There was recent conversations regarding informed consent. Often times if a mom chooses to get an epidural it will be after she has been in a situation where she is hurting and it is hard to make a decision much less read the form- so here is a form from http://www.gentlebirth.org/archives/epdrlrsk.html for you to read now so you understand the risks involved.
Epidural Consent Form
Here's the consent form I mentioned a while back. The only thing I'd like to see added is increased c-section rate, which seems to finally be proven.
CONSENT TO EPIDURAL FOR LABOR PAIN CONTROL AND/OR CESAREAN SECTION
1. I authorize the performance upon _________ of the following
procedure ______________ performed under the direction of
______(physician's name).
2. I consent to the administration of local anesthetics, narcotics,
and/or other medications into the epidural space.
3. I understand that the following, among others, are possible
complications or risks of the procedure and that while they are
uncommon, they have been reported in the medical literature:
-Failure to relieve pain.
-Hypotension (low blood pressure).
-Postdural puncture (spinal) headache which may require
medical therapy.
-Persistent area of numbness and/or weakness of the lower
extremities.
-Temporary nausea and vomiting.
-Breakage of needles, catheters, etc. possibly requiring
surgery.
-Hematoma (blood clot) possibly requiring surgery.
-Infection.
-Rapid absorption of local anesthetics causing dizziness
and seizures.
-Temporary total spinal anesthesia (requiring life
support systems).
-Respiratory and/or cardiac arrest (requiring life
support systems).
-Back pain.
-Fetal distress resulting from one of the above complications.
4. I consent to the performance of procedures in addition to or
different from those now contemplated, whether or not arising from
presently unforeseen conditions, which the above named doctor or his
associates or assistants including residents, may consider necessary or
advisable in the course of the procedure.
5. The nature and purpose of the procedure, possible alternative
methods of treatments, the risks involved and the possibility of
complications have been fully explained to me. I understand that no
guarantee or assurance has been given by anyone as to the results that
may be obtained.
Notes from Midwifery Today tape on epidurals
After 7 hours on an epidural, the woman's temp is up 2.1 deg. F, which is considered a maternal fever, which requires a neonate septic workup.
Of 96 first-time moms, 0 w/o epidural had a c-sect., 25 w/ had a c-sect. Of those getting epidurals < 3 cm, 33% had c-sects, 3-4 cm, 26%, > 5 cm, 0% MORAL - try to wait until 5 cm before epidural.
Problems with epidurals: 5% got no pain relief; 5% got inadequate pain relief, often had windows of sensation, which are just as annoying as all over pain.
Epidurals require catheters, which can require antibiotics, which may interfere with nursing.
Another study of 11,000 women having epidurals showed that 18% of women had chronic backache within 6 months of birth, lasting > 3 months. Of those with chronic backache, only 10% didn't have an epidural.
Lactation consultants say that nipples don't get erect for 24 hours after end of epidural. Newborns can't get a good latch. (Ref: Dr. Edie? Laurence, "Measuring Effects of Breastfeeding Success and Epidurals", U. Rochester.)
Rare complications of epidurals: cardiac arrest, respiratory paralysis, convulsions (most often from high spinals or intravascular injection). Other complications, 9 had spinal headache for 6 weeks, 5 for a full year.
Ways to minimize risks: Choose attendant w/low -sect. rate. One study showed that 46% of primips have epidurals. 1% of "clinic" patients have c-sects. 20% or private patients. If you get an epidural, make sure the facility has emergency c-sect. available and full resuscitation team. For a first baby, posterior or VBAC, delay epidural until after active labor is well established.
Robbie Davis-Floyd says "Women's satisfaction with the birth experience is directly related to her sense of having mastered it."
You lose endorphins and euphoria.
Monday, November 30, 2009
Wednesday, November 18, 2009
Doulas Being Advocates
Recently I received an email from a potential doula client that started like this, “I am looking for a doula to advocate for me and my husband's wishes in the hospital, and for the baby during labor.”
When I replied with a statement, “Why do you feel you will need an advocate to share your wishes in your labor? A doula will not speak for you- you can speak for yourself- if you can't then your partner will do so- we support you- we remind you of what you wanted- we help you find your questions to find your answers- but if you feel some need to be protected we need to discuss why that is- let's talk more about this.” She was taken a back and emailed me back this, “I think there has been a misunderstanding, I have no problem speaking up for myself; I don't know where that came from. I have a list of questions to help me find a doula. What I'm looking for is a good fit, the optimal organization, because I am assembling my team, and would like a doula present. And I don't know where this inference of needing to be "protected" came from? “
This made me think about the word advocate. Perhaps there was a misunderstanding of that word. When someone says initially something like they need an advocate to be with them- it sends up a red flag. My thesaurus lists these words: supporter, backer, promoter, believer, activist, campaigner, and sponsor. One who would support, encourage and be in favor of. I do think a doula can be these things. I do think there was a misunderstanding.
But this email came on the cusp of hearing from one of my doulas about a couple who had hired her. The father to be was initially one who was gun ho on having a very medicalized birth where all decisions were given over to their doctor. And then as they began to examine more of the birth journey- they had begun to explore options available to them and find out more about birth; he had changed quite a bit. The mother to be wanted a low intervention birth and was hoping to have a gentle vaginal birth in the least and was considering going natural.
Well after going a week past her due date and sharing how her care provider was not pressuring her to do anything to push this labor along, she went in for her 41 week prenatal appointment. After doing a non stress test and biophysical, it was determined that the amniotic fluid level was low- actually he admitted it was just what they expected it to be- well within the normal range- but lower than weeks earlier- but he suggested that they go straight to the hospital for an induction.
Her cervix was not ripe- but they could ripen it with cervidil. And after less than the suggested eight to twelve hours, it was removed and pitocin was started to bring on contractions although her cervix had not changed nor was it any more ripened than it had been the day before. The consideration of a second dose of cervidil was not discussed. And sometime in the night, her water had either been broken or had released due to the cervidil.
The pitocin was bringing on mild contractions initially since the couple had been requesting a slow start to the pitocin. But by mid morning, when the doctor made the decision to bring the pitocin up to normal management levels, the mom was struggling with the pain and the baby showed a few signs of also not being happy with the plan. The doctor had even said these contractions were like those of a mom who was close to pushing, but her cervix remained closed and unchanged. An epidural was placed and the doctor told them he would give them until 2pm to make some progress or she would have a surgical birth. I am unclear as to why this time was determined to be the magic hour of calling for the surgical birth- ACOG says a mom should have eighteen hours to be in active labor after her water was broken- perhaps he had broken her water at 8pm the night before.
Now mind you, they were in very little contact with their doula, and she was not with them- she was awaiting them inviting her to come be with them- whenever they needed her- she was ready- but they felt they did not need her yet. For inductions it can be tricky. Cervical ripenings is usually done while the mom sleeps. And the early onset of a pitocin induction can take hours before a mom even feels the first "real" contraction. So not having a doula present for the early parts of an induction is normal. But after several calls to them to help her know what might be occuring, she was finally able to find out at 3pm that they were going in at 4pm to have a surgical birth.
The doula was disappointed to have not been invited to be a part of this birth. What had happened? She was trying to be that supporter, believer, campaigner and encourager that they had wanted. But no phone calls had invited her to do so. And this care provider who was not going to push her into labor was now pushing her bed into the OR. But this was not the doulas's birth. These were not her choices to make. She could not make these decisions for them. But had they been adequate advocates for themselves in the midst of this situation?
It is hard to be an advocate if someone will not be their own advocate. A doula can not step in and throw herself over your bed and say no. She can not give you medical advice. She can not speak up when you fail to do so. She can not save you from the choices you make freely along the journey. And sometimes I think folks hire us to do just that. I was trying in this email to be clear about our role. The antonym to advocate is opponent and discourager. Sometimes we find the folks we choose to be with us may very well be those things- whether it is the care provider or a friend or family member.
I can reassure you that will not be us- we will support the choices you make in your pregnancy and labor. We will remind you of what you desired. We will assist you in getting your questions answered and considering what your options are along the way. If you are desiring that, then we can be your advocates.
When I replied with a statement, “Why do you feel you will need an advocate to share your wishes in your labor? A doula will not speak for you- you can speak for yourself- if you can't then your partner will do so- we support you- we remind you of what you wanted- we help you find your questions to find your answers- but if you feel some need to be protected we need to discuss why that is- let's talk more about this.” She was taken a back and emailed me back this, “I think there has been a misunderstanding, I have no problem speaking up for myself; I don't know where that came from. I have a list of questions to help me find a doula. What I'm looking for is a good fit, the optimal organization, because I am assembling my team, and would like a doula present. And I don't know where this inference of needing to be "protected" came from? “
This made me think about the word advocate. Perhaps there was a misunderstanding of that word. When someone says initially something like they need an advocate to be with them- it sends up a red flag. My thesaurus lists these words: supporter, backer, promoter, believer, activist, campaigner, and sponsor. One who would support, encourage and be in favor of. I do think a doula can be these things. I do think there was a misunderstanding.
But this email came on the cusp of hearing from one of my doulas about a couple who had hired her. The father to be was initially one who was gun ho on having a very medicalized birth where all decisions were given over to their doctor. And then as they began to examine more of the birth journey- they had begun to explore options available to them and find out more about birth; he had changed quite a bit. The mother to be wanted a low intervention birth and was hoping to have a gentle vaginal birth in the least and was considering going natural.
Well after going a week past her due date and sharing how her care provider was not pressuring her to do anything to push this labor along, she went in for her 41 week prenatal appointment. After doing a non stress test and biophysical, it was determined that the amniotic fluid level was low- actually he admitted it was just what they expected it to be- well within the normal range- but lower than weeks earlier- but he suggested that they go straight to the hospital for an induction.
Her cervix was not ripe- but they could ripen it with cervidil. And after less than the suggested eight to twelve hours, it was removed and pitocin was started to bring on contractions although her cervix had not changed nor was it any more ripened than it had been the day before. The consideration of a second dose of cervidil was not discussed. And sometime in the night, her water had either been broken or had released due to the cervidil.
The pitocin was bringing on mild contractions initially since the couple had been requesting a slow start to the pitocin. But by mid morning, when the doctor made the decision to bring the pitocin up to normal management levels, the mom was struggling with the pain and the baby showed a few signs of also not being happy with the plan. The doctor had even said these contractions were like those of a mom who was close to pushing, but her cervix remained closed and unchanged. An epidural was placed and the doctor told them he would give them until 2pm to make some progress or she would have a surgical birth. I am unclear as to why this time was determined to be the magic hour of calling for the surgical birth- ACOG says a mom should have eighteen hours to be in active labor after her water was broken- perhaps he had broken her water at 8pm the night before.
Now mind you, they were in very little contact with their doula, and she was not with them- she was awaiting them inviting her to come be with them- whenever they needed her- she was ready- but they felt they did not need her yet. For inductions it can be tricky. Cervical ripenings is usually done while the mom sleeps. And the early onset of a pitocin induction can take hours before a mom even feels the first "real" contraction. So not having a doula present for the early parts of an induction is normal. But after several calls to them to help her know what might be occuring, she was finally able to find out at 3pm that they were going in at 4pm to have a surgical birth.
The doula was disappointed to have not been invited to be a part of this birth. What had happened? She was trying to be that supporter, believer, campaigner and encourager that they had wanted. But no phone calls had invited her to do so. And this care provider who was not going to push her into labor was now pushing her bed into the OR. But this was not the doulas's birth. These were not her choices to make. She could not make these decisions for them. But had they been adequate advocates for themselves in the midst of this situation?
It is hard to be an advocate if someone will not be their own advocate. A doula can not step in and throw herself over your bed and say no. She can not give you medical advice. She can not speak up when you fail to do so. She can not save you from the choices you make freely along the journey. And sometimes I think folks hire us to do just that. I was trying in this email to be clear about our role. The antonym to advocate is opponent and discourager. Sometimes we find the folks we choose to be with us may very well be those things- whether it is the care provider or a friend or family member.
I can reassure you that will not be us- we will support the choices you make in your pregnancy and labor. We will remind you of what you desired. We will assist you in getting your questions answered and considering what your options are along the way. If you are desiring that, then we can be your advocates.
Monday, November 2, 2009
Isabel's Birth Story
I was 39 weeks pregnant, feeling good physically and emotionally--better than I had for most of the pregnancy. Over the weekend, I started to get the feeling that something was going to happen soon. Isabel had changed the way she was moving inside of me. Instead of kicking, punching, and having "playtime" in there, it suddenly started to feel as though she was getting down to business. Her movements were more studied and intentional, like she was getting lined up for her big entrance into the world. She would move her little head back and forth, telling my body it was time to start opening up. She made little changes to her body position, making sure everything was just right for the big day.
Psychotropic Drug Use During Breastfeeding
Psychotropic Drug Use During Breastfeeding: A Review of the Evidence
Pediatrics 2009;124;e547-e556; originally published online Sep 7, 2009;
Filomena Fortinguerra, Antonio Clavenna and Maurizio Bonati
DOI: 10.1542/peds.2009-0326
OBJECTIVE: The objective of this study was to review the existing literature on the use of various classes of psychotropic medications during breastfeeding to provide information about infant exposure levels and reported adverse events in breastfed infants.
METHODS: A bibliographic search in the Medline (1967 through July 2008), Embase (1975 through July 2008), and PsycINFO (1967 through July 2008) databases was conducted for studies on breastfeeding and psychotropic medications for a total of 96 drugs. References of retrieved articles, reference books, and dedicated Web sites were also checked. The manufacturers were contacted for drugs without published information. Original articles and review articles that provide pharmacokinetic data on drug excretion in breast milk and infant safety data were considered, to estimate the “compatibility level” of each drug with breastfeeding.
RESULTS: A total of 183 original articles were eligible for analysis. Documentation was retrieved for 62 (65%) drugs. In all, 19 (31%) psychotropic drugs can be used during lactation according to an evidence based approach. For 28 drugs, the available data do not permit an evaluation of the drug’s safety profile during breastfeeding and, for an additional 15 drugs, the exposure dose or observed adverse effects make their use unsafe.
CONCLUSIONS: Although most drugs are considered safe during breastfeeding, compatibility with breastfeeding has not been established for all psychotropic drugs. There is a need for additional research and accumulation of experience to guarantee a more rational use of psychotropic drugs during breastfeeding. Pediatrics 2009;124:
e547–e556
AUTHORS: Filomena Fortinguerra, PharmD, Antonio Clavenna, MD, and Maurizio Bonati, MD
Laboratory for Mother and Child Health, Public Health Department, Mario Negri Institute for Pharmacological
Research, Milan, Italy
I love the way this article begins with this statement, “Breastfeeding is essential for the physical and psychological health of both mother and child, and its benefits are well documented.”
And then the comment that, “Despite the increased attention toward breastfeeding, however, information on breast milk drug excretion and knowledge of the adverse effects on the infant are often unavailable or still limited for many drugs that frequently are used by women of childbearing age, and misinformation abounds.” But the truth is it is not profitable for most pharmaceutical companies to research the small population of women breastfeeding to determine if a drug has an interaction with their baby’s breastmilk. It is easier to just determine that it is not okay for a mom to take most medications than to do the tests.
The article then makes this statement, “Worldwide, more than half of breastfeeding women take some type of drug and the concern about potential harm to the nursing infant from maternal medications is often cited as a reason to stop lactation,11 even if discontinuing breastfeeding is often the wrong decision. The Summary of Product Characteristics should not be considered a reliable source of breastfeeding information; it often indicates that a drug is not recommended during lactation, suggesting that it be avoided or that breastfeeding be interrupted. The warnings are not necessarily related to observed or reported adverse effects; they are often used as a defensive measure on the part of the manufacturer when the drug’s safety information is not available.”
What is astounding is how many women who could benefit from drugs are not getting them or not taking them or weaning their babies unnecessarily since no one is doing any real studies on drugs that could be helpful to them.
“It has been estimated that, each year, more than 500 000 pregnancies in the United States are complicated by psychiatric disorders such as depression, anxiety, and psychosis, which often develop, recur, and/or worsen during and after pregnancy. Furthermore, 13% of all psychiatric hospital admissions for women occur during the first postpartum year. Depression is the most frequent mental disorder in the perinatal period: 10% to 16% of pregnant women fulfill diagnostic criteria for major or minor depression, but up to 70% report symptoms of depression. Furthermore, 7% to 20% of women receive a diagnosis of postpartum depression in the first year after delivery. Untreated depression and anxiety can have a negative impact on pregnancy, and adverse short-term and long-term effects can have a negative impact on the developing infant and child.”
This article sited several studies to determine what is really known out there regarding drug interactions with breastfeeding infants from psychotropic drugs that their mothers were taking. They looked at several methods of determining how safe the drugs were- from dosage- to length of time the drugs were taken- to amount found in breastmilk to effect on babies in adverse ways. They looked at what may be compatible, what needed to be used very cautionary and what was contraindicated.
“A total of 19 (31%) psychotropic drugs can be used during lactation according to an evidence-based approach, whereas for 28 drugs, the available data do not allow an evaluation of their safety profile during breastfeeding.”
Antidepressants had been studied most. “In particular, among the antidepressants, sertraline, paroxetine, and fluvoxamine are the first-choice drugs for treatment of depression in breastfeeding mothers because they have the lowest degree of excretion into human breast milk.” “Antipsychotics are the class with the smallest number of studies concerning use during breastfeeding. The available data regarding the use of hypnotic and anxiolytic agents during breastfeeding are scant.”
I found it interesting that, “there have been no studies on infants’ long-term exposure to very low dosages of antidepressants.” It is as if the studies allows the mother to go on the drug but does not care once they determine it is okay what the long term effect on the infant could possibly be. Looking at long term effects seem the most important as that is what will cause the longer lasting issues.
The article stated, “The decision to prescribe psychotropic agents to breastfeeding mothers should depend on an individual risk/benefit analysis: the known benefits of breastfeeding and medication use for both mother and infant must be weighed against the risk of untreated maternal illness or the risk of infant exposure to medications through breast milk.”
But since so often physicians would rather just have the mom wean the baby and treat their patient without regard to the individual desires and needs of the nursing dyad, many moms wean unnecessarily. Or a mother who needs treatment will forgo the treatment at risk to herself and possibly her infant.
The conclusion of these authors was that more studies need to be done and the safety issue of many of these drugs is still unknown and quite controversial. So, this was their call to action report of sorts.
I attended a dinner that Dr Zachary Stowe, a renowned physician (Professor, Psychiatry & Behavioral Sciences Director, Women’s Mental Health Program Emory University School of Medicine in Atlanta, Georgia) presented information about psychotropic drugs and breastfeeding moms. He gave several ways to help a mom avoid depression, which included simple things like receiving postpartum help, going for walks outside in the sunshine and many others. But he stated that it is important in order to have a happy baby to have a happy mom. Getting moms the medication they need without unnecessarily weaning a baby is imperative. We know the benefits of breastfeeding on the baby and we need to stop throwing the proverbial baby out with the bath water. Research needs to be done more fervently and more physicians need to try to keep the baby and mother nursing dyad together. Mental illness needs to be treated like so many other diseases and illnesses- with avid research in order to be treated without putting the baby at risk- and that includes weaning the baby when we know the health benefits of nursing that are well documented.
Teresa Howard
Pediatrics 2009;124;e547-e556; originally published online Sep 7, 2009;
Filomena Fortinguerra, Antonio Clavenna and Maurizio Bonati
DOI: 10.1542/peds.2009-0326
OBJECTIVE: The objective of this study was to review the existing literature on the use of various classes of psychotropic medications during breastfeeding to provide information about infant exposure levels and reported adverse events in breastfed infants.
METHODS: A bibliographic search in the Medline (1967 through July 2008), Embase (1975 through July 2008), and PsycINFO (1967 through July 2008) databases was conducted for studies on breastfeeding and psychotropic medications for a total of 96 drugs. References of retrieved articles, reference books, and dedicated Web sites were also checked. The manufacturers were contacted for drugs without published information. Original articles and review articles that provide pharmacokinetic data on drug excretion in breast milk and infant safety data were considered, to estimate the “compatibility level” of each drug with breastfeeding.
RESULTS: A total of 183 original articles were eligible for analysis. Documentation was retrieved for 62 (65%) drugs. In all, 19 (31%) psychotropic drugs can be used during lactation according to an evidence based approach. For 28 drugs, the available data do not permit an evaluation of the drug’s safety profile during breastfeeding and, for an additional 15 drugs, the exposure dose or observed adverse effects make their use unsafe.
CONCLUSIONS: Although most drugs are considered safe during breastfeeding, compatibility with breastfeeding has not been established for all psychotropic drugs. There is a need for additional research and accumulation of experience to guarantee a more rational use of psychotropic drugs during breastfeeding. Pediatrics 2009;124:
e547–e556
AUTHORS: Filomena Fortinguerra, PharmD, Antonio Clavenna, MD, and Maurizio Bonati, MD
Laboratory for Mother and Child Health, Public Health Department, Mario Negri Institute for Pharmacological
Research, Milan, Italy
I love the way this article begins with this statement, “Breastfeeding is essential for the physical and psychological health of both mother and child, and its benefits are well documented.”
And then the comment that, “Despite the increased attention toward breastfeeding, however, information on breast milk drug excretion and knowledge of the adverse effects on the infant are often unavailable or still limited for many drugs that frequently are used by women of childbearing age, and misinformation abounds.” But the truth is it is not profitable for most pharmaceutical companies to research the small population of women breastfeeding to determine if a drug has an interaction with their baby’s breastmilk. It is easier to just determine that it is not okay for a mom to take most medications than to do the tests.
The article then makes this statement, “Worldwide, more than half of breastfeeding women take some type of drug and the concern about potential harm to the nursing infant from maternal medications is often cited as a reason to stop lactation,11 even if discontinuing breastfeeding is often the wrong decision. The Summary of Product Characteristics should not be considered a reliable source of breastfeeding information; it often indicates that a drug is not recommended during lactation, suggesting that it be avoided or that breastfeeding be interrupted. The warnings are not necessarily related to observed or reported adverse effects; they are often used as a defensive measure on the part of the manufacturer when the drug’s safety information is not available.”
What is astounding is how many women who could benefit from drugs are not getting them or not taking them or weaning their babies unnecessarily since no one is doing any real studies on drugs that could be helpful to them.
“It has been estimated that, each year, more than 500 000 pregnancies in the United States are complicated by psychiatric disorders such as depression, anxiety, and psychosis, which often develop, recur, and/or worsen during and after pregnancy. Furthermore, 13% of all psychiatric hospital admissions for women occur during the first postpartum year. Depression is the most frequent mental disorder in the perinatal period: 10% to 16% of pregnant women fulfill diagnostic criteria for major or minor depression, but up to 70% report symptoms of depression. Furthermore, 7% to 20% of women receive a diagnosis of postpartum depression in the first year after delivery. Untreated depression and anxiety can have a negative impact on pregnancy, and adverse short-term and long-term effects can have a negative impact on the developing infant and child.”
This article sited several studies to determine what is really known out there regarding drug interactions with breastfeeding infants from psychotropic drugs that their mothers were taking. They looked at several methods of determining how safe the drugs were- from dosage- to length of time the drugs were taken- to amount found in breastmilk to effect on babies in adverse ways. They looked at what may be compatible, what needed to be used very cautionary and what was contraindicated.
“A total of 19 (31%) psychotropic drugs can be used during lactation according to an evidence-based approach, whereas for 28 drugs, the available data do not allow an evaluation of their safety profile during breastfeeding.”
Antidepressants had been studied most. “In particular, among the antidepressants, sertraline, paroxetine, and fluvoxamine are the first-choice drugs for treatment of depression in breastfeeding mothers because they have the lowest degree of excretion into human breast milk.” “Antipsychotics are the class with the smallest number of studies concerning use during breastfeeding. The available data regarding the use of hypnotic and anxiolytic agents during breastfeeding are scant.”
I found it interesting that, “there have been no studies on infants’ long-term exposure to very low dosages of antidepressants.” It is as if the studies allows the mother to go on the drug but does not care once they determine it is okay what the long term effect on the infant could possibly be. Looking at long term effects seem the most important as that is what will cause the longer lasting issues.
The article stated, “The decision to prescribe psychotropic agents to breastfeeding mothers should depend on an individual risk/benefit analysis: the known benefits of breastfeeding and medication use for both mother and infant must be weighed against the risk of untreated maternal illness or the risk of infant exposure to medications through breast milk.”
But since so often physicians would rather just have the mom wean the baby and treat their patient without regard to the individual desires and needs of the nursing dyad, many moms wean unnecessarily. Or a mother who needs treatment will forgo the treatment at risk to herself and possibly her infant.
The conclusion of these authors was that more studies need to be done and the safety issue of many of these drugs is still unknown and quite controversial. So, this was their call to action report of sorts.
I attended a dinner that Dr Zachary Stowe, a renowned physician (Professor, Psychiatry & Behavioral Sciences Director, Women’s Mental Health Program Emory University School of Medicine in Atlanta, Georgia) presented information about psychotropic drugs and breastfeeding moms. He gave several ways to help a mom avoid depression, which included simple things like receiving postpartum help, going for walks outside in the sunshine and many others. But he stated that it is important in order to have a happy baby to have a happy mom. Getting moms the medication they need without unnecessarily weaning a baby is imperative. We know the benefits of breastfeeding on the baby and we need to stop throwing the proverbial baby out with the bath water. Research needs to be done more fervently and more physicians need to try to keep the baby and mother nursing dyad together. Mental illness needs to be treated like so many other diseases and illnesses- with avid research in order to be treated without putting the baby at risk- and that includes weaning the baby when we know the health benefits of nursing that are well documented.
Teresa Howard
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