228 Obstetrics and Gynecology Board Review •••
❍ What antihypertensives are considered most compatible with breastfeeding?
Beta blockers such as propranolol, metoprolol, and labetalol.
Calcium channel blockers such as diltiazem, nifedipine, and verapamil.
❍ Which antihypertensives should be avoided during breastfeeding?
Acebutolol and atenolol have been reported in cases of infant bradycardia and hypotension. ACE inhibitors should
be used cautiously in the first few weeks of life because neonatal kidneys are very sensitive to these agents.
❍ What is the preferred medication for treatment of postpartum depression while breastfeeding?
Sertraline (Zoloft).
❍ What are some drugs that should not be taken while breastfeeding?
Cytotoxic agents (methotrexate, cyclophosphamide, doxorubicin).
Immunosuppressive agents (cyclosporine).
Lithium.
Chloramphenicol.
Isotretinoin.
Ergot alkaloids.
Amiodarone.
Radiopharmaceuticals.
❍ How long after a woman consumes alcohol is her breast milk free of the substance?
A single drink (12 oz of beer, 5 oz wine, or 1 oz hard liquor) will clear from maternal circulation in 2 to 3 hours.
Alcohol moves freely from maternal milk to plasma, so it is not necessary to express and/or discard milk after this
time period in order to avoid infant exposure. Mothers can be advised to refrain from nursing until 2 to 3 hours
after a single drink. They should refrain from nursing for an additional 2 hours for each additional drink.
❍ What is the most common cause of lactation failure?
Inadequate stimulation is the usual cause of insufficient milk production to adequately nourish and satisfy an infant.
This may be secondary to poor technique with inadequate contact with the breast or simply to not nursing frequently
enough. The average newborn will nurse 8 to 10 times in 24 hours. True lactation failure not related to poor
stimulation is very rare, and may be due to either anatomical defects such as hypoplasia (which may be unilateral) or
to absence of prolactin. Other causes of inadequate intake include infant oral-motor or neurologic abnormalities.
❍ What are the most common misconceptions about breastfeeding that lead a woman to bottle feed? What
arguments can you give to contradict these misconceptions?
(1) I want to go back to work—upon returning to work, you can pump and save, or gradually wean down to only
have milk during the hours you are home. Or you can nurse until you return to work and then wean. Even
2 to 3 weeks is valuable as it delivers colostrum and all its benefits.
(2) I am too embarrassed—discuss discrete techniques, availability of clothing just for nursing, and refer patient to
supportive group.
(3) My husband does not want me to—common reasons are that he wants to feed the baby and that he fears
sexual activity during lactation. Reassure him that an occasional bottle of pumped milk or even formula is
fine after the first 2 to 3 weeks. Also let him know that sexual contact with the breast during lactation is not
harmful. Letdown may occur, even during orgasm.