Medication and imaging safety, clinical management protocols, and more
These links are for YOU: primary care providers and medical specialists who are:
· NOT doing “breastfeeding medicine”
· But ARE seeing patients who happen to be breastfeeding
The NIH National Library of Medicine
publishes LactMed, a frequently updated searchable peer-reviewed list of evidence-based monoraphs on many commonly and not so commonly used medications, with clear guidance and discussion of the issues. Each fully referenced monograph includes information on the levels of the medication found in breast milk and infant blood, and any reported or potential adverse effects on the nursing infant. Suggested therapeutic alternatives to those drugs are provided where appropriate.
The American College of Radiology
publishes an annually updated Manual on Contrast Media 2023 that clearly explains on pages 107 and 108 why both iodinated and gadolinium-based contrast agents are safe to use in lactating patients, without any need to abstain from breastfeeding at all. Both are excreted so minimally into breastmilk and absorbed so minimally by the infant gut that an infant would receive less than 1% of the dose actually given to neonates receiving contrast themselves.
The Academy of Breastfeeding Medicine
publishes free peer-reviewed evidence-based clinical protocols on a variety of clinical topics, most of them relevant to clinicians not specializing in the field. A few examples include such issues as managing infant hypoglycemia, managing maternal cancer, supporting breastfeeding during maternal or child hospitalization, and supporting LGBTQ+ patients.
Often misunderstood as a very simple organ, the function of this organ system is MORE complex than many other organ systems that we were taught way back when.
Simplistically, this complexity involves four primary issues:
1. Staged embryology, mammogenesis, lactogenesis, lactation and involution: This endocrine organ is only very minimally developed at birth, further develops at puberty, as well as with each menstrual cycle, and only completes full development for actual physiologic function during pregnancy and the week after birth. And then, after weeks, months or years of physiologic lactation, weaning brings on the organ's involution, perhaps to restart the process all over again with a next pregnancy.
2. Breastmilk has both immune and nutritional functions. The breast evolved orginally as an organ devoted solely to providing immune support to the young. Human breastmilk supports infant survival via a huge variety of bioactive ingredients, most of them serving dual nutritional and immunologic functions, and responding dynamically to changing environmental conditions.
3. It's a two-person organ system: The breast's physiologic function is dependent upon the effective communication and biobehavioral interaction of two organisms, mother and child, whose innate neurobehaviors for feeding and lactation can be easily thwarted by issues described in our fourth reason for complexity, below. Milk expression by hand or pump can certainly substitute for the infant's participation in the process, but not without complicating homeostatic control of physiologic function.
4. Psycho-social issues affect both physiology and pathology: The entire process is heavily influenced by historical, social, cultural, family, personal and iatrogenic factors. These include unphysiologic traditions, expectations, guidelines and rules; misinformation, contradictory advice, maternal doubt and how informed the family’s clinicians are about how to support this physiologic process. The absence of this topic from the curricula of medical and nursing professional schools has contributed to the presumption that this complex organ's function is actually simple. This professional ignorance has unfortunately contributed to many of the clinical problems we now see.
The AAP and CDC Breastfeeding Curriculum
To address all 4 of the issues described above, the American Academy of Pediatrics and the Center for Disease Control have collaborated to develop an evidence-based, self-directed online Breastfeeding Curriculum about how this organ system works, as well as practical clinical guidance for patient care. Originally aimed at pediatric and OB/GYN residency programs, it is now available free online for all clinicians. There you can start with basic anatomy and physiology or jump directly to any of four other sectors. In each section you’ll find goals and objectives, key concepts, powerpoint slides, links to other online resources, charts, videos, references and much more, to peruse at your own pace. The goal is NOT to make you a breastfeeding and lactation medical specialist, but a professional just as knowledgeable about this aspect of your patients' care as you are about other clinical factors affecting care.
