I am always very cautious when I am prescribed medications as a breastfeeding mother because you just never know. But with every illness and treatment, you must weigh the pros and cons before making a decision, just make sure you have all the information. Considering the widespread use of Tylenol 3’s, I thought this article posted by the London Free Press needed to be passed on. It is also copied entirely below, you know, just in case.

Breastfed babies at risk

Thurs, August 21, 2008

Some moms may pass morphine on to baby

A University of Western Ontario medical professor investigating the morphine overdose death of a baby is urging doctors to reconsider the widespread practice of prescribing Tylenol 3 painkillers to new mothers.

Dr. Gideon Koren and fellow researchers found the codeine in Tylenol 3 can be transformed by some women’s bodies into dangerous levels of morphine in their breast milk.

“To the medical community, we should rethink carefully if we are not overusing this medication,” said Koren, the Richard and Jean Ivey Chair in molecular toxicology at the Schulich School of Medicine and founder and director of the Motherisk Program at the University of Toronto.

In addition to the baby who died, the researchers found another baby who had been close to death because of high morphine levels and others who showed signs of central nervous system depression.

The babies’ mothers had a genetic variation found in about one per cent of Caucasian women, but in as many as 30 per cent of Ethiopians.
 
“In a place like Ontario where you have people from over 200 countries, you can’t really predict who will have it,” Koren said.

The research results are published in Nature’s Clinical Pharmacology Journal.

It’s estimated Tylenol 3 is prescribed to 40 per cent of breastfeeding mothers in North America, mainly women who have had a caesarean section or episiotomy.

The researchers found that babies are much more sensitive to the morphine from codeine than adults.

Koren said that’s probably because the blood-brain barrier is not as developed in infants.

The effect of the central nervous depression on the babies studied included drowsiness and sleeping more than normal.

Mothers often wouldn’t be able to wake them for feeding.

“The important point in all cases is once mom either stopped the codeine or stopped the breastfeeding, the baby was a new baby,” Koren said.

Detecting that a baby is sleeping too much is difficult for new parents who have no experience to measure it against, he said.

“Babies don’t tell us, they don’t speak to us, new parents will not know. It’s a very tricky situation.”

In most cases where the baby was sleeping too much, the mother also had signs of grogginess.

“If mom begins to feel she is not OK, think about the baby because the baby may not tell you about it,” he said.

If the mother has side effects from the codeine, the baby needs to be seen by a physician, Koren said.

He also recommends that breastfeeding women prescribed Tylenol 3 take the minimal amount needed to control their pain.

During their study, the scientists found one baby with central nervous system depression whose mother had only taken one and half Tylenol 3s.

Mothers should try not to use codeine for more than four days, Koren said.

The scientists found that babies who were affected were ones where the mothers had taken codeine for seven, eight or nine days.

European and other developed countries do not prescribe Tylenol 3 to new mothers, mainly to avoid the side effect of constipation.

Studies, including a Canadian one, have found other drugs are just as effective at controlling pain, Koren said.

But it may be a hard sell to convince physicians used to prescribing Tylenol 3 to switch to something else, he said.

“It won’t be easy because T3s are like Frigidaire . . . it is one of the things that North America is very used to, and generations of physicians are used to, but they may need to rethink it.”

It’s back in vogue and not going anywhere anytime soon, yet some people are still squeamish aobut breastfeeding. I have met some of those squeamish people, my girlfriend married one, but really? Check out Elizabeth Payne’s article for The Ottawa Citizen for the facts and figures, some of them are surprising. I think this is a call for a young, hip ad campaign, don’t you?

Elizabeth Payne . Squeamish about breastfeeding 

Elizabeth Payne, The Ottawa Citizen
Published: Tuesday, August 19, 2008

It’s been a summer of “nurse-ins” in Canada, in which breastfeeding mothers get together and nurse their babies in public to make a point. If you thought that the point — namely, that breastfeeding is good and should be encouraged — was long ago made and agreed on by almost everyone, you would be wrong.

Surprising numbers of Canadians still find breastfeeding unpleasant and highly inconvenient. Even more surprising is that some of them are new mothers. One study found 23 per cent of mothers who didn’t nurse said they found it unappealing or disgusting.

It is no wonder that nursing mothers occasionally get treated as if they are doing something shameful when they feed their babies in public. There remains a stubborn strain of squeamishness about breastfeeding in Canada, particularly among the young, which is interfering with efforts to encourage mothers to breastfeed exclusively for at least six months — the goal of the World Health Organization and others.

Which isn’t to say that lots of Canadian women don’t give breastfeeding a try. They do. Eighty four per cent of new mothers in Canada began breastfeeding their babies in 2003, according to Statistics Canada.

Fewer than half of mothers breastfed their baby for six months or more, and just 17 per cent of Canadian mothers breastfed exclusively for the first six months of their baby’s life, according to a 2003 survey. Among mothers under 25 year old, just eight per cent breastfed exclusively for six months.

Still, compared to 1972, the low ebb of breastfeeding in Canada, the breastfeeding bounceback is revolutionary. In 1972, only about 25 per cent of new mothers breastfed at all.

Infant formula, which was introduced by Nestlé in the mid 19th century, became increasingly popular, particularly in North America, during the mid 20th century. By the ’50s and ’60s, as more women were in the workforce, breastfeeding rates were plummeting. Marketing practices of infant formula manufacturers became a lightning rod issue when women in countries without access to clean drinking water and little money began switching to formula instead of nursing, resulting in illnesses and deaths among some babies.

As with many social changes, the turn away from breastfeeding was the result of a convergence of factors. But there is little doubt the medical establishment was complicit. Hospital nurseries were set up so that babies conformed to a rigid feeding schedule — one which made more sense when they were being fed formula. One woman recalled being handed a large pill after a particularly harrowing birth and almost taking it before her husband enquired what it was. To help your milk dry up so you can bottle feed, she was told.

A colleague, whose father, an organic chemist, did research at the Max Planck Institute in Germany on the beneficial proteins and other substances in breast milk, says neighbours and friends in the U.S. where they lived in the late 1950s considered it strange, even off-putting, that she wasn’t bottle feeding.

That kind of research and the multitudes of studies done since then about why breast is best make it difficult to overstate the importance of breastfeeding babies for as long as possible. It provides babies with protection against disease, may help reduce obesity and diabetes rates and improves maternal health. Some research has even suggested it boosts IQs.

If any group in society could use the boost provided by breastfeeding, it is children born to the youngest, and often poorest and least educated, mothers. Many of these babies face more obstacles than babies born to older, more settled mothers. If breastfeeding has any beneficial effect on these babies, it is worth pushing for.

Dr. Jack Newman, director of the Newman Breastfeeding Clinic and Institute in Toronto, says the health care system still undermines breastfeeding by failing to provide adequate support to nursing mothers.

Cultural acceptance is important. In Kentucky earlier this year, a woman was arrested by police for trespassing after she was asked to leave a Macdonald’s restaurant for nursing her baby. Not surprisingly, Kentucky has among the lowest breastfeeding rates in the U.S.

Similarly, a clerk at a Windsor lingerie store — of all places — was told “we don’t let people do that in our store” and gestured towards the door when a mother began nursing her seven month old baby. Company officials said it was store policy to support nursing mothers. But the incident suggests social acceptance, especially among the young, remains elusive, no matter what our intentions are.

Many new mothers feel awkward and embarrassed enough when they are mastering breastfeeding. Attitudes that reinforce that embarrassment will only lead more mothers to conclude that, while breast may be best in theory, in the real world, the bottle still prevails.

Elizabeth Payne is a member of the Citizen’s editorial board.

© The Ottawa Citizen 2008

My daughter, now 15 months, has reached that age where she tells me when she wants to nurse. She tells me in a not so quiet, not so discreet kinda way. She wants the boob and she lets the whole world know it by first, requesting loudly in her sing-song, babbling voice that she would like to be picked up. Second, continuing with her babbling sing-song voice she then begins to smack my chest and ask “mama?”

Now I love my baby’s sing-song voice, there really is nothing in the world that is more precious and lovely to hear right now. But it is summer, which means tank tops and bathing suits, and that smacking hits bare flesh and really echoes across the pool.

I remember once upon a time before breastfeeding I proclaimed my breasts were mine and not to be used for breastfeeding. I then changed my tune when I became a mother and proclaimed the breastfeeding stops when she can ask for it because that would just be too embarrassing. I also remember when that time came with my eldest daughter and I was not ready to stop breastfeeding, so I introduced quieter,  more discreet ways of asking to nurse. The pounding on my chest while asking “mama?” really brings me back. A little awkward at the pool, but it reminds me of why I love breastfeeding.