Nov 092012

“It’s safe for breastfeeding, but not pregnancy. Do you understand why? I don’t get it, but whatever.” ER doctor to breastfeeding mom discussing safety of an antibiotic.

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 November 9, 2012  breastfeeding, informed consent  Add comments

  12 Responses to ““…I Don’t Get It, But Whatever.””

  1. Shouldn’t the doctor know this? Don’t they teach Pharmcology in med school?

    • Not as much as you might think. That’s why I ALWAYS double check with my pharmacist. My pharmacist went to school specifically for determining the effects of medications on the human body, the side effects, and the possible adverse reactions to taking different medications. Plus, the pharmacist has a computerized national data base of medicinal information and books bigger than phone books which are updated every year for cross referencing.

      My doctor didn’t even know that I could take a simple inhaled steroid when I was pregnant. That steroid made the difference between me being able to breathe through my nose and never sleeping during my pregnancy at all (bad allergies + limited medication choices = no sleep at all).

      And then my doctor prescribed me an antibiotic for a sinus infection that my pharmacist told me was actually Class III (can’t be taken during pregnancy).

      Also, there are medications you can’t take while pregnant but it’s okay to take while nursing. Advil comes to mind. Ibuprofen may affect a fetus’ developing heart and liver, but not an infant’s already formed heart and liver. But it never hurts to ask the pharmacist what they recommend.

      • THANK YOU!

        And even if they went over the medicine in med school, the truth is indications change as do the medications out there and an ER doc does ER medicine, pregnant women and breastfeeding women aren’t their usual patients. Even the midwives and OBs where I go look up all meds to make sure even if they are used to it being prescribed.

      • Yes, THIS! I carry a handheld thing called Nursing Central that allows me to look up medications because, yes, we take Pharm (I’m in it now, actually) but we don’t learn every single medication. And someone who has studied to be an ER doctor has done maybe one OB rotation and/or one Women’s Health, but his/her primary focus has been on emergency medicine … which is not heavy on the differences between antibiotics harm to fetuses, but the body’s ability to filter what gets to the milk. These are concepts MANY doctors don’t understand, nor do many nurses.

      • Not to mention that medical information CHANGES over time. Thalidomide was once widely used as an anti-nausea medication for pregnant mothers experiencing morning sickness.

        Later it was discovered that Thalidomide causes MASSIVE congenital defects. It has since been removed from the list of pregnancy safe medication.

    • They do, and lots of it, but there is no general teaching of pregnancy and nursing + pharmacology. It’s taught in reverse, as in mentioning the teratogenic effect of some medications (i.e. those where you have birth defects when taking them in early pregnancy). But unless you take the initiative, you will probably only remember the three biggest no-nos (like tetracyclines = tooth damage). Which drugs are safe for nursing is no topic as all, but breastfeeding is similarly no topic in med school (safe for none class). :-|

  2. I would tend to give this ER doc a pass because
    a) they’re overworked and can be saddled with really long shifts at some hospitals
    b) they don’t normally deal with breastfeeding mothers
    c) doctors in general seem to get about five minutes of breastfeeding coursework in school, all of it wrong

    Since this isn’t a pediatrician or an OB, I can see why the doctor might not be up to speed on the exact mechanisms by which things cross the placenta or cross into the milk. The doctor did look up the safety of the drug, didn’t say, “Well, it says it’s safe for breastfeeding, but I’m still going to tell you to wean because it’s unsafe for pregnancy,” didn’t make something up that had no basis in reality in order to avoid saying “I don’t know.” This would be okay in my book.

    If a pediatrician said this, or a pharmacist, I’d be leery.

    • To me, the problem isn’t that the doctor didn’t know, but his/her attitude. Maybe s/he could have said something like, “I don’t know why this is considered safe for breastfeeding but not for pregnancy, but here’s how you can find out” or “I’ll look into that and get back to you” instead of “oh well, whatever, we don’t need to understand, just take the drugs!”

      • To be fair, though, I know many people who wouldn’t really care that a drug was safe for one and not the other and would just take it when it was safe and because the doctor said it was safe. They wouldn’t really care about the mechanism nor really even the doctor getting back to them. And for all those people, this answer would be just fine. :-)

        It’s exactly as you said, only they’re not being ironic: We don’t need to understand; just take the drugs.

  3. To me it wasn’t that he didn’t know, but that he was asking me why, and dismissing it without a second thought.

    I fell down some stairs at my apartment complex and broke my ankle. This was my second ER visit that week because a scrape I received in the fall was infected and my foot and toes were numb. He threw this one at me when he told me I’d be on antibiotics for the infection.

  4. This is a huge pet peeve of mine, not just with medical staff but with everybody. If I ask you a question that pertains to something in or around your field of expertise and you dont know, GO FIND OUT.

    I used to work in customer service as a call center rep for ATT. If I didnt know, I would always tell them I didnt know, but that I would find out. At the end of the call I would tell them that I am glad they asked, because I learned something new.

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