Over the Counter Pain Medication and Breastfeeding

Can I Take Ibuprofen, Acetaminophen, or Aspirin While Breastfeeding?

Model poses as a breastfeeding mother at night
Breastfeeding through the night is exhausting and can add to pain. Photo_Concepts / Getty Images

The early days after giving birth can be painful. Sleep deprivation often causes headaches and other body aches. You might have breast pain related to breastfeeding, or vaginal or abdominal pain after delivery. So you might feel you need to take pain medications, but are thinking twice about how it might affect your breastmilk and whether it could harm your baby. So do over the counter pain medication and breastfeeding mix?

The choice of whether to take pain medication when breastfeeding is highly personal. Only you know how much pain you are in, and how willing and able you are to explore alternatives. While some pain medications are considered safe while breastfeeding, they do still enter breastmilk and are ingested by your baby.

Ask Yourself If You Really Need Pain Medication

The last thing your doctor will want to do at this stage is to discourage you from breastfeeding. The main message they want to communicate is "Breast is Best." They also don't want to deny you the pain relief a pill could provide. So they might even encourage you to use over the counter painkillers, such as ibuprofen (Advil) or acetaminophen (Tylenol) if you are in pain.

While no one should suffer unnecessarily, least of all an exhausted new mom recovering from vaginal delivery or a c-section, you should also be able to make informed choices about how to manage your own pain -- and that doesn't always have to include medication.

Not only are there many effective preventative and non-medicinal approaches to pain management, such as relaxation and distraction, but many of the pains that new moms struggle with are the result of behaviors that can be changed. For example, research shows that physicians hardly ever provide breastfeeding support to new moms beyond prescribing medication, yet poor breastfeeding technique is a major cause of difficulty breastfeeding, and of breast pain.

Tip:

Think realistically about your pain. If you are recovering from surgery or another painful condition, don't deny yourself medication. But if you are suffering from fatigue-related headaches, take a break instead of a pill. And if you have breast pain, ask your doctor for a referral to a lactation consultant -- you may be able to breastfeed without pain.

Breastfeeding and Over the Counter Painkillers

There are several different types of painkillers, and what your doctor prescribes or recommends you take will vary, depending on the condition being treated, your personal response to each medication, and your history of addiction. Painkillers also vary in terms of how they affect your breastmilk and your baby.

Here's what the research tells us.

In general, acetaminophen, also known as paracetamol or Tylenol, and ibuprofen, also known as Advil, are not considered harmful enough to the baby to discourage breastfeeding, so your doctor may suggest you use these medications as needed.

There is, however, some evidence that both acetaminophen and ibuprofen can have short and long-term health effects.

Ibuprofen is a treatment of choice for newborns needing treatment of patent ductus arteriosus, and in rare cases, this can result in kidney and liver problems -- from which the baby typically recovers. While breastfeeding after taking ibuprofen would result in only a fraction of the dose administered directly to an infant, it is indicative of the strain that medications place on a newborn baby's immature system. A small, uncontrolled study showed a link between wheezing in breastfeeding babies and acetaminophen, which was linked to research showing that children exposed to acetaminophen pre- and postnatally have an increased risk of developing allergies and asthma. There was a reported case study of a baby developing a skin rash when her mother was using the same medication.

At present, ibuprofen seems the safest choice if you need pain relief when breastfeeding. It is also more effective than acetaminophen in relieving perineal pain after childbirth. However, several authors have pointed out that the kidneys and liver of a newborn baby are very immature, making it more difficult for them to process these medications.

Aspirin is not recommended, and it is unlikely that your doctor will encourage its use during breastfeeding.

A small percentage of people -- including mothers and babies -- process these medications differently from most people, resulting in higher concentrations of the drug. And while studies tend to focus their attention on life-threatening and severe conditions, another way to think about painkiller use is whether you could give your baby better quality breastmilk by avoiding these medications if possible. If you are in severe pain, you shouldn't suffer for fear of harming your baby by taking a painkiller, but if you have a mild headache, a glass of water and a lie-down might be just as effective, without exposing your baby to the medication.

Tip:

Just because an over-the-counter medication is easily available and not formally contraindicated doesn't mean it is a good idea to take it for every ache and pain. Always breastfeed before, rather than after taking medications, consider trying non-medical approaches to managing pain -- especially getting enough rest, and try to wait a few hours after taking medications before breastfeeding again.

The Bottom Line

While it is natural to try and be the "perfect" mom and do everything yourself, you might be able to avoid taking medication by having adequate rest. This will certainly help with headaches, and will promote healing. Rather than taking a painkiller and doing the housework, try lying down and practicing relaxation exercises when your baby is asleep. Also, make sure you are drinking enough water, as dehydration makes headaches worse. However, if you need medication for more serious pain, ibuprofen is unlikely to cause your baby significant harm, especially if you take it after breastfeeding.

Sources:

American Academy of Pediatrics "Policy Statement: Breastfeeding and the Use of Human Milk." Pediatrics 129:e827-e841. 2012.

American Academy of Pediatrics "The Transfer of Drugs and Other Chemicals into Human Milk." Pediatrics 108:776-789. 2001.

Antonucci, R. & Fanos, V. "NSAIDs, prostaglandins and the neonatal kidney." Journal of Maternal-Fetal and Neonatal Medicine, 22(S3):23–26. 2009.

Erdeve, O. & Sarici, S. & Sari, E. & Gok, F. "Oral-ibuprofen-induced acute renal failure in a preterm infant." Pediatr Nephrol, 23:1565–1567. 2008.

Fanos, V., Antonucci, R. & Zaffanello, M. "Ibuprofen and acute kidney injury in the newborn." Turkish Journal of Pediatrics 52: 231-238. 2010.

Kamondetdecha, R. & Tannirandorn, Y. "Ibuprofen versus acetaminophen for the relief of perineal pain after childbirth: a randomized controlled trial." J Med Assoc Thai 91:282-6. 2008.

Strong, G. "Provider Management and Support for Breastfeeding Pain." JOGNN, 40:753-764. 2011.

Verd, S. & Nadal-Amat, J. "Paracetamol and asthma and lactation" Acta Pædiatrica 100:e1–e4. 2011.

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