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Sudden Weaning for Medical Reasons

Sarah McCann, Carrickfergus, Northern Ireland
Adapted from her blog “Breastfeeding Resources, Northern Ireland,” posted August 2, 2011.

Sudden weaning in order to take a medication comes with risks and difficulties for mother and baby. Sarah looks at the implications of an early end to breastfeeding and explains that many medications are compatible with breastfeeding.

When a mother is pressured to stop breastfeeding in order to take a medication, those doing the pressuring often don’t understand the implications of weaning for mother and baby. A health professional may not have much or any breastfeeding experience and may feel that breastfeeding into toddlerhood is strange. They may see nursing as the baby’s food and not be aware of the relationship. They may think that breastfeeding is a nice thing to do if all is well, but that it is stressful if a mother is ill (Calvert, 2014). They may wonder, “Why breastfeed for more than a few months anyway?”  

Why breastfeed for more than a few months anyway?

Katherine Dettwyler, Associate Professor of Anthropology at the University of Delaware, USA (2003), suggests that the natural weaning age of humans is probably between three and seven years of age. Both La Leche League and the World Health Organization support breastfeeding beyond the early months and into toddlerhood. As the length of time that a baby is breastfed increases, there is a reduced risk of infection, optimal teeth and jaw development, and development of a normal immune system, which is not mature until about six years of age (Dettwyler, 2003). Breastfeeding also provides pain relief (during teething, for instance), acts as a nutritional cushion during illness, and helps to avoid hospitalization. Breastfeeding is an easy way to comfort a baby or toddler and helps them to fall asleep. A mother’s confidence from these basic activities may have been vital to her parenting experience up until that point.

Risks of sudden weaning to the mother.

Sudden weaning can affect an individual nursing dyad in many different ways and may also have implications for the mother’s partner and wider family.

Sudden weaning may:

  • Induce pain and engorgement. A mother may continue to make a large volume of milk whatever baby’s age.
  • Lead to plugged ducts, mastitis, or an abscess.
  • Increase mother’s stress levels, leading to increased symptoms of depression (Kendall-Tackett, 2007).
  • Lead to feelings of loss, grief or incompetency (Sharma and Corpse, 2008), even mimicking child loss (Gallup, 2010) and thus bringing on depression (Sharma and Corpse, 2008).
  • Cause mother to lose an easy way to feed and comfort her baby, especially during teething or illness.
  • Require dealing with baby or toddler’s continued desire to breastfeed, distressing both parties.
  • Cause a loss in the calming effects of prolactin and oxytocin, important hormones produced during breastfeeding that help mothers and babies relax and bond.
  • Increase mother’s fertility, particularly if she has no access to other forms of contraception or chooses not to use birth control (Sears, 2015).
  • Increase the risk that mother or another family member will have to put time and effort into caring for a sick baby or toddler.
  • Lead a mother to avoid treatment of a potentially dangerous and life-threatening situation for her and her baby to avoid sudden weaning (Amir, Ryan and Jordan, 2012).
Risks of sudden weaning to the baby.

There are many implications for babies, including:

  • An increased risk of infection.
  • Losing comfort and closeness with their mother, reducing bonding.
  • Becoming suddenly totally dependent on outside sources of food, such as baby formula and solid foods. This can be difficult for some babies, especially if they won’t take a bottle or cup, or are only accepting a small amount of solid food, which is also stressful for the mother.
  • Losing the protective effects of breastfeeding on future mental health, a particularly important issue if a mother is depressed. Research shows that the baby of a breastfeeding mother being treated for depression has better future mental health outcomes than the formula-fed baby whose mother is being treated for depression (Jones, McFall, and Diego, 2004).
Risks to the baby of medications in the mother’s milk.

Mothers may hear that early weaning is necessary due to increased risk to the child from medications in the mother’s milk. The reality is that:

  • Risks to the baby are greater during pregnancy than during breastfeeding (Kendall-Tackett and Hale, 2010).
  • If a toddler is feeding only a few times per day, his exposure to the medication will be much lower than that of a newborn.
  • Many medications are considered compatible with breastfeeding and are believed to cause no harm to the infant. Many medications don’t cross over into mother’s milk and most only cross in very small amounts, equivalent to a very small percentage of the mother’s dose (Hale, 2015).

See Breastfeeding and Medications for a summary of books, reputable websites, and helplines for checking the compatibility of medications during breastfeeding.

Gentle weaning

If it is necessary for a mother to wean before she was planning to, here are some questions a Leader can use to encourage a mother to discuss options with her physician and pharmacist:

  • Could an alternative, more compatible medication be prescribed?
  • Can the medication be delayed until she planned to wean? Could it be delayed long enough to allow gradual, more natural weaning?
  • Would the infant’s exposure to the medication for a relatively short time be safe, allowing for a more gradual weaning?
  • Might the mother temporarily wean and get baby back to the breast later?
When weaning is necessary

Sadly, there will be mothers who are faced with such serious illness that weaning is necessary. Cancer drugs, for instance, are so toxic that it is unlikely a mother could continue breastfeeding while receiving treatment (Jones 2013). As knowledge of the importance of breastfeeding and the safety of most medications spreads and grows, more women will continue to breastfeed who would in the past have weaned. However, not all doctors or mothers will want to take the risk of exposing their patients and babies to the risks of a specific medication, or the mother may be too ill to breastfeed.

Recently a mother phoned to say she had been diagnosed with thrombocytosis (a life-threatening condition of the blood) and was due to start a chemotherapy drug and another, less serious medication for life. We discussed temporary weaning, dry-up medications, and herbs. She decided to go for purely mechanical methods of weaning by pumping when her breasts felt uncomfortable and using cold cabbage leaves and ice packs.

Another mother was told to wean her ten-month-old daughter to start a stronger medication for depression. Once her daughter was suddenly weaned, the mother suffered pain in her breasts, developed mastitis, and her mood took several weeks to stabilize. Leaders cannot make decisions for the mother, yet they may be the only other people who understand how upset she is at having to wean. As La Leche League Leaders, we can give a mother information, support, and compassion.

If a mother does decide to wean suddenly, ice packs, cold cabbage leaves, sage tea, and a supportive bra can all be helpful. Pumping to remove some milk may also prevent and relieve engorgement (The Womanly Art of Breastfeeding, 2010; Humphries, 2003). Speaking to a board-certified lactation consultant may also help. Only the mother knows the full details of her situation. The Leader’s nonjudgmental attitude and helpful information may help her return to La Leche League for help if she has another baby and breastfeeds again.

Sarah McCann has been a Leader in Ireland since 1995. She is married to Mike, and they have three children, Ashleen (24), Timothy (21), and Eloise (18). Sadly, Mike and Sarah’s fourth child, Nathan, born in 2006, lived only a few hours. Sarah leads with LLL of Carrickfergus in Northern Ireland and has been in private practice as a lactation consultant for the last eight years.

References

Amir, L.H., Ryan, K.M., and Jordan, S.E. Avoiding risk at what cost? Putting use of medicines for breastfeeding women into perspective. International Breastfeeding Journal 2012; 7(14)

Bengson, D. How Weaning Happens. LLLI, 1999.

Bumgarner, N.J. Mothering Your Nursing Toddler. Schaumburg, IL: LLLI, 1999.

Calvert, H. Breast isn’t best, it’s just normal. Nursing children and young people 2014; 26(10):15.

Dermer, A. A well-kept secret: Breastfeeding’s benefits to mothers.
New Beginnings July-August 2001; 18(4):124-127.

Dettwyler, K.A. A time to wean: the hominid blueprint for the natural age of weaning in modern human populations. In Breastfeeding: Biocultural Perspectives. Stuart-Macadam, P, and Dettwyler, K.A, ed. New York: Aldine De Gruyter, 2003; 39–73.

Dewey, K. Guiding principles for complementary feeding of the breastfed child. World Health Organisation, 2003.

Gallup, G.G. Jr. et al. Bottle feeding simulates child loss: postpartum depression and evolutionary medicine. Med Hypotheses 2010 Jan; 74(1):174-6

Hale, T.W. and Rowe, H.E. Medications & Mothers’ Milk. 16th edition. Plano, TX: Hale Publishing, L.P., 2014.

Humphries, S. The Nursing Mother’s Herbal. Minneapolis, MN: Fairview Press, 2003.

Jones, W.  Breastfeeding and Medication. Oxon, United Kingdom: Routledge, 2013.

Jones, N. A., McFall, B.A., and Diego, M.A. Patterns of brain electrical activity in infants of depressed mothers who breastfeed and bottle feed: the mediating role of infant temperament. Biological Psychology 2004; 67:103–24.

Kendall-Tackett, K. A new paradigm for depression in new mothers: the central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health. International Breastfeeding Journal 2007; 2(6)

Kendall-Tackett, K. New research on postpartum depression: The central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health. Leaven 2007; 43(3):50–53.

Kendall-Tackett, K. and Hale, T.W. The use of anti-depressants in pregnant and breastfeeding women: A review of recent studies. Journal of Human Lactation 2010; 26(2):187-195.

Pearson-Glaze, P. Medications and Breastfeeding, Breastfeeding Support 2014, http://breastfeeding.support/ (accessed 6th February 2015).

Sharma, V. and Corpse, C.S. Case study revisiting the association between breastfeeding and postpartum depression. Journal of Human Lactation 2008; 24(1): 77-79.

West, D. Breastfeeding and Cancer. Breastfeeding Today 2011;10:18-19.

The Womanly Art of Breastfeeding, 8th Edition. Schaumburg, IL: LLLI, 2010; 335, 388.

World Health Organisation. Maternal, newborn, child and adolescent health 2014. http://www.who.int/maternal_child_adolescent/topics/child/nutrition/breastfeeding/en/ (accessed 18th November 2014)