Breastfeeding should be encouraged by education throughout pregnancy and the puerperium. Mothers should be told the benefits of breastfeeding, including infant immunity, emotional satisfaction, mother-infant bonding, and economic savings. The period of amenorrhea associated with frequent and consistent breastfeeding provides some (although not reliable) birth control until menstruation begins at 6–12 months postpartum or the intensity of breastfeeding diminishes. Even a brief period of nursing is beneficial. Transfer of immunoglobulins, macrophages, and lymphocytes in colostrum and breast milk immunoprotects the infant against many systemic and enteric infections. The intestinal flora of breastfed infants inhibit the growth of pathogens. Breastfed infants have fewer bacterial and viral infections, fewer gastrointestinal tract infections, and fewer allergy problems than bottle-fed infants. Furthermore, they are less apt to be obese as children and adults.
Frequent breastfeeding on an infant-demand schedule enhances milk flow and successful breastfeeding. Mothers breastfeeding for the first time need help and encouragement from providers, nurses, and other nursing mothers. Milk supply can be increased by increased suckling and increased rest.
Nursing mothers should have a fluid intake of over 3 L/day. The United States RDA calls for 21 g of extra protein (over the 44 g/day baseline for an adult woman) and 550 extra kcal/day in the first 6 months of nursing. Calcium intake should be 1200 mg/day. Continuation of a prenatal vitamin and mineral supplement is wise. Strict vegetarians who avoid both milk and eggs should always take vitamin B12 supplements during pregnancy and lactation.
1. EFFECTS OF DRUGS IN A NURSING MOTHER
Drugs taken by a nursing mother may accumulate in milk and be transmitted to the infant (Table 19–2). The amount of drug entering the milk depends on the drug’s lipid solubility, mechanism of transport, and degree of ionization.
Table 19–2.Drugs and substances that require a careful assessment of risk before they are prescribed for breastfeeding women.1 |Favorite Table|Download (.pdf) Table 19–2. Drugs and substances that require a careful assessment of risk before they are prescribed for breastfeeding women.1
|Drugs ||Concern |
|Atenolol ||Has been associated with hypotension and bradycardia in the infant. Metoprolol and propranolol are preferred. |
|Ciprofloxacin ||Association with adverse effects on fetal cartilage and bone. Must weigh risks versus benefits. |
|Codeine, oxycodone ||Cause CNS depression. Unpredictable metabolism. |
|Cyclophosphamide ||Neonatal neutropenia. No breastfeeding. |
|Diphenhydramine ||Present in very small quantities in milk; sources are conflicting with regard to its safety. |
|Fluoxetine ||Present in breast milk in higher levels than other SSRIs. Watch for adverse effects like an infant’s fussiness and crying. |
|Lisinopril ||Unknown effects. Captopril or enalapril is preferred if an ACE inhibitor is needed. |
|Lithium ||Circulating levels in the neonate are variable. Follow infant’s serum creatinine and blood urea nitrogen levels and thyroid function tests. |
|Tetracyclines ||Concern for bone growth and dental staining. |
|Valproic acid ||Long-term effects are unknown. Although levels in milk are ...|