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Question from another mommy.

Posted by on Mar. 2, 2011 at 6:25 PM
  • 7 Replies
Quoting FormerlyFriday:

I had wanted to breast feed but decided not to after everything I went through. My body had gone through enough trauma and in the week I was in the hospital, not once my breasts were tender or showing any signs of getting milk in. I figured from all of the blood loss and everything that it wasn't going to happen.

Today is our 3rd day home and my breasts are sore. I am guessing my milk is trying to come in. I was considering trying to breast feed if Maliya will take to the boob. She's been on bottle/formula since she was born, so a week and a day now. 

My question is about the pain medication I am taking. I am taking Roxicet for pain management, along with Motrin. I only take one Roxicet maybe 2-3 times a day tops although I can take up to 2 every 4 hours. I try to take the least amount possible. I know that is a pretty heavy pain medication and I was curious if that is one that is transferred through breast milk or not. If it is then I will probably not try to breast feed as pain management at this point is extremely important in my recovery. If it will not transfer through the breast milk then I may try to breast feed, at least attempt to see if she will take the boob. 

If it is not transferable, I have another question. How do I go from a bottle fed baby to breast feeding? I had been using those little pre-made bottles with disposable nipples then when we changed to powdered formula yesterday, her actual bottles are NUK Orthodontic which the box said they support breast feeding (the reason I originally bought them).

Any tips are welcome and appreciated. I was not able to breast feed ds because after a week of bottle feeding (he was tongue tied and got his tongue clipped at a week old) he preferred the bottle to the breast. I had been devastated so I came into this pregnancy with lower expectations on breast feeding. I figured I'd try and if it didn't work out then it didn't work out. 

Thanks!

So here's her question. If anyone can PM her or something or reply here so I can reply in my birth group.

pregnancy due date

Lilypie Fourth Birthday tickers

by on Mar. 2, 2011 at 6:25 PM
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Replies (1-7):
Nameismommy
by on Mar. 2, 2011 at 6:45 PM

BUMP!

PhotoBella
by on Mar. 2, 2011 at 6:47 PM

Its simple.. just have her put baby to breast. It sounds like baby is still new and will probley have no issue switching over, she may be a bit engorged and will need to hand express some to help with latch on, but the sooner she tries the better.

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Nameismommy
by on Mar. 2, 2011 at 6:49 PM

But what about the medications she's on?

PhotoBella
by on Mar. 2, 2011 at 6:51 PM

That part Im not sure. Have you tried looking it up on LACTMED? Tabby may know.

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PhotoBella
by on Mar. 2, 2011 at 6:52 PM

Could she request new meds from her OB? Or maybe just cut back to just motrin 800s? She can take vicodin, they tried to give it to me in the hospital.

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gdiamante
by Gina on Mar. 2, 2011 at 7:11 PM

Roxicet AKA Percocet AKA Oxycodone. SHE is at greater risk than baby. The stuff is addictive. She really needs to work her way off it as quick as she can.

Oxycodone
CASRN: 76-42-6

For other data, click on the Table of Contents


Drug Levels and Effects:


Summary of Use during Lactation:
Maternal use of maximum dosages of oral narcotics while breastfeeding can cause infant drowsiness. Newborn infants seem to be particularly sensitive to the effects of even small dosages of narcotic analgesics, particularly in the first week of life. However, the newborn's dosage is limited by the small volumes of colostrum in the first 2 to 3 days postpartum. Once the mother's milk comes in, it is best to limit maternal intake of oral oxycodone (and combinations) and to supplement analgesia with a nonnarcotic analgesic if necessary. A maximum oxycodone dosage of 30 mg daily is suggested. Oxycodone elimination is decreased in young infants and much inter-individual variability exists. Monitor the infant for drowsiness, adequate weight gain, and developmental milestones, especially in younger, exclusively breastfed infants. If the baby shows signs of increased sleepiness (more than usual), difficulty breastfeeding, breathing difficulties, or limpness, a physician should be contacted immediately.


Drug Levels:
Oxycodone is metabolized to the active metabolites, noroxycodone and oxymorphone. Oxycodone has an oral bioavailability of 60% to 87% in adults.[1] Oxycodone elimination is decreased in young infants and much inter-individual variability exists. Oxycodone can be dangerous when used as an analgesic in newborns.[2]

Maternal Levels. Six breastfeeding mothers who were using 1 to 2 capsules containing a combination of 5 mg oxycodone and 500 mg acetaminophen every 4 to 7 hours for post-cesarean section pain had their milk sampled several times after successive doses. Peak oxycodone milk levels reportedly occurred 1 to 2 hours after the first dose and then at variable times after successive doses. The number of hours after a mother's last dose when oxycodone could still be measured in milk was depended on the number of doses taken. Oxycodone could be measured in milk up to 4, 12, and 36 hours after 4, 9, and 11 doses respectively. In all the mothers, measured oxycodone milk levels ranged from undetectable (<5 mcg/L) to 229 mcg/L. The authors estimated that an exclusively breastfed infant would receive a maximum 8% of the maternal weight-adjusted dosage of oxycodone, but active metabolite levels were not measured.[3]

Fifty mothers who delivered by cesarean section and received oxycodone had milk (colostrum) and serum samples measured for oxycodone at 24, 48 and 72 hours postpartum without respect to the time of the previous oxycodone dose. The most common doses received by the mothers during the previous 24 hours (including one 30 mg dose rectally immediately post surgery in some cases) were 60 mg (range 30 to 90 mg), 40 mg (range 0 to 90 mg), and 20 mg (range 0 to 50 mg), respectively. Mean colostrum concentrations at the 3 collection times were 58 mcg/L (range 7 to 130 mcg/L), 49 mcg/L (range 0 to 168 mcg/L), and 35 mcg/L (range 0 to 31 mcg/L), respectively. Little correlation was found between maternal dosage and colostrum concentrations, although colostrum levels correlated well with maternal serum levels, with a colostrum concentrations 3.2 to 3.4 higher than serum. Ten mothers had colostrum oxycodone concentrations over 100 mcg/L and 5 had detectable oxycodone in milk 37 hours after the last dose.[4]

Infant Levels. In a study of 50 mothers taking oxycodone post-cesarean section, 45 blood samples were taken from 41 breastfed infants at 24, 48 or 72 hours postpartum. Only 1 of the samples had a detectable (>2 mcg/L) oxycodone level of 7.4 mcg/L. Because these infants were in the first 3 days postpartum, their dose was probably limited by the small volumes of colostrum they were ingesting.[4]


Effects in Breastfed Infants:
A 10-month-old, 7.7 kg infant of a prescription drug-dependant mother died of cardiac arrest after a 12- to 24-hour period of lethargy, hypersomnolence and dyspnea. The infant also had a recent history of fever. The mother had reportedly been breastfeeding the infant 3 times a day for several weeks and had taken 180 mg of oxycodone, as well as muscle relaxants, the day prior to her infant's death. A blood oxycodone level of 600 mcg/L was measured on autopsy. The medical examiner considered it unlikely that such a high level of oxycodone in the infant's blood could be due to breastfeeding exposure as reported by the mother and thus considered the death a homicide resulting from either the intentional administration of oxycodone directly to the infant or from a higher dose of oxycodone in breastmilk than that reported by the mother.[5]

In a study of 50 mothers taking oxycodone post-cesarean section, 50 neonates were evaluated for sedation ever 24 hours after birth. None was severely sedated and less than 4% had sedation of 3 on a 1 to 5 scale. Because these infants were in the first 3 days postpartum, their oxycodone dose was probably limited by the small volumes of colostrum they were ingesting.[4]

A case-control study of 66 women taking oxycodone after a Cesarean section compared mothers of excessively sedated infants to those who were not sedated. The mothers of sedated infants were taking an average dose of 0.87 mg/kg daily and the mothers of nonsedated infants were taking 0.27 mg/kg daily. The sedated infants also slept longer during the night than the control infants (8.3 vs 4.9 hours).[6]


Possible Effects on Lactation:
Oxycodone can increase serum prolactin.[7] However, the prolactin level in a mother with established lactation may not affect her ability to breastfeed.

tabi_cat1023
by Group Admin -Tabitha on Mar. 2, 2011 at 7:25 PM

Roxicet  is Oxycodon which is safe if taken in less than 30mg a day for a mom of a newborn..have her check her dosage. 

OH and pass on to her that while still trying to BF go BACK to liquid formula, powder is NOT safe for babies under a month old, it is not sterile at all!!

kellymom.com has an article called back to breast that will give lots of info.

PLUS she needs to see a LC asap!

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