...to not want to breastfeed whilst on medication?

[RoboticSealpup]

Even if fanatics breastfeeding groups like La Leche League, as well as some physicians are saying that it's "probably OK" to take steroids? AIBU to think that "probably" is not good enough, and put up with sore joints and inflammation (rheumatoid arthritis) while I try to teach my EBF baby to accept a bottle of formula, however long that will take?

I'm so confused and upset about this. I wanted to BF for a year, but there's so much conflicting information everywhere, I feel like I should just take the safest option, even if it will be hard. DD won't even take a bottle of EBM at the moment, who knows if she will even tolerate formula?

Thanks everyone for your very helpful answers. I have phoned the BFN helpline that many of you suggested and a waiting for them to get back to me.

Pretzel, does the injection only work at the site of application? My main problem is my knees at the moment but I also get pain in my back, wrists and shoulders. I don't expect they will be able to inject in that many different places.

Robotic You can have steroid injections directly into the joint but you can also have intramuscular injections which administers a large dose that will go into your bloodstream and hopefully help the whole body.

I was reading an interesting article yesterday and the author suggested that inflammation/uncontrolled RA was a higher risk to baby than certain medications. I'll see if I can find it for you.

Glad you've rung, hope they help you make the best decision for you

Glad you've rung BFN. They have always been very helpful to me and others I've known ring them. Hope it helps you make your decision and your pain decreases soon.

Disclaimer: I don't know anything about RA drugs or RA except it's hard to live with.

There are a lot of benefits from breastfeeding which probably outweigh the tiny negatives of the drugs you're on.

One rule of thumb is that baby ends up getting about 2% of your dose (adjusted for their body size). So the drug has to be pretty powerful, or something that is especially tricky for the liver to break down (important because baby livers are so immature) to be likely to have negative effects, given what a diluted dose they get.

I had the intramuscular injection so it helped my whole body. My main problems were my fingers, wrists and feet. So all the tiny joints! You could try the injection just in the knees or the worst affected joints if you still feel uncomfortable about taking drugs and breastfeeding?
It may help make RA more manageable for you.

This meta-analysis www.ncbi.nlm.nih.gov/pubmed/24614280 from 2014 (I don't have access, so can only see the abstract) actually says that Hydroxychloroquine and Sulfasalazine (which I was on before pregnancy) are "compatible with nursing", whereas steroids depend on dosage.

Now I'm confused. I thought steroids were supposed to be better? I guess my rheumatologist must have been talking about injections.

Yeah, I'd agree, were you advised to not use your previous drugs when nursing? This is where the lactation-med advice people come in as invaluable, they check the evidence. What is unsafe in pregnancy may be very safe for lactation, I suppose you know that, but don't expect GP to totally get it all. GPs will always go for the no-meds-with-nursing option when they don't know enough about the evidence.

It looks like a long list of suitable drugs you can try, that's the good news.

I guess my main concern is that only the effects on the "infant" have been studied, i.e. no adult follow-up. When I know that, for example, something like low birth weight can lead to a whole range of illnesses in adulthood (as per 'the Barker hypothesis' - a very well accepted theory). How do I know that there are no effects in adulthood, even though there are none in infancy? The answer is, I don't. But I might be overly cautious here. Extreme caution is my usual modus operandi...

ragged, I stopped the medication when I got pregnant despite my rheum being comfortable with continuing. RA symptoms often go into remission during pregnancy (due to natural steroids) and this was the case for me. My rheum said that "there are medications you can take while BF" and I remember him mentioning steroids in some form.

Keep in mind that there are adulterants, residues and such like in formula and other infant foods, too, due to it being based on cow's milk and rest of our food chain. At least your milk has terrific custom-made anti-microbials.

It's really not fair to label people who want to give full information about the surprising number of drugs that are safe to breastfeed with as fanatics!

No one though is ever going to be able to show no risk whatsoever, that's just not scientifically possible with anything.

As you and your rheumatologist think about drugs, look at the drugs that you might be prescribed on Lactmed toxnet.nlm.nih.gov/newtoxnet/lactmed.htm

Prednisolone:

Limited information indicates that maternal doses of prednisone up to 50 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants.

Hydroxychloroquine:

Early literature indicated some reluctance to allow breastfeeding during hydroxychloroquine use. Newer information indicates that infants exposed to hydroxychloroquine during breastfeeding receive only small amounts of the drug in breastmilk. In a small number of infants up to at least 1 year of age, careful follow-up found no adverse effects on growth, vision or hearing.[1][2]

A survey of US, Canadian, British and Mexican physician experts in the treatment of systemic lupus erythematosus completed prior to the publication of the above safety data indicated that 63% would allow breastfeeding in mothers who took an antimalarial during pregnancy and 53% would "often" or "always" advise a mother to breastfeed if the antimalarial were begun after delivery. Only 13% would have "never" advised breastfeeding in this circumstance.[3] Another review concluded that hydroxychloroquine could be used during lactation.[4]

I thought it might be nice to have a conclusion to this thread, for anyone who uses the search function in future to look for information on this issue.

BFN phoned me back, but didn't really tell me anything I hadn't already found out myself from academic journals. My rheumatologist told me that the steroid injection is the normal course of action for breastfeeding mothers and, like Pretzel, I went ahead with that. I feel comfortable with it now!

The fact that I have had so much pain that it affects how I look after my baby also helped me to make the decision to take the treatment, as I really don't want to disable myself rather than take a medication that is, after all, considered safe. DD still refuses bottles but we're working on it...

Thanks for all your replies!