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Breastfeeding Success Stories
Breastfeeding on a Medication with no Prior Studies
(Lugol's Iodine for Grave's Disease)
Mothers commonly tell me they had to stop breastfeeding because they were required to take a particular medication.
This Mother and Baby (6 months) came to me for information regarding the safety of breastfeeding while being treated for Grave's disease (hyperthyroidism). Several medications for thyroid are approved for breastfeeding mothers by the American Academy of Pediatrics (AAP). The medications considered "safe" by the AAP caused a life threatening side effect, a drop in this mother's white blood cell count, but was reversible upon her discontinuation.
Now off medication, her thyroid was functioning incorrectly and she was sick. Other options for thyroid treatment were considered. Surgery (thyroid removal) was the definitive treatment. But she needed to be medically stable before a surgeon could operate. Her medical options were limited to Lugol's Iodine, a concentrated solution of iodine: a medication which I had very little data about safety in breastfeeding. In fact I had oppositional advice within the international lactation community prior to treatment discouraging the use of Lugol's Iodine and continued breastfeeding. The surgeon eventually did prescribe the Lugol's in order to stabilize her for surgical removal of her thyroid.
I am respectful of the fact that Iodine has a high affinity for breastmilk, But, being that the baby was no longer an infant and the anticipated short term use of the medication, the mother decided to continue breastfeeding as long as she was able to check the Iodine breast milk levels and the baby's thyroid levels once a week along with a physical exam. The mother was on the medication for three weeks. The baby's thyroid test results remained normal. The Iodine breastmilk levels never went too high. The mother's hyperactive thyroid was probably using most of the available Iodine and probably very little of it reached the baby's blood. After three weeks of treatment, the mother's thyroid and blood count were stable and she had her thyroid removed. She recovered well.
The surgeon and mother are also commended for following through with the surgery while the hospital had been ordered to evacuate for a hurricane.
Most surgery is compatible with breastfeeding but, the anesthesiologist still sternly warned this mother not to breastfeed for 24 hours following surgery. More intimidation and inaccurate information for this mom to deal with! Mothers can breastfeed post c-section and following most other surgery as the mother is awake. This is well documented.
It was very important for this mom to continue and be in control of her breastfeeding as a way to help her emotional heal from a repeat emergency cesarean section. This thriving baby has been exclusively breastfed through all of this!
If you are a mother that has been told to stop breastfeeding because you need a medication or treatment it is wise for you to seek information from multiple resources to see if weaning is really necessary. In most cases it is not. Many medications have been studied. The PDR is NOT a good resource when it comes to breastfeeding. Other medications may not have been studied, but if lactational pharmacology is understood an informed decision can be reached.
Thanks to James J. Vopal, D.D.S., M.D., a Dual Board Certified Surgeon at The Breast Care Center of the Treasure Coast, willing to collaborate on her care and share his expertise and thanks to Martin Memorial labs who tested the milk levels weekly without a flinch to help complete this care.
Two years later - I twice attempted to submit this unique data for publication in breastfeeding journals. One breastfeeding journal editor rejected an inquiry saying that this case was all personal opinion, and a peer-reviewer of another journal had concerns about the safety of the treatment (the editor was interested and I think disappointed that she could not go further with my experience).
The baby is now over two years old! And he is doing well! The mother is close to finishing her Master's degree in Speech Pathology with an interest in oral motor in the breastfed baby. This should be an encouraging case should someone else have to deal with this.
At the current time, I am not working on revision and am not actively pursuing publication (due to limited time and resources), but I have lab results and records for this case on file.
Original 10/04 Updated 6/06
Failure to Thrive
I met Mother and Baby (6 weeks-old) out in the community. As I was admiring this breastfeed baby, I noticed the baby to be on the thin side. I questioned the weight. The baby had not regained birth weight at 6 weeks old. Failure to thrive is one of the most concerning things I see. We just take for granted that babies grow. Even thin babies may have dimples on their thighs and have the wrinkled-up look. It  is not always easily identifiable unless you actually weigh the baby or know what to look for. The mom brought the baby in the office the next day. In my own training we would have panicked and immediately given formula, IV fluids, and look for disease by doing a lot of invasive testing. With my interest in lactation, it made sense to me to evaluate milk transfer first. In another situation I may have wanted a failure to thrive baby admitted to the hospital. I had the advantage of meeting the mom out in the community, so I knew her extended family and knew she had support. The baby was not dehydrated so I knew I didn't have to use formula or IV immediately. After getting a medical history on both mother and baby and doing a physical exam, my suspicion of disease causing the baby not to gain weight was low. I observed the mother breastfeeding and thought the baby just wasn't getting enough in. After making a few breastfeeding suggestions in the office, this improved. We adjusted position and latch and talked about how to get more high fat milk into the baby. I advised her to nurse all the time and talked about how to get more high fat milk into the baby. I advised her to nurse all the time including at night, side by-side, (dare I say "co-sleep"). I discouraged pacifiers which are non-nutritive sucking. And we discussed ways to increase milk supply. Mother had the baby weighed in three days. Things had turned around quickly. After a few weeks, he continues to grow and thrive without artificial milk or supplements. The mother's milk supply is adequate and baby was spared much invasive testing.
It is an honor for me to work with this family through this challenging situation. I appreciate their willingness to share so that others can learn how difficult situations can be handled.
If you enjoy this article, you will enjoy the book Permission to Mother which includes the updated version.
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