Need a very good site to look up what meds could be safe for BF - Mothering Forums
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#1 of 18 Old 10-23-2013, 12:22 PM - Thread Starter
 
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....otherwise I will only be bf for a few weeks.  Urologist said the meds I am supposed to take now are not safe for bf, so apart from one he approved of, am taking them. 

 

Meds I should be taking as soon as baby is born are desmopressin, oxybutinin, trimipramin and citaloprame. Where do I find out if they are safe? Only taking citaloprame and despropressin now, not very happy with it and can't wait to start the others again.

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#2 of 18 Old 10-23-2013, 12:33 PM
 
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http://www.safefetus.com/

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#3 of 18 Old 10-23-2013, 12:45 PM - Thread Starter
 
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They all just say not enough data.... :(

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#4 of 18 Old 10-23-2013, 01:00 PM
 
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Have you asked your urologist about alternative medications that are safe for breastfeeding?

Also, you can call the Pregnancy Risk Line at 1-866-626-6847. They have great info and will answer all sorts of medication questions as they relate to pregnancy and breastfeeding.
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#5 of 18 Old 10-23-2013, 01:11 PM - Thread Starter
 
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Nah, there aren't any. It took months to find the specific combo to treat everything and the one alternative med for oxybutinin (mictonorm) has the same results in the search. 

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#6 of 18 Old 10-23-2013, 01:57 PM
 
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Oh, here...

Quote:
The InfantRisk Center will be dedicated to providing up-to-date evidence-based information on the use of medications during pregnancy and breastfeeding.  Our goal is to provide accurate information regarding the risks of exposure to mothers and their babies.  By educating healthcare professionals and the general public alike, we aim to reduce the number of birth defects as well as create healthy breastfeeding relationships. 
 
We are now open to answer calls Monday-Friday 8am-5pm central time. Please contact us at (806)-352-2519.
From http://www.infantrisk.com/ which I believe is connected to Dr. Hale.
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#7 of 18 Old 10-24-2013, 10:41 AM
 
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There's e-lactancia.org, a database compiled by a pediatric hospital in Alicante, Spain. It's both in Spanish and English. You could try looking them up there.

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#8 of 18 Old 10-24-2013, 03:27 PM
 
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PLEASE talk to a Lactation Consultant or LLL Professional Liaison leader about meds, especially poly drug therapy!

 

Dr. Hale is a good source, BUT he uses a great deal of technical data and wading through the multiple studies and medical language and interpreting the results of all this data is difficult if you aren't medically trained.

 

PLUS, many drugs that are contra indicated during pregnancy are often completely acceptable during breastfeeding. Pregnancy and breastfeeding are two completely different things and what is safe in one is not always safe in the other and visa versa.

 

You really need to either call an IBCLC or a local LLL leader and the LLL leader will send you to a Professional Liaison Leader who can interpret the complicated data related to meds and breast feeding.

 

DO NOT USE the Physicians Desk Reference or the insert that comes with the drug. Do not ask your pharmacist. These are notorious for always telling women NOT to take the medication during lactation, even if this drug is not contraindication in lactation because they do NOT take research into account, virtually EVERYTHING in the PDR and drug inserts is an exercise in CYA medicine. (In other words the drug companies who write these drug profiles not only don't want to get sued, they don't care if you breastfeed or not and seeing as many drug companies also sell formula, they actually profit from scaring you.) In fact, my pharmacist calls me when he needs drug data because even he doesn't trust the PDR for lactation.

 

Also, Dr Hales site does not have ALL medications on it. It is also set up for use by medical professionals, and one would need both his book (Medications in Mother's Milk) to make the website work properly.


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#9 of 18 Old 10-24-2013, 03:44 PM
 
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Hon, I just tried to look up your meds and only two showed up at all in my search. My guess is your spelling is off. Please look on the bottle of pills and spell the meds correctly so they can be researched. I'd be happy to look them up for you. :)  There are a LOT of drugs with similar names, so the spelling has to be exact in order for anyone to look them up and give you the safest and most accurate data.

 

Desmopression is a nasal spray. The drug is destroyed in the infant's GI tract is in thus this drug is considered compatible with breastfeeding.

 

Oxybutynin an anticholenergic which the amount transferred to the child via breastfeeding is "clinically irrelevant" (means "not a big deal and nothing to worry about" in medical speak)  although the manufacturer has claimed some cases of decreased supply because of the anticholinergic properties of the drug. You may want to talk to your doctor for a different drug if you see this side effect.

 

I assume you are taking these drugs during pregnancy, most drugs are MUCH more dangerous in pregnancy, so my guess is most of them are compatible, although many drugs can be dangerous in pregnancy and still be completely safe during lactation.

 

If you can get me the proper spelling of the other meds, I'll look them up.


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#10 of 18 Old 10-24-2013, 06:40 PM
 
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Try LactMed:

 

http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT

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#11 of 18 Old 10-25-2013, 09:28 AM - Thread Starter
 
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Okay, I contacted them (and my friend in the LLL) and no-one has any idea if it is really safe to bf. 

 

The Desmopressin is  a pill, I think it is kids who get the nasal spray. It doesn't really have side effects and is deemed safe during pregnancy, that is why I am still taking it. Awesome stuff. 

 

Citalopram is spelled the German way... I think Americans call it Celexa? I am only on 10mg, down from 40. It's for PTSD after my little guy was in a coma and we heard the words "nothing more we can do but hope and pray". 

 

Trimipramine is also called Surmontil or Rhotrimine. This one isn't too important. Also for anxiety caused by PTSD, but am doing okay without it. Just hope that being in a hospital, etc, doesn't trigger flashbacks, etc. 

 

And if I take Oxybutinine or Propiverine doesn't matter, they both work the same. This is med I really, really miss and even after C-section, I will NEED it. Can wait a few weeks, but not much longer. I already need it now, but am not taking it during pregnancy.

 

I am already having to have a section, otherwise will have no bladder control again, none whatsoever and am a bit young for that. Last birth was two days long, wonderful, peaceful, perfect. Exactly what you want. Recovery was very quick, but the after-effects on my already buggered bladder were awful, so I can't do that again.

 

So, if I leave out the Trimipramine, it will be the combination of: Celexa, Propiverine and Desmopressin.

 

And that, in combination is what makes doctors so unsure, but you are right, they always just say "formula feed" and that is that. I never had trouble bf, good latch, nice supply, very little pain, good LC in the hospital. So it would be just really sad :(

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#12 of 18 Old 10-25-2013, 10:41 AM
 
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Originally Posted by MaggieLC View Post
 

DO NOT USE the Physicians Desk Reference or the insert that comes with the drug. Do not ask your pharmacist. These are notorious for always telling women NOT to take the medication during lactation, even if this drug is not contraindication in lactation because they do NOT take research into account, virtually EVERYTHING in the PDR and drug inserts is an exercise in CYA medicine. (In other words the drug companies who write these drug profiles not only don't want to get sued, they don't care if you breastfeed or not and seeing as many drug companies also sell formula, they actually profit from scaring you.) In fact, my pharmacist calls me when he needs drug data because even he doesn't trust the PDR for lactation.

 

I'm a pharmacist. The package insert is only one of the sources I consult for information about a medication. Usually that isn't even a place I stop for lactation data; I've got several other different options. Since I don't have access to the Internet at work I don't currently have the Lactmed app on my handheld device. If I decide to get a smartphone or they put in wifi at work, I plan to get it. Until then I consult the sources I do have, which are sometimes quite detailed as to the results of clinical trials and sometimes not so good. If I don't have good information one way or the other I'm honest with the patient about it. So I don't really appreciate being painted with this brush. Since you are a medical professional as well, you should be able to understand this. I certainly agree that some pharmacists aren't very knowledgeable about lactation issues but I don't think it's fair to jump from that to assume we are all the same. 

 

Citalopram was the only drug on the list I was able to find much information on (right now I'm not at work and have access to only one source, and it wasn't detailed on the other drugs, and doesn't have propiverine at all since that is not on the market in my country). There's some data to show it might delay milk coming in, and the typical considerations of the infant possibly experiencing sedation, irritability, and other such adverse effects. I wouldn't avoid breastfeeding out of fear of these complications, personally--I would keep an eye out. 


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#13 of 18 Old 10-25-2013, 10:45 AM
 
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Celexa- "

Infants receive citalopram in breastmilk and it is detectable in low levels in the serum of some. The dosage that the infant receives and serum level achieved are probably related to the genetic metabolic capacity of the mother and infant. A few cases of minor behavioral side effects such as drowsiness or fussiness have been reported, but no adverse effects on development have been found in infants followed for up to a year.

If citalopram is required by the mother, it is not a reason to discontinue breastfeeding."

 

Oxybutinyn- Drug Levels:

Effects in Breastfed Infants:
Relevant published information was not found as of the revision date.


Possible Effects on Lactation:
Relevant published information in nursing mothers was not found as of the revision date. Anticholinergics can inhibit lactation in animals apparently by inhibiting growth hormone and oxytocin secretion.[1][2][3][4][5] Anticholinergic drugs can also reduce serum prolactin in nonnursing women.[6] The manufacturer reports that cases of lactation suppression have been reported with oxybutynin in postmarketing surveillance.[7] The prolactin level in a mother with established lactation may not affect her ability to breastfeed."

 

The thing about this drug is that there isn't a lot of information. It appears to cause LESS problems if it is started after the milk supply is established (after 3-6 weeks.) 

 

Trimiparmine- "Summary of Use during Lactation:
If trimipramine is required by the mother, it is not a reason to discontinue breastfeeding. Because of the lack of data on use during breastfeeding, other antidepressants are preferred during breastfeeding, especially while nursing a newborn or preterm infant.


Effects in Breastfed Infants:
Published information on trimipramine was not found as of the revision date. Follow-up for 1 to 3 years in a group of 20 breastfed infants whose mothers were taking a tricyclic antidepressant found no adverse effects on growth and development.[1] Two small controlled studies indicate that other tricyclic antidepressants have no adverse effect on infant development.[2][3] In another study, 25 infants whose mothers took a tricyclic antidepressant during pregnancy and lactation were tested formally between 15 to 71 months and found to have normal growth and development."

 

IMO, a more modern antidepressant in the SSRI catagory would be MUCH preferable. Something like Zoloft or Paxil as they have much fewer side effects than tricyclics. I assume you live in Germany. They seem to be using a lot of OLD drugs. Often newer drugs have cleaner side effect profiles and cleaner profiles mean less side effects, including fewer problems with breastfeeding. The drug you mentioned CAN be taken during breastfeeding, it is not contraindicated, but SSRIs (except Prozac, which is not good during lactation) are a better choice.  You'd be hard pressed to find a doctor who would prescribe a tricyclic antidepressant as a first or second choice in this day and age in the USA when we have SSRIs with cleaner profiles and less side effects.

 

Desmopressin-

 

"Summary of Use during Lactation:
Desmopressin is excreted in negligible amounts into milk and is poorly absorbed orally by the infant, so it appears acceptable to use during breastfeeding.

 

However, as this drug does cause secretion of Vasopressin (which can counter Prolactin necessary for lactation) it might be better to use a different diuretic. There are many that do not cause as much Vassopressin increases. OR you can take it and if you have milk supply issues, change drugs then.

 

I always like to approach a drug necessity problem with "why take a chance on taking on the problems we know formula causes?"  The problems with formula feeding and its after effects are well known.


 


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#14 of 18 Old 10-25-2013, 08:42 PM
 
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Originally Posted by erigeron View Post
 

I'm a pharmacist. The package insert is only one of the sources I consult for information about a medication. Usually that isn't even a place I stop for lactation data; I've got several other different options. Since I don't have access to the Internet at work I don't currently have the Lactmed app on my handheld device. If I decide to get a smartphone or they put in wifi at work, I plan to get it. Until then I consult the sources I do have, which are sometimes quite detailed as to the results of clinical trials and sometimes not so good. If I don't have good information one way or the other I'm honest with the patient about it. So I don't really appreciate being painted with this brush. Since you are a medical professional as well, you should be able to understand this. I certainly agree that some pharmacists aren't very knowledgeable about lactation issues but I don't think it's fair to jump from that to assume we are all the same. 

 

Citalopram was the only drug on the list I was able to find much information on (right now I'm not at work and have access to only one source, and it wasn't detailed on the other drugs, and doesn't have propiverine at all since that is not on the market in my country). There's some data to show it might delay milk coming in, and the typical considerations of the infant possibly experiencing sedation, irritability, and other such adverse effects. I wouldn't avoid breastfeeding out of fear of these complications, personally--I would keep an eye out. 


I certainly didn't mean to offend, I'm sorry if I was too broad in my criticism of pharmacists. My own and many other LCs experiences with many pharmacists (mine for well over 20 years)  have left us a bit gun shy. (I have a close friend who is a pharmacist and he calls me when he has a lactating mother who is taking meds he isn't sure about, since he no longer trusts the PDR for lactation information.)  It appears that you have gone above and beyond your original training to help people with lactation issues:thumb  but most pharmacists use the PDR and the inserts (same information) and that's it. I was told by a pharmacist when I picked up my pain meds after my last baby was born, "DO NOT use this if you are breastfeeding. You MUST pump and dump for 6 hours after every dose." It was for Vicodin. It was prescribed q4h! LOL! It's a fairly safe drug in lactation. (I don't have problems with opiates or excessive morphine metabolism problems, so it isn't a problem for me.)  I told him I was a Lactation Consultant and my Neuro AND my Ped said the Vic was safe  and even brought him xeroxed copies from Medications in Mother's Milk by Dr. Hale to prove my point, I was told, "I can't go on that wacky book, I have to use the PDR." *sigh* This is far from the only time I have run into this from some of the pharmacists in our area. Obviously, they have not gone above and beyond the call of duty as you have, and IMO they should have. Think of all the women who are throwing out their milk and giving formula because the pharmacist tells them the same thigns he told me about things like Vicodin and that mother goes home and wastes her milk based on false information from someone she should be able to trust. Sad.

 

 You don't have access to the internet at your pharmacy? Yikes!  How do you verify insurance copays and check Controlled Substance Registries on patients? All the pharmacies in my state are required to have complete internet hook ups for these things, and all our pharmacists also have Smart Phones to quick check side effects etc But, most of them use the PDR site, not the much better Lactmed app. But, I have found unless a RPH goes out of his or her way to learn like you have, they tend to stick to the "old ways" and use just the PDR or the CDT. (Compendium of Drug Therapy) which is actually a little better with lactation than the PDR but nothing as great as MiMM by Hale or Lactmed.

 

I also couldn't find propiverine either. I don't think it's marketed in the USA. I've also not seen Desmopressin used orally, since it is destroyed in the GI tract almost completely, but in some countries they have an oral form used in pediatrics. Have you seen Desmopressin used orally? I'm sure you see more of it than I do, but I haven't ever seen the oral form in the US. (It's also an older drug, so I assume that's why we see so little of it.)

 

A good thing to have: Dr. Hale's Medications in Mother's Milk.  http://www.amazon.com/Medications-Mothers-Milk-Thomas-Hale/dp/0984774637/ref=sr_1_1?s=books&ie=UTF8&qid=1382758701&sr=1-1&keywords=medications+in+mothers+milk  EVERY health care professional should own an updated copy in my opinion, and it's affordable and easy to carry around. Since I introduced it to my Ped's office, not only do they have one at every nurse's desk but every Ped and NP has a copy in her or his pocket all times. My Neuro saw my copy while we were checking out meds for me to take for migraines after my last baby was born and he geeked out! "This is SOOO cool! I have to get a copy of this book." I gave him the address (this was before Dr. Hale was on the net) and he has had a copy with him every since.

 

I have been using MiMM by Hale since the first edition was released in the 1990s and I highly recommend it for any HCP who has any work with lactating mothers. As you know the Pregnancy Risk Catagory simply is not accurate in lactation. Two different things.

 

I am sorry if I offended you. I was mostly trying to protect women who may be given "You can't take this drug!" scare tactics by RPHs who are much less conscientious than you are.


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#15 of 18 Old 10-26-2013, 06:45 AM
 
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No worries. I'm a little frustrated with some of the women's health/lactation stuff I see from my colleagues too. I was nursing and pumping when my daughter was 6 months old, and had a cold. I remarked to a colleague (a pharmacist of >10 years tenure) that I wanted to avoid pseudoephedrine if I could because it could reduce supply, and she denied that it did. duh.gif I think a lot of my colleagues would probably be more inclined to refer the patient back to the doc rather than shoot off their mouths about pumping and dumping, but still. I don't know a lot of pharmacists who use the PDR. We didn't even discuss it as a source when I was in school. At my work Facts & Comparisons and Clinical Pharmacology are the main two we have access to, so I would expect most of my work colleagues use one or the other of those. Checking the package insert is more annoying than using either of those, so I only use it when I have a question about the formulation (like, what flavor does this amoxicillin suspension come in, or what are the inactive ingredients), which I think is pretty common as well.

 

At work I have access to a few different online drug databases and stuff like the controlled substance tracking program, state law, DEA, etc. but I don't have unrestricted Internet access so I can't always get other stuff I want to use. I honestly haven't tried to access Lactmed. 

 

I have seen desmopressin orally, typically used in kids as an adjunctive treatment for ADHD--I almost never see it used in adults. 


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#16 of 18 Old 10-26-2013, 10:19 AM
 
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For what it's worth, I'm also on 10 milligrams of citalopram and have been able to breastfeed with no side effects to me and the baby. It's important to remember that there are simply too few studies on breastfeeding safety and medication. It would be extremely unethical to give a potentially harmful drug to a breastfeeding woman just to see what will happen. Because of this even the most innocuous drugs may simply not have the data to say "yes, this is definitely safe". Unfortunately no matter how good your source is you're going to run into a lot of 'may/may not' or 'insufficient evidence'. The best you can do is run it by the health professionals in your life and try to make an educated decision. As a guideline I use Kellymom's drug safety page, and for pregnancy I use motherrisk which is AMAZING and may have some good bf info too.
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#17 of 18 Old 11-14-2013, 11:45 PM - Thread Starter
 
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Thank you for your advice! As I have made the decision to have an elective C-section (well, my urologist insisted on that) anyway.That might mean I might not  have to rely on the propiverine as much as I thought I would. While not pleasant, I can cope without that and the Surmontil. That leaves desmopressin and citalopram, both in relatively low dosages. 

 

The citalopram and surmontil are for PTSD which is getting better anyway as DS's health continues to stabilise. Four years ago we had no idea if he would even make it to the next day, he was four and couldn't walk, talk, move or see anymore and then relapsed twice, so my anxiety was through the roof. Now looking at him, you wouldn't even know he has a special needs status at school :)

 

I do dread a section though, my last natural birth was wonderful and I was fit so very fast, but the effects it had on my already battered bladder were devastating. I am a young woman, I don't want to be in nappies for the rest of my life!  Will I be able to bf straight after the section or will they push for formula? 

 

Had no problems bf last time, perfect supply and DS put on weight quickly, no mastitis or anything. But I did wean at two months after a few UTIs and having to take lots of different medications. Also still had Uni and DH was the stay-at-home dad. This time, I will be able to stay at home. 

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#18 of 18 Old 11-15-2013, 06:42 AM
 
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Thank you for your advice! As I have made the decision to have an elective C-section (well, my urologist insisted on that) anyway.That might mean I might not  have to rely on the propiverine as much as I thought I would. While not pleasant, I can cope without that and the Surmontil. That leaves desmopressin and citalopram, both in relatively low dosages. 

 

The citalopram and surmontil are for PTSD which is getting better anyway as DS's health continues to stabilise. Four years ago we had no idea if he would even make it to the next day, he was four and couldn't walk, talk, move or see anymore and then relapsed twice, so my anxiety was through the roof. Now looking at him, you wouldn't even know he has a special needs status at school :)

 

I do dread a section though, my last natural birth was wonderful and I was fit so very fast, but the effects it had on my already battered bladder were devastating. I am a young woman, I don't want to be in nappies for the rest of my life!  Will I be able to bf straight after the section or will they push for formula? 

 

Had no problems bf last time, perfect supply and DS put on weight quickly, no mastitis or anything. But I did wean at two months after a few UTIs and having to take lots of different medications. Also still had Uni and DH was the stay-at-home dad. This time, I will be able to stay at home. 

I'm so glad your son is doing better! I'm glad you were able to get your med situation in order, too.

 

C Sections sound scary, I know, it is major abdominal surgery, but I've had 3, (looooong story, long labors, long 2nd stages and an android pelvis) and you should be able to breast feed in the recovery room right after the C Birth without problem. My first birth was so long (56 hours of futile labor and 4 hours of futile pushing) that I was shaking too hard to even hold my baby right after that birth, but that was 27 years ago. With my next two section births, I had my babies on the breast immediately after I got into the recovery room. I have a friend who had her husband hold the baby over her shoulder while she was being stitched up while still in the operating room.

 

I made sure I had a good Birth Plan. You might want to talk to a Doula agency to help with the birth plan. My 3rd C Birth was planned (after I labored with the first two and ended up with sections.)  I had my Birth Plan tailored to my situation, specifying the baby would room in, he or she would have NO bottles or pacifiers, no formula and be in my arms asap and requests for anesthesia, analgesia, placement of catheters etc. They gave my daughters to my husband right after they were born and weighed, and he took them out of the OR. Then when they finished up with me (my yelling the whole time to "Hurry up! I want my baby!") and then wheeled me into the recovery room, where I was able to be with my husband and my babies. My second and third babies went right to the breast, my third was even swallowing colostrum in the recovery room. The nurses didn't believe me, but I called them over to come listen. They were laughing that "those crunchy lactation consultant mamas always have a ton of milk." Yeah, well....we've learned. :)

 

My OB made sure he had 8 copies of my birth plan by my 32th week (my body had threatened to birth my children early so he wanted to be ready) He made sure every department that might have myself or my baby had a copy of my plan and my OB even called from home to make sure they were following my plan. Nobody tried to force formula on my babies with my last two births because I made my desires clear, while being polite and people were more than happy to comply. Most good nursery and maternity nurses don't like to see babies formula fed, either, so they are usually on your side.

 

A good birth plan should be two pages or less. Making requests rather than demands will be more likely to be honored. Mine had things like "We request our baby not be offered any artificial nipples or bottles." We request, if possible, that the baby be allowed to room in with me as soon as I am placed in my room." "We request, if possible, that our baby not spend any time, other than for weighing, in the Central Nursery." "We request that all blood tests be run by one of us and OKed in writing before being done on the baby.." "We do not give permission for the baby to be given any vaccinations without our written permission beforehand." etc. I also have urinary issues and did not want the urinary catheter placed in my body until after the epidural or spinal had been administered. I have scar tissue in my urethra and catheters cause me a great deal of pain, so that was one request, as well as having the catheter removed as soon as possible after the C Section.

 

You will probably want  to get the plan to the doctor and the hospital weeks before the birth. Hospitals staff can not honor a 10 page birth plan handed to them as the woman walks into the hospital in labor.

 

Everything on my plan was honored! I had OKed in my plan the PKU test, but had also said no testing or drugs could be administered to the baby, unless they were for emergency purposes. My DD had been taken down to the nursery to be weighed one day and I got a frantic call, "Mrs. C. we're so sorry! I know your birth plan says no tests without written approval. The baby was just given a PKU test, I don't know what to do now!" I assured the panicked nurse that my plan had OKed the PKU test without prior approval (as it's law in our state) and he had nothing to worry about.

 

Talk to your OB about your birth plan, make sure he or she has copies of it weeks before the birth and have him read it while you are in the room with him. My OB did all this and everything we requested in our plan was honored.

 

Good luck!


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