On experts who bother

This week I went to the doctor and, long story short, I have to go on a course of vaginal antibiotics. Well now, this is an issue because whenever you take medicine while breastfeeding, you have to find out whether the medicine you've been prescribed is compatible with breastfeeding. And this is an issue because there are relatively few studies done on medicines and breastfeeding, and those that are done do not differentiate between breastfeeding newborns and (let's say) 10 month olds. Obviously there is a weight difference as well as a difference in the child's physical development and ability to process drugs. Also 10 month olds nurse less frequently and get proportionally less of their calories from breastmilk. So there are differences.

The problem is that despite these differences, even well-informed medical professionals seem to mostly read the yes-or-no answer to breastfeeding while taking medicines off a table somewhere. These tables are clearly based on medical data, but it's data I don't have access to, so I am unable to make my own informed decision. In this case, my gynecologist told me that the medicine he had prescribed was compatible with breastfeeding, and the pediatrician said it was not. Grr. In fact it was the nurse at the pediatrician's office that actually returned my call, and she was clearly reading it off a table, and did not pay attention to the fact that I mentioned the medicine was not oral but topical (which means less is absorbed into my bloodstream, so less is available to the milk-making process). She told me I needed to just pump for a week and throw out the milk.

Now, when you're nursing a baby who's ten months old, eating solids, and drinking from a cup, and is used to breastfeeding about 4 times a day, forgoing nursing altogether for a week doesn't just mean he's going to be very mad (though I wouldn't look forward to that), it might mean he gives up nursing altogether. So I called the gynecologist back to see if he could prescribe a different medication. He called me back himself (concept) to say that he still thought the original medication would be fine vaginally, but he had another thing he could prescribe. It was often used to treat premature infants, he said, so was ok for babies. Then he called back again and said, regardless of the fact that it is used in pediatric patients, that medicine is specifically not recommended for breastfeeding mothers by the American Academy of Pediatrics (why? wouldn't we like to know?). He said we'd have to go back to the first medicine, but we wondered if I could still nurse a couple of times a day without affecting Thomas too much.

Well, there's something I always do when I have medical questions about Thomas I can't answer. I try to put it off as long as possible when the questions aren't cardiology-related, but... I inevitably call his cardiology team. Because they answer the phone, they answer my questions, and they always thank me for calling. So this time I called, and I got Kerry, and I explained the problem. She would consult with the hospital pharmacist, she said, and call me back. When she did, she said the pharmacist had looked up some studies and had some numbers for me. There were no studies on breastfeeding while on the vaginal preparation, but there were studies that showed that the concentration of antibiotic in the blood while using the vaginal preparation were 1/50th of the levels while taking the oral preparation. About a third of women still reported side effects. Breastfeeding while on the oral antibiotic tended to cause diarrhea (a major problem in a newborn; less so in an older infant). After discussing it with her, I felt confident that I could store some milk in the fridge and then try nursing Thomas, see if he has any problems. Nursing him a couple of times a day will almost certainly not cause a problem.

I told Kerry she deserved a medal, and she denied it. I don't think people like her realize what an amazing luxury it is to have someone like her, with medical knowledge and access to specialists outside her area, just a phone call away.

I was going to end this post with a special tribute, but it's already too long and I have too much to say about the tributee. Next time.

Thoughts on breastfeeding at 9 months

Thomas has been biting while nursing. When he first got his bottom teeth, he sort of chomped a couple of times, I said "ouch", and he never did it again -- but this week he's been doing it a lot. At first it was just when he was tired of nursing, but after a while he'd sometimes do it right at the beginning. I've been doing what they say you should do (take him off the breast and say no, let him nurse again, and if he does it again put him down altogether and wait a few minutes). He cries. Sometimes he doesn't bite but sometimes he does.

There are some odd things I've noticed. He never does it when we're lying down nursing, only when I'm sitting up in the rocker. He's less likely to bite if he's either not very tired or if he's extremely tired, and he's less likely to bite if I hold him closer to me than if I just let him sit on me. He does seem to do better after the "nursing time-out" I described above. And yesterday and today, at the time he'd normally nurse to sleep, he did the biting thing and I said he was done and put him down, and then he climbed into Matt's lap (last night) or mine (this afternoon) and just fell asleep cuddling. Then tonight he nursed himself to sleep again. I don't know what to make of it all but he doesn't seem to be weaning himself (for half-articulatable reasons, I'm not ready for this to happen), he seems to just be experimenting with some different things.

More later, I guess.