Why don't doctors have Hale's "Medications and Mother's Milk?"

[NewMama2007]

Instead of automatically telling mothers that their medication is incompatible with bfdg, they could actually look into it and see for themselves!

Yesterday (I'm a CLC in a maternal/infant health program) I had a mom come in that wasn't taking her asthma medication because her doc said not to while bfdg. It's an L1 (safest)!

Then another mama came in who was on antibiotics for a retained placenta and was told to "pump and dump" and give formula for 14 days. Baby was only 3 weeks old! The medications were L2 (safer).

Does anyone know of any funding available to get medical professionals this book? Our funding sources all are used for pumps, nipple shields, supplemental feeding systems, etc. We have no funds leftover for this. It's hard enough for us to even get the newest edition whenever it comes out.

IDK, I really feel like it's necessary for doctors to understand the medications and how they come through human milk, instead of blanket-statement advising formula and pumping and dumping.

[isabchi]

[RoadWorkAhead]

I think its more a CYA thing. Easier to say it and not research, even if they had Hales at their finger tips - What if Hale's research was wrong?? Law suits seem to motivate most things in the medical community. Thankfully our ped has it and refers to it and is well versed in what is safe, and will answer questions about med safety 24/7 for BFing mamas.

[beautyful]

IME, it's been that doctors don't know it exists. I spent a lot of time at different doctor's offices last year, and I made sure to bring my copy to at least one appointment with each office. All of them wrote down the information for it at least, and they seemed genuinely surprised that such a thing existed. (And they all wanted to get copies for the offices. )

[Tine]

I've often wondered that myself. It strikes me as odd that there's a book so perfect and useful for the medical profession -- and that many ordinary moms have bought for themselves (despite its expense) -- that most MDs have never even heard of.

Very strange. Conspiracy theory, anyone?

[hipmummy]

That is the reason why I left my PCP. They told me I had to pump and dump for a half of dose (1 Time) of an L2. It was a suppository that was not even absorbed by the gut. The l2 warning is for the oral dose. I explain all of this to her and she still kept repeating it over. I made sure to call back and said I was bfing like crazy!

[KurumiSophia]

I wish I knew. I have a feeling I'm going to be going around and around w/my NP that I see through my therapist's office about having something for my ADHD.

When I requested something before she told me to wean immediately and she would. Hopefully time has mellowed her a skosh and I can convince her that it's ok for me to have my ADHD under control and nurse. *headdesk*

[mama24-7]

I think it's a few things:

1. Many HCPs don't know it exists.
2. Many HCPs don't value breastfeeding in themselves or others and/or believe formula/bottle feeding is just fine.
3. Liability.

Sus

[BugMacGee]

We use it all the time

We did at my last hospital too. IME it's the moms who are more worried about anything in their breastmilk than the MD's RN's or LC's.

[Ammaarah]

My pediatrician's office always has the latest edition! Love them!

[miss_sonja]

Yes! I want to know! This bothers me so very much. I actually told a doctor, when she claimed the drug I was considering taking would be incompatible, to give me the scrip and let me talk to my LLL leader, who has a Hale's. Turned out, the drug was one that, in the dose I was going to take, would be totally HARMLESS. The doctor just plain didn't know, and didn't know about Hale's. She was a urologist, someone who sees women, and often pregnant or nursing women. Got me so very mad.

[milkeriffic mama]

Originally Posted by Ammaarah

My pediatrician's office always has the latest edition! Love them!

Mine too! So thankful for that since I know it's not the norm.

[elanorh]

I think many don't know about it.

My sister is a speech pathologist and sometimes encounters latch issues with her job -- deals a lot with infant/toddler issues. She has recommended the purchase of Hales for a couple different doctors who work with her office (and they've purchased it).

I think sometimes when the recommendation comes from another 'professional' it's received more openly by the doctors (the ones who are authoritative/patronizing towards patients, anyway).

I think my Ped has it; I don't know about my OB. If a medical professional really values bf, and keeps informed about it, I think they probably have it (after all it isn't that expensive a book, KWIM?). Or will purchase it if they become aware of it. I loaned my Ped some MSPI cookbooks and she bought her own copies to loan to mothers she was suggesting dairy/soy elimination to.

[BusyBeeMom]

The do not know it exists. I give it as a gift to all the doctors I know. Very, very few doctors have learned a thing about BFing in med school. It is slowly beginning to be taught. A new ped I know (she's just finishing her intern year) actually had a LACTATION ROTATION!! I sent her Hale's as a graduation gift, and she said it had been on her list of books to buy!

So, some docs are becoming aware, but it's few and far between. Columbia med school also does a lactation rotation, and Touro our in California has an IBCLC give a lecture.

Honestly, if you can afford it, buy it as a gift for your ped, or a doctor you know and consider it your good deed for the month. Some may ignore it, but so many don't know.

Also, the whole biochemistry of how and why drugs do or don't get into milk is fairly complex. My mom, who is a physician, was very suspicious of claims that some drugs didn't pass get into milk in appreciable quantities until I read her the explanation in Hale's. She said it was a "great discussion." BTW, I've turned her into quite the lactavist She once called me to have me look up a drug for a nursing mom she was talking to when she was visiting friends

[BusyBeeMom]

Originally Posted by KurumiSophia

I wish I knew. I have a feeling I'm going to be going around and around w/my NP that I see through my therapist's office about having something for my ADHD.

When I requested something before she told me to wean immediately and she would. Hopefully time has mellowed her a skosh and I can convince her that it's ok for me to have my ADHD under control and nurse. *headdesk*

I've wrangled with this.

I had two doctors review the Hale's info on the various ADHD drugs, and we decided that I could take the regular, not long-acting ritalin, and time things so that I don't nurse for at least 3 hours after taking it, preferably more. These are drugs that I'm not comfortable having my kids get in appreciable doses, but the non-extended release ritalin has a very short half-life, so it's possible to do it. I would not have done this with a newborn. My DS was about 10 months, and big, when I went back on it. I watched him for signs of decreased appetite, change in mood or activity level, and other behaviors.

A lot of HCPs are going to be wary of the possibility of these drugs getting into LOs systems, and, I think, with good reason. But I think it's possible to work out a good routine, I think.

[MommytoTwo]

I showed it to a psychiatrist who was refusing to treat me for PPD unless I weaned. He had never heard of it and expressed no interest in it whatsoever.
My ppd went untreated and I did not wean.

[heatherweh]

Right! Very frustrating. Also so many drugs aren't listed in there or just say "no studies or results incomplete" or some such. What do you do then? I got bursistis when DS was very little, maybe 2 months old or so, and it got to the point where I literally couldn't walk or pick him up anymore before I broke down and got the cortisone shots (insufficient studies or something was the consensus). I had to weigh out the options, a mama who is in too much pain to mother and collapsing on the ground is no good to anyone!

[Tine]

So it's pretty unanimous...doctors simply don't know about Hale's. WHY? Is it me, or does that seem just...crazy? :

[gabysmom617]

I brought my Hales along when my psychiatrist was going to prescribe me with meds for depression and possibly AD/HD.

He kept tapping into this little electronic computer pad he had that supposedly had which meds were safe with bfing and which ones weren't. (Basically, EVERYTHING in the little pad said "unknown" reactions to kid, so he ruled them all out.)

I told him I had my Hales book and it had psychiatric medications in there, and he just skimmed through it, and said, "Well, no one really knows for sure" and totally dismissed me and the Hale's book. It was clear he didn't want to be "taught" something he didn't know by little old me. That was the last time I ever went to him.

What I since started doing was to not tell the doctor I"m "still" bfing, let them prescribe whatever med for me, come home, and check my Hale's myself to see if it's safe before I take it. I've never had a medication prescribed to me yet that I came home and discovered that I should not take it, so I've never had to come up with what to do in that situation as of yet...

My guess would be, if I happen to get prescribed a med that I shouldn't take while bfing (according to Hales) would be to come home and then do some extra research to find an extremely pro-bfing knowledgable dr. to go (even if that means some minor traveling) and get a second opinion from, explain to that doc that I"m still nursing and maybe get that dr. to prescribe a safer alternative med for me. But I've never had it come down to this yet.

It would save me a WHOLE LOT of steps if all docs had (and READ, AND USED!) the Hale's book.

[LizLizard]

My PCP whipped out a copy the last time I saw her and needed some meds... it blew my mind. She's leaving the practice soon to be a medical director at some company... luckily her cohorts are very like-minded, so I feel comfortable sticking with them. I may even switch DD to them, from her ped that isn't as good as I had hoped.