breast. That's all I can do. :