I’d love to hear from the 99NICU community about your go-to references.

A few years ago, our team cared for a remarkable mother whose story reminded us how much nuance—and teamwork—breastfeeding counseling can require. She had undergone a liver transplant as a teenager and remained on lifelong anti-rejection medications. Years later, she delivered a healthy full-term baby and had a strong, heartfelt wish to breastfeed.

As you can imagine, her medications raised questions about safety and infant exposure. Instead of defaulting to “no,” our team—neonatologist, clinical pharmacist, and the mother’s own transplant specialist—reviewed each drug carefully. We dove deep into pharmacokinetics and pharmacodynamics, half-lives, peak serum times, and milk-plasma ratios. The goal was to adapt the medication schedule to support breastfeeding, rather than ask her to give up breastfeeding because of the medications.

Together, we developed a practical plan:
• She could directly breastfeed from 7 AM to 7 PM.
• She would take her immunosuppressive dose immediately after 7 PM and avoid breastfeeding until 7 AM the next morning.
• She would pump at least twice overnight to maintain supply, but this milk would be discarded.
• Her baby would receive formula as needed during the nighttime window.

With this tailored approach, she was able to partially breastfeed her baby for eight months, which meant the world to her. For us, it was a powerful reminder that with the right information—and interprofessional collaboration—we can often make breastfeeding possible even in complex medical situations. This case was one that helped me shape my personal practice when it comes to breastfeeding support and orientation. It also highlighted how important it is to have trustworthy, up-to-date resources on medication safety in lactation.

So I’m curious: what resources do you rely on to check whether a medication is compatible with breastfeeding?
Have you managed similar cases you would like to share, and what tools or references were most helpful (e.g., online databases, institutional guidelines, books, lactation pharmacology experts)?

Would love to learn from your experience!

Thanks Mariana, great topic, and an everyday question.

Our standard in Sweden is https://janusmed.se/amning, will share more later 😀

We are using https://www.embryotox.de/

We are seeing a change in practice toward allowing more medications in breastfeeding. Lately I came across an infant whose mother was on Lithium, this has been a no for us in the past, but she insisted on wanting to breastfeed, and while doing a literature search (with the help of OpenEvidence 😁). I found an article in Acta Pediatrica with a reasonable follow-up schedule.

PubMed

Lithium use during breastfeeding was safe in healthy full...

Serum lithium concentrations in breastfed infants were stabilised at barely measurable levels after the first weeks of life. Before that, concentrations higher than the mothers were found. Lithium tre

While questions about breastfeeding while taking various medications are common - and we do have a great Swedish resource that Stefan referred to above - most answers tend to be ”we don’t know” or possibly some effect.” there are only a few medications that are a clear no. For me, several immunosuppressants have fallen into that category, so hearing about your practical approach is really valuable!

Thank you for this excellent topic. I struggled with this a few days ago and came to the conclusion that we also need adequate resources within the perinatal center. At a moment we use synbase.ee and lactmed.com. OpenEvidence is very good source to find latest evidence.

I’ll add a good article reference here that will help us look at the topic more broadly

Best,

Annika

I

MOBM.pdf

I use https://www.e-lactancia.org/. Wasn't even aware of other resources listed here, thank you!

Thank you for the paper, @Annika

This is indeed an interesting topic with many unanswered questions. Lot of research required. Areas of real concern if mother is on antipsychotics or anti depressants. Any take on this

What a powerful case — thank you for sharing it. Stories like this really capture the nuance of breastfeeding counselling and the importance of moving beyond reflexive “no’s.”

One set of resources that has consistently shaped my own practice in complex situations like this is the Academy of Breastfeeding Medicine (ABM) Clinical Protocols. I find them particularly helpful because they are practical, evidence-based, and explicitly encourage individualized, patient-centred decision-making with interprofessional collaboration — exactly what you describe.

https://www.bfmed.org/protocols

A few protocols I often return to:

• ABM Protocol #21 – Breastfeeding and Substance Use / Substance Use Disorder

• ABM Protocol #18 – Use of Antidepressants in Breastfeeding Mothers

• ABM Protocol #15 – Analgesia and Anesthesia for the Breastfeeding Mother

Beyond individual drug safety, what I appreciate most about ABM protocols is their framework: assess the drug, the infant, the maternal condition, timing, and alternatives — and then adapt the plan to support breastfeeding whenever safely possible.

Your case beautifully illustrates that philosophy in action. I’d love to see more teams approach complex medication scenarios with that same curiosity and collaboration rather than default restriction.

We use https://www.e-lactancia.org/. in Argentina.

Best wishes

Hello, in Spain, www.e-lactancia.org is the most used