1) Community News

Hi All-
Sorry this newsletter is coming to you so late!! It's been one thing after another here and sometimes I swear that I hear the "Days of Our Lives" theme song playing in the background. Hopefully the rest of the summer will be less eventful! I found a very resourceful article on support for work-at-home moms. I hope it's helpful to those of you who are juggling work and parenting at home...and maybe it will be inspiring to those of you who need that extra little boost to put that work-at-home idea into action.

Enjoy your summer!

Hannah
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2) You Should Continue Breastfeeding (1) (Drugs and Breastfeeding)

Over the years, far too many women have been wrongly told they had to stop breastfeeding. The decision about continuing breastfeeding when the mother takes a drug, for example, is far more involved than whether the baby will get any in the milk. It also involves taking into consideration the risks of not breastfeeding, for the mother, the baby and the family, as well as society. And there are plenty of risks in not breastfeeding, so the question essentially boils down to: Does the addition of a small amount of medication to the mother’s milk make breastfeeding more hazardous than formula feeding? The answer is almost always: Almost never. Breastfeeding with a little drug in the milk is almost always safer. In other words, being careful means continuing breastfeeding, not stopping.

Remember that stopping breastfeeding for a week may result in permanent weaning since the baby may then not take the breast again. On the other hand, it should be taken into consideration that some babies may refuse to take the bottle completely, so that the advice to stop is not only wrong, but often impractical as well. On top of that it is easy to advise the mother to pump her milk while the baby is not breastfeeding, but this is not always easy in practice and the mother may end up painfully engorged.

Breastfeeding and Maternal Medication

Most drugs appear in the milk, but usually only in tiny amounts. Although a very few drugs may still cause problems for infants even in tiny doses, this is not the case for the vast majority. Nursing mothers who are told they must stop breastfeeding because of a certain drug should ask the physician to make sure of this by checking with reliable sources and/or prescribing an alternative safe medication. In this day and age, it is rarely a problem to find a safe alternative. If the prescribing physician is not flexible, the mother should seek another opinion, but not stop breastfeeding.

Why do most drugs appear in the milk in only small amounts? Because what gets into the milk depends on the concentration in the mother’s blood and the concentration in the mother’s blood is often measured in micro- or even nano-grams per millilitre (millionths or billionths of a gram), whereas the mother takes the drug in milligrams (thousandths of grams) or even grams. Furthermore, not all the drug in the mother’s blood can get into the milk. Only the drug that is not attached to protein in the mother’s blood can get into the milk. Many drugs are almost completely attached to protein in the mother’s blood. Thus, the baby is not getting amounts of drug similar to the mother’s intake, but almost always, much much less on a weight basis. For example, in one study with paroxetine (Paxil), the baby got less than 0.3% of the drug for each kilogram of his weight than the mother did (the mother got over 300 micrograms per kg per day, whereas the baby got about 1 microgram per kg per day).

Most drugs are safe if:

They are commonly prescribed for infants. The amount the baby would get through the milk is much less than he would get if given directly.
They are considered safe in pregnancy. This is not always true, since during the pregnancy, the mother’s body is helping the baby’s get rid of drug. Thus it is theoretically possible that toxic accumulation of the drug might occur during breastfeeding when it wouldn’t during pregnancy (though this is probably rare). However, if the concern is for the baby’s merely getting exposed to a drug, say an antidepressant, then the baby is getting exposed to much more drug at a more sensitive time during pregnancy than during breastfeeding.
They are not absorbed from the stomach or intestines. These include many, but not all, drugs given by injection. Examples are gentamicin (and other drugs in this family of antibiotics), heparin, interferon, local anaesthetics, omperazole.
They are not excreted into the milk. Some drugs are just too big to get into the milk. Examples are heparin, interferon, insulin.

The following are a few commonly used drugs considered safe during breastfeeding:

Acetaminophen (Tylenol, Tempra), alcohol (in reasonable amounts), aspirin (in usual doses, for short periods). Most antiepileptic medications, most antihypertensive medications, tetracycline, codeine, nonsteroidal antiinflammatory medications (such as ibuprofin), prednisone, thyroxin, propylthiourocil (PTU), warfarin, tricyclic antidepressants, sertraline (Zoloft), paroxetine (Paxil), other antidepressants, metronidazole (Flagyl), omperazole (Losec), Nix, Kwellada.

Note: Though generally safe, fluoxetine (Prozac) has a very long half life (stays in the body for a long time). Thus, a baby born to a mother on this drug during the pregnancy, will have large amounts in his body, and even the small amount added during breastfeeding may result in significant accumulation and side effects. These are rare, but have happened. There are two options that you might consider:

Stop the fluoxetine (Prozac) for the last 4 to 8 weeks of your pregnancy. In this way, you will eliminate the drug from your body and so will the baby. Once the baby is born, he will be free of drug and the small amounts in the milk will not usually cause problems and you can restart the fluoxetine (Prozac).

If it is not possible to stop fluoxetine (Prozac) during your pregnancy, consider changing to another drug which does not get into the milk in significant amounts once the baby is born. Two good choices are sertraline (Zoloft) and paroxetine (Paxil).

Medications applied to the skin, inhaled (for example, drugs for asthma) or applied to the eyes or nose are almost always safe for breastfeeding.

Drugs for local or regional anaesthesia are not absorbed from the baby’s stomach and are safe. Drugs for general anaesthesia will get into the milk in only tiny amounts (like all drugs) and are extremely unlikely to cause any effects on your baby. They usually have very short half lives and are eliminated extremely rapidly from your body. You can breastfeed as soon as you are awake and up to it.

Immunizations given to the mother do not require her to stop breastfeeding. On the contrary, the immunization will help the baby develop immunity to that immunization, if anything gets into the milk. In fact, most of the time nothing does get into the milk, except, possibly some of the live virus immunizations, such as German Measles. And that’s good, not bad.

X-rays and scans. Ordinary X-rays do not require a mother to stop breastfeeding even when used with contrast (example, intravenous pyelogram). The reason is that the material does not get into the milk, and even if it did it would not be absorbed by the baby. The same is true for CT scans and MRI scans. You do not have to stop for even a second.

What about radioactive scans?

We do not want babies to get radioactivity, but we rarely hesitate to do radioactive scans on them. When a mother gets a lung scan, or lymphangiogram with radioactive material, or a bone scan, it is usually done with technetium (though other materials are possible). Technetium has a half life (the length of time it takes for ½ of all the drug to leave the body) of 6 hours, which means that after 5 half lives it will be gone from the mother’s body. Thus, 30 hours after injection all of it will be gone and the mother can nurse her baby without concern about his getting radiation. But does all the radioactivity need be gone? After 12 hours, 75% of the technetium is gone, and the concentration in the milk very low. I think that after most radioactive scans, the mother can continue breastfeeding, but if she and her physician are truly concerned, waiting 2 half lives is enough, for a material such as technetium. Note that if the mother is getting the scan during the first few days after the baby’s birth, the baby will get much less because the baby gets much less milk during this time. During this early period, I believe no interruption of breastfeeding is necessary or desirable. Colostrum is desirable for the baby.

If you decide that interruption of breastfeeding is the best course to follow, then express milk for several days in advance (if you have advance warning about the test). Only occasionally is a radioactive scan that urgent that it cannot be delayed for a few days.

Thyroid scans are different. Radioactive iodine is concentrated in milk and will be ingested by the baby and it will go to his thyroid where it will stay for a long time. This is definitely of concern. So, the mother will have to stop breastfeeding? No, because often the test does not need to be done. Differentiating postpartum thyroiditis from Graves’ Disease (the most common reason for doing the scan in nursing mothers) does not require a thyroid scan. Get more information from the clinic. If a scan needs to be done, it is possible to do a thyroid scan with technetium.

Questions? (416) 813-5757 (option 3) or newman@globalserve.net

January 2000
Written by Jack Newman, MD, FRCPC
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3) Support, Links and Lists for Work-At-Home-Moms
by Tammy Frisselle-Deppe

Working at home and raising your children is quite challenging! Dedication and support for both working and mothering greatly helps. Whether you are currently working at home or thinking about it here are some great resources for you:

LINKS

*Moms Home Work www.momshomework.com	*Bizy Moms www.bizymoms.com
*Home Office Magazine www.bizymoms.com	*WAHM www.wahm.com
*Home Based Working Moms www.hbwm.com	*Mommy's At Work www.mommysatwork.com
*Moms Network www.momsnetwork.com	*Parentpreneur Club www.parentpreneurclub.com
*The US Work At Home Directory www.uswahd.com	*Work At Home Classifieds www.workathomeclassifieds.com

BOOKS

*Motherhood at the Crossroads : Meeting the Challenge of a Changing Role
by Sue Lanci Villani, Jane E. Ryan

*Diary of a Small Business Owner : A Personal Account of How I Build a Profitable Business
by Anita F. Brattina

*The Stay-At-Home Mom's Guide to Making Money : How to Create the Business That's Right for You Using the Skills and Interests You Already Have
by Liz Folger

*101 Best Home Based Businesses for Women
by Priscilla Y. Huff

*101 Best Extra Income Opportunities : Special Money-Making Ideas for Women Who Run Out of Money Before They Run Out of Month
by Jennifer Basye Sander, Jennifer Basye

*How to Raise a Family & A Career Under One Roof : A Personal Guide to Home Business for Parents"
by Lisa M. Roberts

*Mompreneurs : A Mother's Practical Step-By-Step Guide to Work-At-Home Success
by Patricia Cobe, Ellen H. Parlapiano

LISTS

Here are just a few discussion/support lists. A great way to find more is to go to ONELIST.com and do a search for "work at home". You will then come up with hundreds to look over!

~Work At Home ASAP: www.onelist.com/group/work-at-home-ASAP
~Work At Home Moms: www.onelist.com/group/work-at-home-moms
~Work At Home: www.onelist.com/group/work-at-home
~Caring At Home: www.onelist.com/group/caringathome
~Safe Ads: www.onelist.com/group/safeads
~WAH-R-Us: www.onelist.com/group/wahrus

Copyright by J.E.D. Publishing

Reprinted from Attached! Newsletter Spring 2000
For more AP information, support, features, areas, and products visit: www.GetAttached.com
Tammy Frissell-Deppe is a fourth generation attachment parent and has two children with her husband William. She has recently published a book entitled, Every Parent's Guide to Attachment Parenting. Tammy is a Medical Information Specialist as well as an attachment parenting expert and she tours the country speaking and educating parents and parents-to-be on the different aspects and benefits of attachment parenting. Tammy's articles have appeared in many different newsletters and journals and she continues to help and support hundreds of attachment parents weekly.
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4) From the Message Boards

Breastfeeding-

"Ouch Pinching!"
Hello, I'm Sarah, mama of Gus (15 mos) and 8 mos pregnant with a second baby. Gus is a great guy, but for about 6 months he has been PINCHING hard and PULLING my hair, hard. He only does this to me, not to his dad, who also has long hair. I have tried everything, from gently asking him not to do it, to socks on his hands (which he can now pull off), to crying, and even yelling OUCH when it really hurts, and I have even pinched him back :( This feels so wrong to me, and I don't want to be a pinch for a pinch mama. I am at my wits end, and really worried about what will happen when a brother or sister arrives on the scene. I am really tempted to wean him, even though he is not ready and when he's NOT pinching we still both enjoy our nursing relationship. This makes me so sad, and I know I can't be the only one with this problem. Help. Any advice would be appreciated.

Nighttime Parenting-

"Baby sleep through night when cosleeping/breastfeeding?"
I breastfeed and cosleep with my five-month old son. I have spoken to a couple of people who have done the same -- their children didn't sleep through the night for years!! Is this common? I'm just wondering what to expect. I actually don't mind nighttime nursing. The problem is that my husband can't handle it (very light sleeper), so he sleeps in another room. I'd really like all three of us sleeping together someday, if only little Ben would just sleep longer! He is not eating food yet and wakes every two to four hours. Also, I plan to add a toddler bed as a makeshift sidecar to the side of our queen-size bed. I'm figuring this probably won't make a difference (besides the space) since he will still be able to smell me. Any words of encouragement?

Diapering-

"Ideas on diaper storage, Anyone?"
Hi,
I have only been using cloth on my 2 babies for 9 months, and now I am expecting again in September. My question is this- how do you store all the diapers? I have a fabric lined wicker basket that I store my 3 dozen prefolds and plastic Sterlite container (with 3 drawers, like a small dresser) that I keep my fitteds and doublers in. The cloth wipes and and spare diaper pail vinyl liner bags go in a drawer at the changing table (the rest are full of clothes). All the covers hang of the door in a diaper stacker, except the ones hanging above the changing table for use. We live in a small 2 bedroom house, and our newborn will be sleeping in our room. We don't have much room, have a limited income (don't we all), and I just don't know where to put more diapers. I am planning on buying or begging for at least 4 dozen more diapers, 2 dozen cloth wipes, and at least 15 covers. What do you all do with your diapers and accesories? Do any of you have experience with 2 or more in cloth at once. All my friends and family use disposies, so I have no idea what I can do. Thanks everybody, I really appreciate your help.

Join in the discussions at the Babies Community Message Boards!
www.mothersnature.com/babies/boards