Medications during breastfeeding: what is possible, what is not? Contraindications for breastfeeding. Breastfeeding a newborn with perinatal pathology

Pregnant and breastfeeding women are confident that it is better to abstain from medications during these important periods of life. This is true. But situations arise when one-time or long-term medication cannot be avoided. By what criteria is their toxicity assessed and what can be treated during lactation.

Emergency or planned prescriptions of medications may be associated with exacerbation of chronic diseases, the development of acute pathologies or postpartum complications.

In each case, therapists, obstetricians and pediatricians assess the degree of toxicity, the level of entry into milk and the possible risk of negative effects on the baby’s body.

Many developments in the pharmaceutical industry do not undergo testing and clinical trials in pregnant and lactating groups. There are few or no reliable, adequate studies. The list of studied means is quite short. But one thing is clear: if the drug is absorbed and distributed in the body fluids, then to a greater or lesser extent it passes into breast milk.

Therefore, in most annotations for drugs, manufacturers write that use should be careful, for special purposes, without exceeding the dosage.

The degree of risk of any drug is assessed according to several criteria:

Toxicity.
The true amount of the substance that enters the baby’s body with milk.
Features of the influence on immature organs and systems of the newborn.
The period of elimination of the drug from the child’s body.
Possibility of allergic manifestations.
Individual characteristics of mother and baby.
Duration of taking the drug.

Most new drugs have a low degree of toxicity and are considered safe for nursing mothers. This also applies to external preparations: ointments, creams, drops and solutions. They are not absorbed into breast milk.

Antibacterial agents

Despite the fact that drugs of the penicillin, cephalosporin series and macrolides are allowed for the treatment of nursing mothers with the wording in the annotation “usually not contraindicated”, in any case, the question of the appropriateness of such treatment, the calculation of dosages taking into account the condition of the mother and baby is mandatory. Antibiotics of these groups can penetrate milk only in negligible amounts. Average: 0.090% of a single dose for the patient.

There is a danger for babies after using antibacterial agents. They can cause:

Allergic reactions.
Imbalance of the microflora of the gastrointestinal tract with a violation of the production of vitamin K and D, and as a result - a deficiency of prothrombin.

During lactation the following are allowed:

From macrolides Erythromycin. The rest Sumamed, Vilprofen, and other drugs from this group are contraindicated.
Aminoglycosides Neomycin, Kanamycin, Amikacin.

The latter are more toxic, and they are prescribed in special cases: patients who have been diagnosed with meningitis, sepsis, peritonitis or abscess of internal organs.

Completely contraindicated:

Fluoroquinolone group (Norfloxacin Ciprofloxacin Ofloxacin). This series of antibacterial drugs causes disturbances in the formation of bone and cartilage structures during growth.
Group of tetracyclines (Tetracycline, Doxycycline). Gives a high degree of hepatotoxicity.
Nitromidazoles (Metronidazole, Tinidazole). Causes dyspeptic disorders.
Sulfonamides (Streptotsid, Norsulfazol). They depress the liver, provoke pathological jaundice in the baby, and inhibit hematopoiesis.
Biseptol and its analogues. Inhibits bone marrow functions.

Lines of antimycotic and antiviral agents for absorption and action through breast milk have not been fully studied, so their use requires stopping feeding.

If a woman has stopped breastfeeding and completed a course of antibacterial therapy, she should resume it only when all metabolites have been eliminated from the body.

Analgesics, antipyretics, anesthetics

During the postpartum period and in the first months of lactation, a woman experiences enormous stress, hormonal changes, and exacerbation of chronic diseases. Therefore, she is often worried about pain, inflammation, and fever.

To relieve these symptoms during lactation, non-steroidal anti-inflammatory drugs based on two active ingredients are allowed: paracetamol and ibuprofen. They are universal and are used for headaches, muscle, groin, dental and other types of pain.

Despite the fact that the effect of PVNS has not been fully studied, it is believed that a single dose is not capable of producing a toxic effect on the infant’s body. The recommended dosage for women in this category is no more than three doses per day.

Paracetamol as an active ingredient is included in the list of approved drugs:

Panadol.
Efferalgan.
Stimol.

On the basis of ibuprofen are allowed:

Nurofen.
Advil.
Burana.

A woman should take any of the drugs from these groups immediately after breastfeeding. This is necessary so that by the next feeding the drug has gone through a full metabolic cycle and lost its pharmacological activity (toxicity).

Analgesics, or painkillers based on metamizole sodium, are prohibited. This list includes trade names: Analgin, Sedaglin, Tempalgin, Pentalgin, Baralgin.

The main active component of the drugs passes into breast milk and negatively affects the hematopoietic and urinary system of the baby. In addition, metamizole-based analgesics include codeine or caffeine, which can cause dyspepsia and neurological disorders.

Acetylsalicylic acid (Aspirin) is allowed during breastfeeding in a single dose.

During lactation, women are allowed local injections of the latest generation of anesthetics:

Dicaina.
Ultracaine (Articaine).
Ubistezina
Melivacaina (Scandonesta).

With GV, Novocain with Lidocaine is contraindicated.

Nootropics, antidepressants

Drugs from the group of neurometabolic stimulants are indicated during breastfeeding. The list of allowed includes:

Stugeron.
Nootropil.
Vinpocetine.
Glycine.
Pramiracetam.
Bifren.
Cerebrolysin.
Piracetam.

In the treatment of postpartum depression, only one of the groups is prescribed exclusively for special indications: selective serotonin inhibitors (Sertalin, Fluoxetine).

Tablets and injections based on phenobarbital, codeine and caffeine are prohibited.

Groups of drugs without contraindications

Women during lactation are allowed to systematically take the antihypertensive drug Methyldopa and its analogues Dopanol, Dopegit.

In severe cases of hypertension, Capropril, Enalapril can be prescribed in combination with the diuretics Veroshpiron or Hydrochlorothiazide.

The list of medications allowed during breastfeeding includes:

Choleretic agents, enzymes, antienzymes: Festal, Allohol, Cholenzym, Enzistal, Oraza, Pepfiz.
Preparations of enveloping and adsorbing action: Enterosgel, Polyphepan, Activated Carbon, Carbolene, Tanalbin.
Inhaled corticosteroids for bronchial asthma.
Hormonal agents for the treatment of autoimmune pathologies.
New generation monophasic oral contraceptives based on desogestrel and levonorgestrel: Microlut, Lactinet.
Short-term antihistamines: Cetirizine, Loratadine. First generation drugs (Suprastin, Tavegil) are not prescribed.
Plant-based laxatives Guttalax and Regulax are allowed, but in moderate dosages. Bisacodyl is not recommended.
Multivitamins and minerals.

Every woman should know that the safety and toxicity of drugs directly depends on the age and status of the baby. For example, in the weak, premature and in the first two months of a newborn’s life, the process of absorption and excretion of drugs does not occur at the same speed as in older and heavier children. Therefore, dosages, course duration, type and form of medication should be discussed exclusively with a doctor. Only a specialist will suggest the optimal dosage regimen and thereby reduce the risks of negative effects on the child. And this is an axiom that is not discussed.

Treatment of cystitis, thrush, sinusitis, constipation, diarrhea, sore throat, cough and other diseases during lactation

Diet ( nutrition) during lactation

During breastfeeding, a nursing mother is advised to have a nutritious and varied diet, ensuring that the body receives all the necessary vitamins and microelements. It is recommended that a woman eat 5-6 times a day in small portions, which will prevent the development of nausea or vomiting. All food taken should be fresh and well processed ( thermally and physically), which will minimize the risk of developing foodborne infections that can disrupt the process lactation.

In addition, it is extremely important to ensure that a sufficient amount of fluid enters the body, since dehydration ( loss of large amounts of fluid) may be accompanied by a decrease in the amount of breast milk produced.
At normal air temperatures, a nursing woman is recommended to consume at least 2.5 liters of fluid per day ( in the absence of diseases of the cardiovascular system, edema and other contraindications), and in the heat - about 3 - 4 liters.

Products that increase ( improving, stimulating) lactation

There are a number of foods that, if consumed regularly, can stimulate ( strengthen) the process of producing breast milk. It should be noted right away that taking these products in large quantities is also not recommended, as this can lead to the development of a number of undesirable phenomena ( nausea, vomiting, allergies, etc.).

Increase lactation contribute to:

meat broths ( lean meats such as turkey);
cheeses;
carrot juice;
feta cheese ( cow or sheep);
fresh milk ;
dairy products;
buckwheat porridge;
oatmeal porridge;
wheat porridge;
dried fruit compotes;
fresh juices;
jelly;
sunflower seeds .

Do walnuts increase lactation?

By themselves, walnuts do not stimulate the production of breast milk, but they significantly affect its quality. Walnuts contain a large amount of fat and protein, as well as many calories needed by a nursing mother. Eating 4-5 nuts per day will provide the body with iodine and other trace elements, as well as vitamin C, which is contained in large quantities in nut kernels.

At the same time, it is worth noting that the walnut kernel contains essential oil. Although its proportion is relatively small, it can be included in breast milk and, together with it, enter the body of a newborn baby, thereby causing the development of allergic reactions in him ( skin rash). Here's Why You Shouldn't Overeat Nuts While Breastfeeding that is, you do not need to take them in large quantities), and if a child has signs of an allergy, this product should be completely excluded from the diet.

Products that reduce ( reducing) lactation

During the period of weaning the child ( or to reduce lactation for other reasons) it is also recommended to follow a certain diet, which, in combination with other activities, will reduce the amount of milk produced. First of all, all foods that can stimulate lactation should be excluded from the diet ( they are listed earlier). You can also slightly limit the amount of liquid you take per day ( by about 30%). This will not have a significant impact on the mother’s health, but will contribute to the suppression of lactation. In addition, you can eat special foods that will inhibit the production of breast milk.

Suppression of lactation can contribute to:

spices;
diuretic herbs ( lemon balm, linden, St. John's wort);
black pepper;
smoked products;
canned food

It is worth noting that when consuming these products ( especially spices and smoked meats) the taste of breast milk changes significantly, which can help wean the baby off the breast. At the same time, it is important to remember that a baby’s consumption of such milk can cause allergic reactions, as well as gastrointestinal disorders ( intestinal colic, diarrhea or vomiting). This is why doctors advise limiting or completely eliminating breastfeeding when using these foods to suppress lactation.

Is it possible to drink coffee while breastfeeding?

Coffee contains the substance caffeine, which, when introduced into the human body, has a certain effect on the cardiovascular system ( increases heart rate and constricts blood vessels, thereby increasing blood pressure). Caffeine also stimulates the central nervous system ( CNS) person.

If a breastfeeding woman drinks coffee, some of the caffeine that enters her body is included in breast milk and can enter the baby's body along with it. However, it is worth noting that with reasonable coffee consumption, the concentration of caffeine in milk is negligible. So, for example, when drinking 1 cup of coffee ( containing about 100 mg of caffeine) about 0.5 mg of this substance will enter the woman’s breast milk. This is too little to in any way affect the child’s cardiovascular system or central nervous system. This is why nursing women can drink 1 to 3 cups of coffee a day without fear of harming the baby.

At the same time, drinking large quantities of coffee ( 5 or more cups per day) may be accompanied by a marked increase in the concentration of caffeine in breast milk, which can lead to the development of complications in the baby. This can manifest itself as an increase in heart rate and blood pressure, anxiety, tearfulness, and so on.

Is it possible to drink alcohol during lactation?

Drink alcohol while breastfeeding only in limited quantities. The fact is that ethyl alcohol, which is part of alcoholic beverages, easily penetrates into breast milk, and therefore can enter the baby’s body along with it. However, with moderate alcohol consumption, the concentration of ethyl alcohol in milk will be relatively small. Moreover, this alcohol is very quickly eliminated from the mother’s body, which also limits its effect on lactation and on the child. It has been scientifically proven that after drinking a glass of wine or a can of beer, a woman can breastfeed her baby within 3 hours, without fear of harming the baby’s health.

At the same time, it is worth remembering that drinking strong alcoholic drinks ( vodka, cognac and so on) in large quantities is accompanied by a pronounced increase in the concentration of ethyl alcohol in the mother’s blood and in her breast milk. The increased concentration of alcohol can persist for 5 – 10 or more hours, which depends on the amount of alcohol taken, as well as on the condition of the patient’s liver ( It is in the liver that alcohol is neutralized). If, after drinking a large amount of alcohol, a woman breastfeeds her child, some of the alcohol will enter the child’s body along with breast milk, which will cause a number of side effects associated with the effect of ethyl alcohol on the central nervous system and other organs. This can manifest itself as severe drowsiness and lethargy of the child, a decrease in his immunity ( the body's defenses), liver and kidney diseases ( with prolonged exposure to alcohol in the body) and so on. In addition, such children may develop increased tolerance to alcohol, which will contribute to their development of alcoholism ( pathological addiction to alcoholic beverages) in adulthood.

Complications of lactation ( cracked nipples, milk stagnation, mastitis)

Lactation is a physiological process, which, however, can be complicated by a number of unpleasant diseases and pathological conditions.

The development of complications during lactation can be facilitated by:

irregular feeding of the child;
maternal malnutrition;
mother's failure to comply with personal hygiene rules;
decreased immunity in the mother.

Lactation can be complicated:

Cracked nipples. Cracked nipples can appear after the start of feeding a child in almost any woman ( especially in the presence of predisposing factors listed above). The appearance of cracks is accompanied by severe pain in the nipple area, especially while feeding the baby. This can negatively affect a woman's central nervous system, which may result in her milk supply decreasing ( or it will disappear completely). In addition, in the area of the crack, the protective properties of the skin are disrupted, which creates favorable conditions for infection.
Stagnation of milk. Under normal conditions, milk is released from the ducts of the lobules of the mammary gland with each feeding or expression. If for a long time ( 2 – 3 days) milk is not removed from a certain segment ( for example, during a break in feeding, after an injury, etc.), it thickens and clogs the excretory duct. The newly formed milk cannot be released outward, as a result of which it stagnates in the breast tissue, which is manifested by its painful compaction. To eliminate this pathology, it is recommended to place the baby on the affected breast more often, regularly massage the gland, and, if necessary, express milk. If the disease does not go away within 2 days, or if infectious complications develop ( accompanied by increased body temperature and increasing pain in the area of the affected gland) It is recommended to consult a doctor immediately.
Mastitis. This is an inflammatory lesion of the mammary gland, accompanied by severe pain, enlargement and thickening of the mammary gland tissue, as well as a possible increase in body temperature and other infectious complications. Cracked nipples can contribute to the development of mastitis ( through which infection can penetrate the gland tissue), as well as stagnation of milk, which disrupts blood microcirculation and creates optimal conditions for the development of pathogenic microorganisms. To treat mastitis, it is necessary to regularly empty the gland of milk, and also monitor compliance with the rules of personal hygiene. With the development of purulent complications, the use of antibiotics or surgical opening of the abscess may be required ( In this case, breastfeeding will have to be stopped during treatment).

Painful lactation ( Why do nipples and breasts hurt during lactation?)

The process of breastfeeding itself may be accompanied by minor pain in the area of the nipple of the mammary gland, but under normal conditions these pains practically do not cause any concern to the mother. At the same time, it is worth remembering that with the development of certain diseases and pathological conditions, breastfeeding can become extremely painful. For example, the cause of pain in the nipple area can be cracked nipples, as well as damage to the peripapillary area by the child’s teeth ( what can be observed when breastfeeding children older than 1 year). The appearance of bursting pain in the area of the mammary gland may accompany the stagnation of milk in it ( lactostasis), as well as the development of mastitis ( in this case, the pain syndrome becomes more pronounced, the pain intensifies while feeding the child or when touching the skin over the inflammation).

If pain occurs in the mammary gland during lactation, the cause of their occurrence should be identified and eliminated as soon as possible, otherwise the risk of developing infectious complications increases, which can adversely affect the health of the mother, as well as the lactation process itself.

Why do seals appear in the mammary gland and the chest hurts after lactation is completed?

Painful seals in the chest can occur as early as a day after the abrupt cessation of breastfeeding, especially if before that the child was regularly breastfed. At the same time, milk will continue to be produced and accumulate in the mammary glands, squeezing the surrounding tissues and clogging the excretory ducts of the gland lobules. The pain in this case will be bursting, aching in nature and intensify with pressure on the chest.

To prevent the accumulation of milk and the appearance of pain, it is recommended that the baby be weaned from the breast gradually, for several weeks in a row, reducing the number of attachments to the breast and increasing the proportion of complementary foods. At the same time, the amount of milk produced will also gradually decrease. If in this case pain does occur, they will be moderate and disappear on their own within a few days.

If it is impossible to gradually wean the child from the breast, with the appearance of arching pains, it is recommended to express breast milk daily. This will temporarily reduce the severity of the pain syndrome, as well as prevent milk stagnation and the development of infectious and inflammatory complications. In the future, to suppress lactation, you can use medication or folk remedies ( tablets, herbs, infusions and so on).

Why do browns appear ( bloody) discharge from the breast during lactation?

Brown discharge from the nipples during lactation may indicate the presence of some pathological process in the mammary gland. The discharge that appears is milk, the brown color of which is given by an admixture of blood.

The causes of brown discharge during lactation may be:

Cracked nipples. The formation of cracks can be accompanied by a violation of the integrity of the tissues and damage to small blood vessels, the blood from which can mix with the secreted milk, giving it a brown color.
Nipple injuries. During feeding of children older than one year, they can damage the nipple with erupting teeth, as a result of which blood can also enter the milk.
Stagnation of milk. With stagnation of milk ( lactostasis) there is compression of the surrounding tissues and a violation of microcirculation in them, which can also be accompanied by damage to small blood vessels and the ingress of a small amount of blood into the duct of the breast lobule. When lactostasis resolves, the released milk may have a brown tint.
Inflammatory diseases of the breast ( mastitis). If the development of mastitis is complicated by the formation of a purulent focus ( abscess), pus can destroy blood vessels and get into the lobules of the mammary glands, which will be accompanied by the release of a brown-gray purulent mass from the nipple. In this case, the patient will experience severe pain, and she will also have an increase in body temperature and pronounced reddening of the skin over the affected mammary gland, which will distinguish this pathology from other, less dangerous complications.

Is it possible to have sex during lactation?

Having sex during lactation is not prohibited. Moreover, it can help improve lactation and maintain it. The fact is that immediately after the end of sexual intercourse in the woman’s body ( and men) there is a short-term increase in the concentration of the hormone prolactin, which stimulates the production of breast milk. Be that as it may, having sex does not have any negative effect on lactation.

At the same time, it is worth remembering that childbirth through the birth canal is an extremely traumatic process, after which the woman's external genitalia must recover. This is why it is not recommended to resume sexual activity for at least 1 – 2 months after the birth of the child.

Is it possible to get pregnant during lactation?

If you regularly feed exclusively breast milk after your baby is born, you will not be able to get pregnant. It is used by many women as a method of contraception ( preventing pregnancy). At the same time, during breaks in feeding, as well as when introducing complementary feeding or supplementary feeding ( when the child begins to be fed additionally with nutritional formulas) the effectiveness of this method of contraception is sharply reduced, and therefore pregnancy may occur.

The mechanism of action of lactation as a method of contraception is based on hormonal changes occurring in the female body. For pregnancy to occur, it is necessary for the female reproductive cell to develop and mature in the woman’s ovaries ( egg). For this to happen, from the pituitary gland ( a special gland located in the brain that produces various hormones) 2 hormones must be released - follicle-stimulating hormone ( FSH) and luteinizing hormone ( LG). Without them, egg maturation is impossible. However, during breastfeeding, irritation of special nerve receptors in the area of the nipple of the mammary gland stimulates the production of another hormone - prolactin. Prolactin ensures the formation of milk in the mammary gland, while at the same time inhibiting the formation of FSH and LH in the pituitary gland, thereby preventing the development of the female reproductive cell and making pregnancy impossible.

An important condition for maintaining the process described above is the regular attachment of the baby to the breast, which ensures that the concentration of prolactin in the blood is maintained at a sufficiently high level. If you take breaks in feeding ( even before the baby reaches 6 months of age), this may be accompanied by a periodic decrease in prolactin concentration. As a result of this, FSH and LH may begin to be released, which will trigger the process of maturation of the female reproductive cell. If a woman then has sex without using other methods of contraception, she may become pregnant.

Signs of pregnancy during lactation

Identifying early signs of pregnancy during lactation can be extremely difficult. This is due to the fact that these signs can be caused both by the onset of a new pregnancy and by changes in the female body associated with a recent birth or with the lactation process.

The presence of pregnancy during lactation may be indicated by:

unreasonable nausea;
vomit;
taste change;
enlargement of mammary glands ( is also observed during lactation, so cannot be considered a reliable sign);
soreness in the nipple area ( may also occur during breastfeeding);
increased appetite;
frequent urination ( associated with compression of the bladder by the growing fetus);
abdominal enlargement;
disappearance of menstruation ( may indicate pregnancy only if the woman’s menstrual cycle resumed after the birth of the child).

If pregnancy is suspected, a diagnostic test is recommended ( pregnancy test), allowing you to definitely confirm or refute the diagnosis.

Why do lymph nodes become inflamed during lactation?

Inflammation of the lymph nodes during lactation can be observed with the development of mastitis ( breast inflammation) or other infectious complications.

Lymph nodes are unique filters through which lymph ( fluid formed in almost all tissues of the body) flows away from the tissues. If an infection enters the tissue, the infectious agents or their toxins are retained in the nearest lymph node. The immune cells located there protective) systems begin to actively fight the source of infection, which is accompanied by their active division and an increase in the size of the lymph node.

Lymph flows from the mammary gland to the axillary lymph nodes. With the development of mastitis, as well as with infection in the breast tissue ( for example, through cracks in the nipples) infectious agents will quickly enter the axillary lymph nodes, which will be accompanied by their painful enlargement. In this case, you should consult a doctor as soon as possible and begin specific treatment for the disease, since with further development of the infection, bacteria and their toxins may enter the systemic bloodstream, which can lead to the development of much more severe, life-threatening complications.

How long after lactation do menstruation begin?

Period ( bleeding associated with a woman's menstrual cycle) may begin within a few months after birth, or may be absent for six months or more after the birth of the child. Their appearance directly depends on the nature and duration of breastfeeding.

Under normal conditions, maintaining lactation requires a high concentration of the hormone prolactin in a woman’s blood. This is ensured by regularly putting the baby to the breast and irritating the corresponding nerve receptors, which triggers the synthesis of the hormone in the pituitary gland. Prolactin suppresses the development of the female reproductive cell in the ovaries, thereby disrupting the menstrual cycle and preventing the onset of menstruation. Therefore, the longer a woman breastfeeds ( regularly), the later she will get her period.

If you stop breastfeeding, within a few weeks another egg may begin to mature in the ovaries ( female reproductive cell), which can soon lead to the appearance of menstruation.

Why do I get my period during lactation?

The appearance of menstruation during lactation may be due to insufficient levels of the hormone prolactin in a woman’s blood. As already mentioned, under normal conditions, after the birth of a child, regular feeding ( breastfeeding) stimulates the production of prolactin ( necessary for the formation of milk), which suppresses the development of menstruation. During breaks in feeding, as well as when the baby’s sucking reflex is weak, the concentration of prolactin in the blood will fluctuate ( decline periodically), which will create favorable conditions for the growth and development of the female reproductive cell and subsequent menstrual bleeding.

Hair loss during lactation

Lactation itself does not affect the process of hair growth and is not the cause of hair loss. At the same time, hair loss during breastfeeding may be associated with changes and disorders that develop in the female body after pregnancy and childbirth.

The cause of hair loss during lactation may be:

Hormonal changes in the body. In particular, fluctuations in the level of female sex hormones observed before and after childbirth.
Lack of nutrients and vitamins. During pregnancy, some of the microelements and vitamins ( in particular iron, folic acid and vitamin B12) passes from the mother's body to the fetus. During feeding, these substances are also transferred to the baby through breast milk. If a woman does not receive an increased amount of proteins, fats, vitamins and microelements from food, a number of disorders may develop in her body, one of which will be hair loss.
Stress and nervous tension. Stress during childbirth, as well as chronic lack of sleep during the first months after it, can disrupt the functions of the central nervous system and endocrine system, which can also be accompanied by impaired trophism ( nutrition), increased fragility and hair loss.
Improper hair care. Paying all the attention to a newborn baby, a woman can deprive herself and her hair of attention. Rarely washing your hair, poor combing and stopping the use of nourishing balms and other similar substances can contribute to hair loss in the postpartum period.

Is it possible to sunbathe / visit a solarium during lactation?

Sunbathing or visiting a solarium during lactation is not prohibited, since under normal conditions this will not affect the lactation process in any way. At the same time, it is worth remembering that excessively strong exposure of the body to ultraviolet rays ( responsible for sunburn) can contribute to skin damage, skin burns, and so on. Skin burn in the sun is a rather powerful stress factor for the female body, especially in the early postpartum period, when its defenses are weakened. In severe cases, this can lead to disruption of the endocrine system and hormonal imbalances accompanied by the disorder ( weakening or cessation) lactation. To prevent the development of this complication, nursing women should sunbathe carefully, visiting the beach only in the morning or evening hours ( before 10 am and after 6 pm) and not being exposed to direct sunlight for too long.

What medications can you take during lactation ( antibiotics, antihistamines, antivirals, sedatives, activated carbon)?

If any disease or pathological condition that requires drug treatment develops during lactation, it is important to know which drugs can be combined with breastfeeding and which cannot. The fact is that most medications have the ability to penetrate into breast milk and enter the child’s body with it, causing the development of adverse reactions in the baby.

During lactation you should be careful when taking:

Antibiotics. The drugs of choice during lactation include penicillins ( augmentin, amoxicillin). They pass into milk in very low concentrations, so if you use them you can continue to breastfeed your baby. However, it is important to remember that even a small amount of antibiotic in breast milk can be enough to cause the development of allergies in a child. When using other antibacterial drugs, as well as if a child is allergic to penicillin antibiotics, you should refrain from breastfeeding for the entire period of treatment. In this case, milk should be expressed regularly so as not to disrupt the lactation process and to resume feeding the baby immediately after stopping medication.

antihistamines ( suprastin, cetirizine). These drugs are used to treat allergic reactions. They easily penetrate into breast milk and can harm the baby’s body, affecting its central nervous system, cardiovascular system, blood system, sensory organs, and so on. That is why it is recommended to interrupt breastfeeding during treatment with these drugs.
Antiviral drugs. It is also recommended that you stop feeding your baby breast milk while using antiviral medications. An exception may be preparations based on interferon ( a natural component that is part of the protective cells of the human immune system). The mechanism of their action is to enhance the natural protective ( antiviral) forces of the body, and they themselves have virtually no negative effect on breast milk or the baby.
Sedatives. The mechanism of action of most sedatives is to inhibit the functions of the central nervous system, which reduces nervous tension and facilitates the process of falling asleep. If such substances enter the child’s body through mother’s breast milk, this can lead to severe depression of the baby’s central nervous system and the development of a number of complications ( drowsiness, lethargy, lethargy, and with prolonged use - to retardation in mental and physical development). This is why the use of any sedative medications during lactation is not recommended.

During lactation, it is not prohibited to take activated carbon and other similar drugs prescribed for intestinal infections and poisoning. The mechanism of their action is that they bind toxic substances in the patient’s intestines and promote their rapid removal from the body. Activated carbon itself is not absorbed through the mucous membrane of the gastrointestinal tract and does not enter the mother's breast milk, and therefore is absolutely harmless to the baby.

Complications may develop with long-term regular use of this drug, since this will disrupt the absorption of nutrients in the intestines, which may be accompanied by a weakening or cessation of lactation. This is why activated carbon should be used in short courses ( no more than 3 days in a row) and only if there is evidence ( that is, signs of food poisoning or intestinal infection).

Painkillers for headaches and toothaches during lactation ( paracetamol, nurofen, ibuprofen, diclofenac, citramon, nimesil, analgin)

For severe headaches or other pain, you can take some painkillers that are not excreted in breast milk ( or are released in negligible concentrations) and have virtually no effect on the child’s body. At the same time, it is worth remembering that if the pain does not disappear after 1–2 days of using such medications, you should consult a doctor.

For headaches and other pains you can take:

Paracetamol (500 mg orally up to 4 times a day). About 0.2% of the drug is excreted in a woman's breast milk, but it has minimal effects on the baby.
Ibuprofen, nurofen (orally 200–800 mg 2–3 times a day). This drug is allowed to be taken during lactation, despite the fact that a small part of it still passes into the mother's breast milk.
Diclofenac(orally 25 – 50 mg 2 – 3 times a day). It is allowed to be taken only if it is not possible to use other painkillers.

During lactation it is not recommended to take:

Citramon. It contains acetylsalicylic acid ( aspirin, contraindicated during lactation), as well as caffeine, which can enter the child’s body through mother’s breast milk and negatively affect his cardiovascular and central nervous system.
Nimesil. It can enter the baby's body through breast milk, leading to impaired kidney function.
Analgin. It can penetrate the child’s body and affect his hematopoietic system.

Contraception during lactation ( Can I take contraceptives while breastfeeding?)

As stated earlier, regularly feeding your baby breast milk is in itself a reliable method of contraception ( preventing pregnancy). At the same time, to protect yourself especially after the start of complementary feeding), women can use other means of contraception. The method of choice in this case will be a condom, since it will have absolutely no effect on the process of producing breast milk.

To treat hemorrhoids you can use:

Relief candles. One suppository should be inserted into the anus 4 times a day. They have anti-inflammatory and wound-healing effects. The drug is not contraindicated during lactation.
Hepatrombin G suppositories. A combination drug with an anti-inflammatory effect that prevents the formation of blood clots ( blood clots) in dilated veins, thereby contributing to the patient’s speedy recovery. Suppositories should be inserted into the anus after each bowel movement ( but no more than 2 times a day). The drug is not contraindicated during lactation.
Sea buckthorn oil ( candles). Has a wound healing effect. To treat hemorrhoids, 1 suppository should be inserted into the anus ( 500 mg) 2 times a day. Can be used during lactation.
Heparin ointment. Used for application to hemorrhoids ( for the purpose of treatment and prevention of thrombosis). Heparin does not pass into breast milk, and therefore is not contraindicated during lactation.

Is it possible to use vasoconstrictor nasal drops during lactation?

Use vasoconstrictor nasal drops ( xylometazoline, naphthyzine and others) should only be done after consulting a doctor.

These drops are used for nasal congestion, which can occur with colds, allergic reactions, and so on. The mechanism of their action is associated with the narrowing of blood vessels and the elimination of swelling of the nasal mucosa, which facilitates nasal breathing. This does not affect the lactation process in any way, however, the active components of the drops can enter the systemic circulation ( in very small quantities) and excreted from the mother's body in breast milk, which can lead to the development of allergic and other undesirable reactions in the child. However, no studies have been conducted to prove that vasoconstrictor drops are harmful to a baby during breastfeeding. If there are strict indications, drugs can be used to relieve nasal congestion, but only in short courses ( no more than 2 – 3 days).

Do I need to take iron during lactation?

Iron is necessary for many physiological processes in the body, in particular for the formation of red blood cells ( red blood cells), transporting oxygen. Pregnancy and breastfeeding are risk factors contributing to the development of iron deficiency in the body. This is due to the fact that part of the iron reserves from the female body is transferred to the fetus, while part is lost during blood loss ( during childbirth), and part is passed on to the baby along with breast milk during lactation. Therefore, to prevent the development of iron deficiency and related complications ( in particular anemia, anemia, hair loss, skin lesions and so on), a woman should start taking iron supplements from the first months of pregnancy until childbirth, as well as during lactation and for several months after its cessation ( to replenish iron reserves in the body).

To prevent iron deficiency during pregnancy and lactation, you can take:

Hemophere prolongatum– orally 100–200 mg 1 time per day.
Sorbifer Durules– orally, 1–2 tablets per day.
Ferro foil– 1–2 capsules orally twice a day ( after meal).

Vitamins ( V6, V12, D) during lactation

Breast milk is fortified with all the nutrients a baby needs, including vitamins. Vitamins can only enter milk from the mother's body. Therefore, for proper and complete feeding of the baby, a woman must also receive all vitamins and microelements in sufficient quantities.

Most vitamins enter the mother's body with food ( with a nutritious and varied diet). At the same time, some vitamins should be administered additionally in the form of medications, since the need for them increases during lactation.

During lactation, a woman can be prescribed:

Vitamin B6. Takes part in metabolism and is also necessary for the normal formation of red blood cells ( red blood cells). The daily requirement during lactation is 2.2 mg.
Vitamin B9 ( folic acid). This vitamin is necessary to ensure cell division processes throughout the body. The daily requirement for it during lactation is 300 micrograms.
Vitamin B12. This vitamin is necessary for normal metabolism in the body, as well as to prevent the development of anemia ( anemia). The daily requirement during breastfeeding is 2.8 micrograms.
Vitamin D. Necessary for the normal development of bone tissue, as well as for the normal functioning of the immune system ( protective) body systems, for metabolism and so on. During lactation, a woman should receive at least 600 International Units of vitamin D per day.
Vitamin C ( ascorbic acid) . It is necessary to ensure metabolism at the cellular level, as well as to maintain the strength of the walls of blood vessels, for the synthesis of many biologically active substances, and so on. When breastfeeding, the daily requirement for this vitamin is 120 mg.

Treatment of cystitis, thrush, sinusitis, constipation, diarrhea, sore throat, cough and other diseases during lactation

During lactation, diseases may occur that are not related to milk production or feeding the baby. Treatment of such pathologies can be complicated, since nursing women cannot be prescribed a number of medications used in standard treatment regimens.

During lactation the following may develop:

Cystitis. This is an infectious and inflammatory disease of the bladder, accompanied by frequent urination, as well as nagging pain in the lower abdomen. Treatment consists of drinking plenty of fluids, as well as using antibacterial drugs that can be excreted in breast milk. That is why it is recommended to interrupt breastfeeding for the period of treatment.

Thrush. This is a fungal disease in which pathogenic fungi can affect a variety of areas of the body ( nails, mucous membranes, gastrointestinal tract and so on). In this case, patients may experience severe pain or burning in the mucous membranes of the genital organs, pain when urinating, pathological discharge from the vagina, and so on. Treatment involves the use of antifungal drugs both locally and systemically. Since most of them pass into breast milk when used systemically, breastfeeding should be avoided during treatment.
Sinusitis. This is an infectious and inflammatory lesion of the paranasal ( maxillary) sinuses, accompanied by inflammation and swelling of their mucous membranes and the accumulation of pus in the sinuses themselves. Purulent sinusitis can be complicated by the spread of infection to brain tissue, and therefore treatment of the disease should involve the use of potent antibiotics. Feeding the baby with breast milk should be stopped until the patient has fully recovered.
Constipation. To treat constipation, you can use laxatives that do not penetrate the systemic bloodstream and are not passed on to the baby through breast milk ( Duphalac, glycerin suppositories and so on). Breastfeeding should not be interrupted.
Diarrhea. To treat diarrhea, first of all, you need to identify its cause. If the cause is an infectious disease of the gastrointestinal tract, treatment should begin with gastric and intestinal lavage. After this, the patient should be given activated carbon preparations, which will also speed up the removal of toxins from the body. Use antidiarrheals ( from diarrhea) facilities ( such as loperamide) are prohibited during lactation, as they can enter the baby’s body along with breast milk.
Angina. This is an inflammatory disease of the tonsils caused by pyogenic bacteria. The main treatment for angina is the use of potent antibiotics, which requires temporary cessation of breastfeeding.
Cough. A cough can develop with colds, flu and other infectious diseases of the respiratory tract. To combat infection in the upper respiratory tract and to relieve cough, lozenges can be used ( septolete, pharyngosept and others), which have an antibacterial effect and are absolutely safe during lactation.

High temperature during lactation

Temperature during lactation may be a sign of damage to the mammary gland itself or other diseases. In any case, an increase in body temperature is a pathological sign indicating the presence of a problem in the body. The cause of the temperature increase should be identified and eliminated as soon as possible, which will prevent further progression of the disease and the development of complications.

The reasons for the increase in temperature during lactation may be:

milk stagnation;
mastitis ( inflammation of the mammary gland);
genitourinary tract infection;
upper respiratory tract infection;
cold;
food poisoning;
intestinal infection;
chronic diseases of the mother and so on.

If your body temperature does not exceed 38 degrees, you should not rush to bring it down, as this can reduce the body’s defenses and contribute to the development of infection. If the temperature rises to 38 degrees or more, you can take antipyretics ( paracetamol, ibuprofen). This will temporarily reduce body temperature, but will not eliminate the cause of its occurrence. If elevated body temperature persists for 2 or more days ( or does not decrease after taking antipyretic drugs), it is recommended to consult a doctor. Before use, you should consult a specialist.

Of course, mother's milk is the healthiest and most appropriate food for a newborn baby. But, unfortunately, it happens that for some reason you have to give up breastfeeding. In what cases should you not breastfeed and why do you have to resort to such extreme measures? There are absolute contraindications, in which breastfeeding is strictly prohibited, and relative (temporary) contraindications, in which breastfeeding is prohibited only for a while.

Mom's problems

Absolute contraindications to breastfeeding

Breastfeeding is absolutely contraindicated for the following diseases:

HIV infection. HIV infection can be transmitted through breast milk and is a contraindication for breastfeeding. It has now been established that an HIV-infected woman can infect her child through breast milk with a 15% chance. Despite the statement of the World Health Organization (WHO) and UNICEF, which was published in September 1999, which supports the freedom of HIV-infected mothers to choose the methods of feeding their infants, in our country in such cases doctors recommend feeding children with milk formulas, and not breast milk.

Open form of tuberculosis. The open form of tuberculosis, in which a woman secretes Mycobacterium tuberculosis and can infect others, is a contraindication for breastfeeding a baby. In this case, the mother must undergo a full course of treatment with anti-tuberculosis drugs before breastfeeding. And only after the end of treatment, after 1.5–2 months, you can start breastfeeding your baby. And if the disease is in an inactive form and does not require treatment, then breastfeeding is allowed.

Relative contraindications for breastfeeding

If absolute contraindications occur quite rarely, then relative ones are more common.

The need to take medications. Sometimes a woman’s health condition requires constant use of medications. In this case, when choosing a drug, one must take into account not only its degree of effectiveness for the mother, but also its safety for the child. Breastfeeding must be stopped if the mother is forced to take medications that are incompatible with breastfeeding: for example, some antibiotics, antidepressants, hormonal agents, antiviral drugs, etc. Of course, if possible, the doctor will try to select medications that can be used when breastfeeding the baby, but In practice this does not always work out.

Exacerbation of severe illnesses of the mother. In some cases, the mother’s body is not able to provide adequate nutrition for the baby due to severe metabolic disorders, for example, severe cardiovascular diseases (chronic heart failure, severe heart rhythm disturbances, etc.), kidney problems (acute or chronic renal failure), liver, severe forms of diabetes, etc. The problem is that breastfeeding can lead to a deterioration in the woman’s general condition, so in such cases the question of maintaining lactation and returning to breastfeeding is decided by the doctor individually after treatment and stabilization of the woman’s condition.

Complications during and after childbirth. If during or after childbirth a woman begins to bleed heavily, she must first restore the mother’s health and then begin breastfeeding the baby.

Mastitis. In cases where a woman develops mastitis (inflammation of the mammary gland), breastfeeding is recommended to continue, since the breasts need constant and thorough emptying. If you need to take antibiotics to treat mastitis, you should choose drugs that are compatible with breastfeeding. If you do not solve this problem in time, then mastitis can become more complicated - pus will accumulate in the mammary gland and an abscess will develop (to find out if there is pus in the milk, you need to express a little milk onto a cotton swab, and it will be absorbed, but the pus will not. To confirm diagnosis is performed by ultrasound of the mammary glands). If pus is detected in the milk, you cannot feed the baby with this breast, but you need to continue to apply the baby to a healthy mammary gland. Milk from an infected breast will have to be carefully expressed and discarded.

Herpes. Herpes simplex viruses are not transmitted through breast milk. So if the mother does not have an exacerbation of this disease, then she can breastfeed her baby. Danger to the child can only arise if there is direct contact between the area of the chest where the herpes rash appears and the baby’s mouth. It is clear that until the affected area is healed, you cannot breastfeed the baby. The mother is prescribed antiviral treatment, after which she can return to breastfeeding.

Hepatitis B and C. Previously, there was an opinion that during breastfeeding, hepatitis B and C viruses could enter the baby’s body. However, when studying this problem, it turned out that the main contact with these viruses occurs when the child passes through the birth canal. But when breastfeeding, the risk of infecting the baby is extremely low, so there is no need to give up breastfeeding. A nursing mother with hepatitis B or C should carefully monitor the condition of her nipples when feeding. Any microtrauma of the nipples and the baby’s contact with the mother’s blood increases the risk of infection. In this case, breastfeeding should be stopped until the nipples heal.

Problems from the child

Absolute contraindications to breastfeeding

It happens that breastfeeding is prohibited not because of the mother, but because of the baby itself. There are a number of conditions in which the baby should not receive breast milk, and a special medicated formula is prescribed.

This includes a whole group of congenital hereditary metabolic disorders: galactosemia, phenylketonuria, maple syrup disease. With these diseases, there is no enzyme in the baby’s body - this does not allow the components of breast milk to be properly broken down and leads to illnesses in the child.

Galactosemia. The disease is based on a deficiency of the enzyme that is involved in the conversion of galactose to glucose. With this metabolic disorder, milk and milk formulas based on cow's milk are strictly contraindicated for a child. Goat milk and goat milk-based formulas are also contraindicated for a baby with galactosemia. It is recommended to use special artificial mixtures based on soy protein or casein hydrolysate as food.

Phenylketonuria. This disease is associated with a metabolic disorder of the amino acid phenylalanine. To prevent the development of the disease, it is necessary to exclude this amino acid from the infant’s diet. It is contained in small amounts in breast milk, so breastfeeding is possible under strict control of the level of phenylalanine in the baby’s blood. When it increases, breastfeeding has to be limited, and several feedings are replaced with special adapted milk formulas that do not contain phenylalanine. How many times a day and in what volume a baby can be fed with breast milk is decided by the pediatrician, taking into account the general condition of the baby and the level of phenylalanine in the blood.

Maple syrup disease. This disease is caused by a violation of the metabolism of the amino acids leucine, valine and isoleucine. These amino acids are present in very small quantities in breast milk, therefore, as in the case of phenylketonuria, it is possible to breastfeed the baby, but in limited quantities, replacing part of the feedings with artificial milk formulas that do not contain “unnecessary” amino acids.

Temporary contraindications to breastfeeding

There are a number of deviations in the baby’s health, in which restrictions on breastfeeding are imposed until the child’s condition returns to normal. Most often, problems arise in weakened children due to unfavorable pregnancy and difficult childbirth. So, you will have to wait a bit with breastfeeding:

if the newborn's Apgar score is below 7 points;
with deep prematurity;
if the child’s birth weight is less than 1500 g;
for respiratory distress syndrome, birth injuries and convulsions in the baby;
with congenital heart defects with severe heart failure in the child.

In all these cases, breastfeeding, which requires a lot of effort from the baby, can lead to a general deterioration in his condition.

In case of prematurity and severe damage to the nervous system, the problem for breastfeeding, as a rule, is that due to the slow maturation of centers in the brain, at the time of birth the baby’s sucking and swallowing reflexes are not expressed (or poorly expressed). The baby is simply not yet able to coordinate breathing, sucking and swallowing, which is necessary for proper latching and sucking of the breast. In addition, with these conditions, newborn babies are very weak and it is simply difficult for them to breastfeed.

When breastfeeding is impossible for some reason, the baby should receive expressed breast milk. The question of when it will be possible to resume breastfeeding is decided together with the doctor individually in each individual situation, and it depends, first of all, on the condition of the child.

Separately, there are such congenital malformations as cleft palate and cleft lip (cleft lip, hard and soft palate). In this case, difficulties arise associated with attaching the baby to the breast and the sucking process itself. In this situation, the baby is fed expressed breast milk using special feeding devices. After surgical treatment, on the recommendation of a doctor, breastfeeding can be resumed.

How to resume breastfeeding

If for any reason a mother cannot breastfeed her baby, she must pump regularly to maintain lactation. Expressing is a kind of signal for the body, indicating the need to produce milk. If the baby is fed expressed milk, then the mother should express the breast immediately before feeding. If the baby is temporarily switched to formula milk, the mother needs to express her breasts every three hours, including at night. With less frequent pumping, the amount of milk will decrease, and when it is possible to return to breastfeeding, the baby will miss it.

If it is necessary to feed your baby expressed breast milk, it should be given from a spoon, syringe (without a needle) or cup. It is important not to teach your baby to suck from a bottle, so that later he does not refuse the breast.

So, the time has finally come for moms to start or resume breastfeeding. Where to start?

The most important thing is the mother’s confidence that she will succeed!

The process of restoring lactation includes several basic steps. First, you need to put your baby to your breast frequently. The baby should be able to breastfeed as often and for as long as he wants, and night feedings are also required. Secondly, physical contact between mother and child during the day is very important (it is convenient to use a sling for this), and sleeping together at night.

That is, the mother’s task at this stage is to ensure almost continuous contact with the baby and regularly offer him the breast. At the same time, it is necessary to ensure that the baby is properly attached to the breast, since the effectiveness of stimulation and emptying of the mammary gland and, accordingly, full milk production depends on this.

Hemolytic disease: to breastfeed or not?

Hemolytic disease of the newborn, which occurs due to Rh or blood group conflict, is not a contraindication for breastfeeding. Previously, the usual measure was to stop breastfeeding due to the presence of anti-Rh antibodies in the mother’s blood. Since these substances are the cause of the destruction of the baby’s red blood cells (erythrocytes), doctors were afraid that their additional intake through the mother’s milk could aggravate the baby’s jaundice and worsen his condition. Research has now shown that Rh antibodies are destroyed in the newborn's gastric juices and breastfeeding does not increase the breakdown of red blood cells. Therefore, a baby with hemolytic disease can be put to the breast already on the first day.

It can be said that it is advisable for breastfeeding women to avoid drug treatment. However, of course, life situations may arise when a mother cannot do without medication. If postpartum complications occur, if chronic diseases worsen, or if serious acute diseases develop, treatment should not be delayed.

In such cases, when choosing medications, it is necessary to evaluate their toxicity and possible adverse effects on the child’s body, after which it is advisable to choose those drugs that are the least toxic and that do not penetrate well into breast milk. It is important to discuss the need and safety of treatment with the doctor who prescribes the drug. You should also consult with a pediatrician to clarify the possible side effects of the medicine on the child’s body. Below is a summary of the drug groups. Given that very few adequate studies have been conducted, information on many drugs may be contradictory. Antacids and coatings. Antacids are drugs that neutralize the acidity of gastric juice; enveloping drugs are drugs that prevent damage to the gastric mucosa. These drugs are prescribed for gastroduodenitis (inflammatory diseases of the stomach and duodenum), and for peptic ulcers of the stomach and duodenum. DENOL. Contraindicated during breastfeeding, . May be used with caution. ALMAGEL, and similarAntiplatelet agents. Drugs that reduce blood viscosity are used to improve blood circulation in the capillaries in various diseases, for example, pathologies of the heart, blood vessels, and kidneys. COURANTIL. Possible short-term use during breastfeeding. . Contraindicated. Antibiotics. They are used to treat various infectious and inflammatory diseases, such as mastitis (inflammation of the mammary gland), endometritis (inflammation of the inner lining of the uterus), salpingo-oophoritis (inflammation of the ovaries and fallopian tubes), tonsillitis, pyelonephritis (inflammation of the kidneys), pneumonia (pneumonia), for some intestinal infections, etc. Penicillins (PENICILLIN, AM-PIOX, etc..),cephalosporins (, and etc.), macrolides(, VILPROFEN, MA-KROPEN, etc.), aminoglycosides ( , ) are usually not contraindicated during breastfeeding. Penicillins, cephalosporins, aminoglycosides penetrate into milk in small quantities, so their toxicity to the child is low. Macrolides penetrate well into milk, but their use during breastfeeding is possible. There is a potential risk of complications associated with the occurrence of allergic reactions, disruption of the normal intestinal flora (diarrhea), and the proliferation of fungi (candidiasis - thrush). To prevent dysbacteriosis, it is recommended to prescribe to a child probiotics (BIFIDUM BACTERIA, etc.). If an allergic reaction occurs in a child, you should stop taking this antibiotic or temporarily stop breastfeeding. Tetracyclines, sulfonamides (, BI-SEPTOL and etc.), , , penetrate into milk, and the likelihood of negative reactions is high. It is recommended to avoid their use while breastfeeding. Side effect CLINDAMICIN- risk of gastrointestinal bleeding. Side effect LEVOMYCETIN- toxic damage to the bone marrow, effects on the cardiovascular system. Side effect tetracyclines- growth retardation of the child, impaired development of bone tissue and tooth enamel. Antihypertensive drugs. Used for high blood pressure. . Compatible with breastfeeding. . Usually not contraindicated during breastfeeding. (). May be used with caution. . Not recommended. ACE inhibitors (). There are no adequate studies. Their use during breastfeeding is contraindicated. DIAZOXIDE. Contraindicated during breastfeeding. Side effect - hyperglycemia (increased blood sugar). RESERPINE. Contraindicated. Antihistamines ( , ). Prescribed for allergic diseases. The use of these drugs is possible during breastfeeding. Preferred CETIRIZINE, LORATADINE, since 1st generation antihistamines ( SUPRASTIN, TAVEGIL) may cause drowsiness in a child. . Contraindicated. Antidepressants. Used to treat depression, including postpartum depression. . The concentration in breast milk is very low. In newborns whose mothers received AMITRYPTYLINE, no deviations were observed, therefore this drug is considered compatible with breastfeeding. There are no studies on other drugs in this group or they are not recommended during breastfeeding. When treating postpartum depression, antidepressants from the group of “selective serotonin reuptake inhibitors” can be prescribed ( (FLUVOXAMINE), , SERTRALINE and etc.). According to doctors, these drugs can be used with caution during breastfeeding. However, in the instructions for the drugs, the manufacturer does not recommend their use during breastfeeding, which is due to the lack of adequate research. Anticoagulants. Drugs that prevent blood clotting. They are used for increased blood clotting, the risk of increased blood clots, and heart disease. . Usually not contraindicated during breastfeeding, as they pass into breast milk in minimal quantities. With long courses (more than 2 weeks), there is a potential risk of reducing blood clotting in the child. . Not recommended. Indirect anticoagulants ( ). Contraindicated during breastfeeding; taking medications may cause bleeding. Local antiseptics. Preparations for the prevention and treatment of local infections. , FUKARTSIN, “zelenka”Antithyroid drugs. They are used for diseases of the thyroid gland that occur with an increase in its function. Use with caution, monitoring the child's condition. Side effect - suppresses the function of the child's thyroid gland. Benzodiazepines. A group of drugs that reduce anxiety and sedate. It is believed that a number of drugs from this group ( , LORAZEPAM, TEMAZEPAM) is compatible with breastfeeding if used for a short time. Side effects - depression of the central nervous system, respiratory depression. Bronchodilators. Drugs that dilate the bronchi. They are used to stop attacks of bronchial asthma. , TERBUTALINE, FENOTEROL. It is believed that they are acceptable for feeding. It is necessary to monitor the child's condition; side effects include agitation and increased heart rate. Venotonics ( ). Used for venous insufficiency, varicose veins, hemorrhoids. There is no data on penetration into breast milk, so it is better to avoid using these drugs during breastfeeding. Vitamins, vitamin-mineral complexes, minerals. Used during breastfeeding. Side effects - allergic reactions. Hormones( , ). They are used for autoimmune diseases (rheumatoid arthritis, systemic connective tissue diseases, autoimmune hepatitis, etc., for some blood diseases, for adrenal insufficiency, etc.). Usually not contraindicated during breastfeeding. However, safety for long-term use has not been proven, therefore, if treatment is necessary for more than 10 days, the issue of continuing breastfeeding is decided individually. If a nursing woman requires long-term treatment with a high dose of hormones (2 times more physiological), it is believed that breastfeeding should be avoided. Thyroid hormones ( ). Used for insufficient thyroid function. Can be used under control of the child's condition. Side effects - increased heart rate, excitability, diarrhea, decreased weight gain. Diuretics(diuretics). They are used in the treatment of hypertension, heart failure, and “renal edema”. When using diuretics, there is a risk of suppressing lactation, so their use is not recommended during lactation. The most stringent restrictions are imposed on the group thiazides( ), they are contraindicated during breastfeeding. ( ) may be used with caution. indicated for increased intracranial pressure. May be used because the concentration in breast milk is too low to cause harmful effects on the baby. Antipyretics. not contraindicated during breastfeeding if used in the usual dose and several times (1 tablet up to 3-4 times a day, no more than 2-3 days). Exceeding the dose and long-term use should be avoided, since the side effect of the drug is toxic effects on the liver and blood. Choleretic agents. Used for diseases of the liver and gall bladder, accompanied by stagnation of bile. Not contraindicated during breastfeeding. (In the instructions for the drug states that no research has been conducted.) Inhaled corticosteroids (BECLOMETHASONE, BBCOTIDE, and etc.). Used to treat bronchial asthma. Not contraindicated. Antidiarrheals. . The drug passes into breast milk, so it is not recommended, but a single dose is possible. Intestinal sorbents. Used for poisoning, intestinal infections, allergic diseases. Activated carbon, etc. Compatible with breastfeeding. Contraceptives During breastfeeding, drugs with a predominant content of progesterone are allowed ( EXCLUTON, . , CONTINUINE). Other drugs are contraindicated during breastfeeding. Local anesthetics. Used when local anesthesia is necessary. , BUPIVACAIN. Compatible with breastfeeding. Methylxanthines( , ). CAFFEINE used to stimulate the nervous system, for low blood pressure, and is part of medications with an analgesic effect, such as , CITRAMON. EUPHYLLINE used for bronchial asthma to dilate the bronchi. These drugs are generally not contraindicated during breastfeeding, but should be used with caution. They penetrate well into breast milk and are slowly excreted from the newborn's body. Side effects - sleep disturbance, agitation, regurgitation, diarrhea, cardiovascular reactions. Nootropics(drugs that improve attention and memory) and drugs that improve cerebral blood flow ( , . , and etc.). Drugs in this group are compatible with breastfeeding. Painkillers. They can be non-narcotic and narcotic. Non-narcotic: PARACETAMOL(see above), , KAFFETIN, BARALGIN. Compatible with breastfeeding with single uses. Their long-term use is not recommended, since the side effect of these drugs is a toxic effect on various organs (liver, kidneys, blood, central nervous system, etc.). Narcotic: ***, . They pass into milk in small quantities, but can cause unwanted reactions in newborns. A single dose of these drugs is possible. Repeated use is not recommended, as respiratory depression (apnea), decreased heart rate, nausea, vomiting, central nervous system depression, and withdrawal syndrome are possible. Expectorants. They are used for various diseases of the respiratory system that occur with cough. , . Breastfeeding compatible Pre- and probiotics (LINEX, PRIMADOFILUS. and etc.). Compatible with breastfeeding. Prokinetics. They are used for gastroesophageal and duodenogastric reflux - the reflux of contents from the esophagus into the stomach or from the duodenum into the stomach. These conditions may manifest as symptoms of gastritis (pain in the stomach, heartburn). . The effect on the child is unknown. Antihelminthic drugs ( , ).Can be used during breastfeeding. Antidiabetic drugs. INSULIN. Usually not contraindicated during breastfeeding, but careful individual dosage selection is required. Side effects - development of hypoglycemic conditions (low blood sugar) in the child. Oral antidiabetic(glycemic) drugs. Side effects: hypoglycemia up to coma (the likelihood of its development increases if the dosage regimen is violated and the diet is inadequate); nausea, diarrhea, feeling of heaviness in the stomach. Sometimes: skin rash, itching, fever, joint pain, proteinuria. Rarely: sensory disturbances, headache, fatigue, weakness, dizziness, pancytopenia; cholestasis, photosensitivity. Contraindicated during breastfeeding. Uroseptics and intestinal antiseptics.