Pregnant friend...ritalin...and BFing

[phreedom]

Not really sure if this would be a lactivism thing or probably just a BFing issue.

I have a friend who is 34 weeks or so pregnant. She doesn't really know alot about BFing, but is curious about it and open to it (but is also really open to the idea of FF as well...not really strong one way or the other) Luckily she seems to have a supportive husband and family as far as BFing goes. She has a job in which she should be able to pump (she's a hairdresser and mom owns the shop) They really seem to be encouraging BFing...so that's really good.

Thing is she has major ADD and is convinced that Ritalin is the ONLY thing that works for her (maybe it is...I don't know). She has went off of it for her pregnancy and is eager to get back on it. I'm not really sure if you can BF on Ritalin...but I don't think you can (it's a major stimulant isn't it)...she doesn't really sound like she would want to BF on it anyway. I've encouraged her to go to her doctor and look up other ADD meds that may possibly be compatible with BFing. She may be suprised. Her family (mother...and husband) are of the school of thought that she should be wary of being on ANY medication while BFing her baby regardless of what studies say. They are encouraging her to stay off of it period.

Same thing with drinking. She isn't a major alcoholic...but she wants to enjoy a drink every now and then. I told she can...and yes you can still BF. But what if she wants to get REALLY drunk she asks. I told her that is probably going to be harder than you think with a brand new baby. But if you feel you MUST...you can pump and give the baby EBM. Then she's kind of whiny about the whole pumping thing. I told her is she feels that is a huge issue then it is possible to supplement the baby with formula...it's just very important to BF it when you are with it.

I hate to mention supplementation, but honestly she seems turned off by the "restrictiveness" of it all. I try to tell her it neednt be that restrictive. (her family seems to think so) If it's the choice between her not BFing at all or BFing "part time", then I think "part time" is better than none. The only thing is if you start doing that especially in those early months...you are really taking a chance with your supply. I've stressed this to her. I wouldn't even consider formula supplementation so that I can drink or avoid pumping at work until the baby were at least taking some solids. (well I wouldn't consider it at all for those reasons...)

Her current plan is to BF a "few weeks" (as in 2). That is honestly just enough to make you miserable IMO. That is when she will probably be engorged and very uncomfortable, and most likely to quit. I told her that is actually the hardest time...if she can at least strive for a 6 weeks at least and get into a groove, she may see that it does get easier and stick with it.

Sigh is there any other advice I can give her? I don't really see this going well. Her family is encouraging...but they also seem to be of the very restrictive school of thought. (No caffine, alcohol, medication anything AT ALL) That is the very thing that seems to be turning her off from it. I've also explained that realistically in those first few months, your life pretty much does revolve around the baby...FF or not. It's not like FF gives you this amazing freedom.

[Emmeline II]

I think you are talking to the wrong people. It seems that her family are sabotaging their own efforts. They make bf sound burdening and restrictive;who would want to do it? I would tell them that they need to stop the "can'ts", "don'ts" and "shouldn'ts" and help find the most healthful ways to "allow" the mom what she wants.


There is a book that seems to be the authority on what medications are compatible with breastfeeding I've heard mentioned here. Adventures in Tandem Nursing has a lot about the benefits to the mother; maybe you could give her the book and mark the relevant pages. Also, unless they qualify for WIC, formula feeding is very expensive....and she won't be able to afford alcohol. I'd find out how many cans a baby would need per month for the first six months and present her with the monthly cost. And if she is going to be on medication how much alcohol should she be drinking anyway?

[gini1313]

I would suggest she talk to an LLL leader or an LC about medications... the book the pp referred to is Medications and Mothers Milk by Thomas Hale. Both LLL Leaders and LCs will be able to look medications up for her and even copy parts of them for her to bring to discuss with the MD who prescribes her ritalin. The medications can be a hard one because in actuality, there are medications that women can't take while breastfeeding. Some women can't or won't live without those drugs for the length of time they would need to for breastfeeding. That said, I don't know specifically about meds for ADD and whether or not she could nurse while on them.

As for her ambivilence about nursing... I would be really supportive of her nursing at all. Encourage her that any breastmilk is really really really good for her baby and that she should initiate breastfeeding when baby is born. Be there to really support her and to help her if she has any difficulties, because she will be really likely to go to formula if it is hard at all. Also, I usually encourage moms to not set a timeline for nursing, but instead to just take it day by day or week by week. Setting a timeline can really be hard because if you say you are going to stop at 2 weeks or 6 weeks or a year or whatever, that amount of time can seem really long and overwhelming at 4 AM when whatever problem is going on. I would just encourage her to play it day by day and to try to give her baby as much breastmilk as she can. You/she never know, she may wake up one day and realize that she is still enjoying nursing her 2 year old Here's for hoping, and even if it doesn't work out that way, in reality, nursing for 2 weeks is infinitely better than not nursing at all...

I have a friend who was really ambivilent about nursing (although her family seemed more supportive of it than the family you are describing) and wasn't sure about even nursing at all when she was pregnant. I was really having a hard time with being able to support her if she decided to not nurse at all, or to wean early, but then I remembered that I haven't walked in her shoes, and so don't know what rationale she might have. I got more supportive and did let her know my feelings about breastmilk/formula, etc, but that I would support her in making the best decisions she could for her baby and herself. I provided her with info and support and she finally weaned her baby at about 18 months.

Hang in there for her. It is hard when someone makes choices that we don't agree with, but if you can give her support and information, she may surprise you!!!

[mamalibby]

I have serious ADD and stopped taking Adderall when I was pg. I continued to have a LOT of ADD symptoms while pg so I didn't know how I would survive with out meds while nursing (like I seriously thought I would lose the baby or something) but after a few weeks, I realized that my symptoms were WAY better.

In fact, I honestly think that having a baby has cut my ADD symptoms into half of what they were before I got pg. Sometimes I long for my meds but when I think of a life without being chained to a prescription bottle just to function...YAY!

Perhaps you could tell her that sometimes the hormonal changes of pg and giving birth (or even nursing) can really help to alleviate your ADD symptoms, and if she'll give it a month or so, she'll probably like her life better without Ritalin (which I used to take, also), and anyway, caffeine can also really help and is much better for her body and her baby's.
Good for you for being concerned and trying to help your friend and her babe!

[sonrisaa29]

I have major ADD as well and reduced my meds for the first trimester and then went back to full dosage. I could only be off my meds for a couple of weeks after I had my ds, and wanted to either do a combo of BF and FF or just BF for two weeks to a month. Let your friend know that LLL will refuse to help her at all if she even mentions that she wants to do any kind of combo or just bf for a couple of weeks because of medications.

I knew that by BF my newborn would be taking in amphetamines (which is what Ritalin, Adderall, Dextramphetamine and so on are) and I knew this would be extremely dangerous to my child.

THere are a couple of other medications out there, but I believe they've got a lower success rate and I know that they've also got a black label (meaning that there is an increase of sucide tendancies with taking them)

Personally I found my ADD to be horrible after I gave birth and having PPD made it 1000x worse. SHe could do a natural approach I suppose but that would require her drinking about 10+ cups of coffee a day.

OP I don't know whether you have ADD or not, but it's hard for people to realize how hard it is to function if they don't have ADD.

[miche28]

A good resource for drugs in pregnancy and nursing is Mother Risk (www.motherisk.org). They have a hotline where your friend can speak to a live person about her individual situation and are very well-respected by the medical community generally.

That said, it sounds like the drug interactions are only part of the issue here. One thing I'd be concerned about is how realistic her expectations are whether she's bottlefeeding or not. Getting completely drunk is an issue of safety whether mom is BF or not and the fact that this is one of her concerns makes me winder whether she's fully thought through the change she can expect.

In the end, one day of breastfeeding is better than none and every day of breastfeeding, every feeding of breastmilk is better than a feeding of formula. Sometimes when it's all overwhelming taking that small goals approach can be really effective because it creates early wins that help bolster confidence to keep going. And, frankly, sometimes, a mom is looking for an excuse not to breastfeed because she just doesn't want to - not the optimal decision for her baby, but it does mean you can't win them all.

PP, re: LLL refusing to help if a mom intends to combo feed or BF for a short time. I'm sorry if this was your experience, but it's absolutely not LLL position and any mother who wants to BF her child for any length of time can get support from LLL. Leaders aren't going to be able help with bottlefeeding questions, but there's no reason a mom shouldn't expect a support because she is doing both or BF for a short time.

[phreedom]

Thanks for the replys everyone. I went to her baby shower, and just from listening to her I don't have a great feeling about her chosing to BF. FWIW she's been pumping (no pun intended) me for information, I'm not approaching her about it. I just don't want to come across like I'm trying to pressure her to BF.

As far as her having ADD, I don't doubt that and I'm not discounting it. I was only curious because she said Ritalin is the only med that works...though she admits she's never tried anything else. She seemed to be under the impression that her ADD would have to be untreated if she were to BF. I told her that MAY not be the case as there are many other treatment options available. They may work for her...or they may not. Really that is something only she can decide. But if she really wanted to BF she could explore her options with that and decide what to do. Like I said...she asked me about this. I'm not recommending she go off Ritalin or stay on it. Only she knows what she can do. I just suggested that she look into her options if she wants to BF.

As far as her drinking. Like I said I don't get why she is getting all worked up about that being a huge issue. Its not like she's going to be this mama that is out hitting the bars the second the baby is born. I just suggested that if she really wanted to BF and this issue came up...just deal with it when it comes. Unless you plan on being drunk for days and weeks at a time (umm...she's not) then wanting to enjoy and occasional drink shouldnt' be a reason to discount BFing all together.

And then there is her family on the other end. They are encouraging her. Her mother (who owns the shop) has stressed how she will have plenty of time to pump. They share positive stories about BFing. I think they mean well...but the whole "restrictive...you must abstain from everything if you love your kid" approach is a huge turn off (heck I wouldn't want to BF either if it were like that)

I don't really have a great feeling about it. She seems counter every reason with a reason why she can't (but yet continues to seek more info...confusing). In the end it's not my choice to make. I'm not going to pressure her to do anything, but I offered to be there if she needs help with anything concerning it.

[MaryJaneLouise]

Originally Posted by phreedom

I don't really have a great feeling about it. She seems counter every reason with a reason why she can't (but yet continues to seek more info...confusing). In the end it's not my choice to make. I'm not going to pressure her to do anything, but I offered to be there if she needs help with anything concerning it.

I hate to say this, but she's looking for "permission" from SOMEONE to not BF. Dr. Hale lists Ritalin as an L3, meaning moderately safe. Lots of women,myself included, BF while on an L3 drug. It's not the best, but it beats the risks of FF (IMHO). If I were her, I would try to minimize the amount I take while BFing, especially in the very newborn period, when LOs are most vulnerable. Or, temporarily go on a different med.

But like you said, it's not yours or my choice to make.


Here's from Dr. Hale's web site:

http://66.230.33.248/discus/messages/43/3697.html

Question: I have a psychiatry colleague who is asking about a patient who is soon to deliver. She has ADHD and OCD. During pregnancy she has been on a low dose of Prozac, but her ADHD is making her home and work life very stressful. She would like to restart her dexedrine, but is worried about its use during lactation. I recommended that she try methylphenidate instead (L3 vs. L4) and use short acting instead of long-acting (and monitor for side effects). But I did encourage her to breastfeed (the risks of not breastfeeding seem to outweigh the potential consequences of the meds). Any other suggestions/comments?

Answer:
The treatment of ADHD is indeed somewhat of a problem in breastfeeding mothers. We are probably going to publish this year a set of data on mothers consuming dextroamphetamine, or methylphenidate. At present our data suggests the amount in milk is probably subclinical for most infants. This is particularly so of methylphenidate. I would agree with your suggestion, that short acting instead of long-acting methylphenidate may be suitable for this patient. Of course, you should always observe the infant closely for weight gain and sleep disturbances.

I also concur that the risks of NOT breastfeeding are probably higher than the risk of these drugs when used appropriately.

Tom Hale PH.D.

[MaryJaneLouise]

duplicate :

[gini1313]

Originally Posted by sonrisaa29

Let your friend know that LLL will refuse to help her at all if she even mentions that she wants to do any kind of combo or just bf for a couple of weeks because of medications.
.

That is not true, we have had many moms who came to our group who were already supplementing, or were thinking about starting for various reasons and they were all welcome.

I, myself, had to wean my baby due to medications (chemo after a cancer diagnosis) and while he was older (13 months when he weaned), my Leader was the one person who kept me sane and helped me transition us from nursing 10 times a day to weaned in two weeks and to do it as gently as possible. I then continued going to meetings all through chemo and afterwards, even when I didn't know if I would be able to have any more kids until I finally had dd. I was going to meetings for 2.5 years when I wasn't breastfeeding at all. LLL will of course encourage her to find a way to nurse that is meeting both of their needs, but if that winds up to be impossible, most leaders will be more than happy to help her initiate breastfeeding if she wants to, then to suggest ways to wean to a bottle as gently as possible.

I am sorry if that was not your experience with LLL, but please don't generalize all of LLL due to one bad experience.

[sonrisaa29]

Originally Posted by gini1313

That is not true, we have had many moms who came to our group who were already supplementing, or were thinking about starting for various reasons and they were all welcome.

I, myself, had to wean my baby due to medications (chemo after a cancer diagnosis) and while he was older (13 months when he weaned), my Leader was the one person who kept me sane and helped me transition us from nursing 10 times a day to weaned in two weeks and to do it as gently as possible. I then continued going to meetings all through chemo and afterwards, even when I didn't know if I would be able to have any more kids until I finally had dd. I was going to meetings for 2.5 years when I wasn't breastfeeding at all. LLL will of course encourage her to find a way to nurse that is meeting both of their needs, but if that winds up to be impossible, most leaders will be more than happy to help her initiate breastfeeding if she wants to, then to suggest ways to wean to a bottle as gently as possible.

I am sorry if that was not your experience with LLL, but please don't generalize all of LLL due to one bad experience.

Quite a while ago I had posted about my experience with LLL on here and many of the posters had told me that it wasn't part of LLL to encourage moms to use FF and BF at the same time.

[gini1313]

Originally Posted by sonrisaa29

Quite a while ago I had posted about my experience with LLL on here and many of the posters had told me that it wasn't part of LLL to encourage moms to use FF and BF at the same time.

Encouraging moms to use formula and discussing breastfeeding/weaning methods with a mom who has already chosen (for whatever reason) to give formula are completely different things. If it is the thread I am remembering (the title was something about all or nothing), the OP (if that was you) said that LLL should have suggested formula to you as an option for her with working and breastfeeding. As a pp in this thread said, a leader wouldn't necessarily discuss or encourage formula/bottlefeeding as an option with the mom, but saying that LLL would refuse to help her at all is quite a far cry from the truth, and not what I read in that thread.

While a leader doesn't have information about formula feeding or in depth info about bottle feeding, a leader definitely could/does talk with a mother about ways to bottlefeed in a more "breastfeeding" (for lack of a better term) way, things like switching sides that the baby is being held in (for eye development), using a newborn nipple (so the flow will be more like the flow from a mama and hopefully encourage jaw development better), holding the baby (rather than propping a bottle) in a "breastfeeding" position (which is also the right distance for a newborn to see the mother's face and positions the baby to better view the mother, holds him/her closer, and in general promotes bonding), among other things.

Also, if a mother is interested in breastfeeding for a short time, she may very well need support to initiate, just like any other mother, and will find that support in LLL. Then, when it is time to wean (whether because of meds, or whatever reason), it is not a leader's place to judge her or tell her not to (although she may try to explore the reasons for weaning to try to help the mom find an alternate solution to the problem), but can offer suggestions for meeting the goal of weaning in a way that is the most gentle to both mom and baby than might otherwise be done.

OP: sorry if this is off topic from your thread... back to the regularly scheduled programing