Breastfeeding and Medication: Having the Conversation That Actually Helps

I have loved volunteering at the Breastfeeding USA support group in Fox River Grove for years, even before I became an IBCLC. Breastfeeding USA is a national nonprofit that trains people to become Breastfeeding Counselors. My co-counselor and dear friend awaits each new edition of Hale's Medications and Mothers' Milk, by Dr. Kaytlin Krutsch and Dr. Thomas Hale, and she carries her copy to every meeting. Any time a parent has a medication question, out it comes. Back when I was a Breastfeeding Peer Counselor at WIC in McHenry County, I noticed the nutritionists all had their own copies ready to go, too. I thought, this is something good lactation supporters do.

Fast forward to the other day, when I got to be a guest on ACOG's Compassionate Conversations podcast alongside Dr. Kaytlin Krutsch herself. You can imagine the instinct to pinch myself.

The episode was on breastfeeding and medication. I sat alongside an OB-GYN who specializes in perinatal mental health and Dr. Krutsch, a clinical pharmacist who directs a national research center on how medications transfer into human milk. We spent our time on the questions that come up in living rooms and clinic visits every day, starting with this one: what do you do when you need a medication and you also want to breastfeed?

I want to bring that conversation here, because the way it usually gets handled leaves a lot of parents feeling stuck. My work is not to tell you to take a medication or to stop one. That decision belongs to you and your prescribing clinicians. My work is to help you think it through with good information and without shame, so that the choice you make is one you understand and feel settled about.

The decision is a conversation, and it belongs to you

There is rarely one right answer that fits every parent. The same medication question can lead to different choices for different families, because the answer depends on your health, your history, your feeding hopes, and what a realistic day looks like for you. When I help a family work through a medication question, I am not reading from a script. I am listening to what you tell me and letting that shape what matters most in the decision.

That is why I ask what you are hoping for early on. If you are hoping to feed your baby some of your own milk and some formula, a medication that affects your supply may be less concerning. If feeding only your milk matters deeply to you, the same medication becomes a bigger part of the discussion. We start with your hopes, then bring in the information.

Breastfeeding is part of the parent's health too

One point from the episode stayed with me. We often treat a medication question as a tradeoff against breastfeeding, as if the two sit on opposite sides. Dr. Krutsch reframed it. She noted that breastfeeding is itself connected to a parent's long-term health, with research associating it with lower rates of high blood pressure, diabetes, breast and ovarian cancer, and even heart attacks later in life. (She was careful to point out that some of these differences can be small, but still.)

Here is the part that struck me. Some of the conditions we reach for medication to treat are the same ones breastfeeding is already working against. So breastfeeding is not only the thing at stake in the decision. It is doing some of the same health work on the parent's side. That does not settle any single medication question, and it is not a reason to stay on a path that is not right for you. It is a reason to see the whole picture, your own health included, before you decide.

Two questions a medication raises

On the podcast, the OB-GYN framed medication and breastfeeding around two separate questions, and I find this framing genuinely useful when families are anxious.

The first question is whether the medication passes into your milk and reaches your baby. The second is whether it affects your milk supply. These are different concerns, and people often collapse them into one worry. A medication can be considered compatible with breastfeeding for your baby and still change your supply. Knowing which question you are actually asking makes the conversation clearer and calmer.

One assumption trips a lot of families up. People often think that if a medication was off the table during pregnancy, it must be off the table during lactation too. Lactation is a whole different ballgame. A medication reaches a baby very differently through milk than through the placenta, and far more options are on the table once your baby is here. That is worth asking about rather than assuming.

I do not assess medication safety myself. That is the work of your prescriber and pharmacist. What I can do is help you name the right question, gather what you need, and bring it back to the people who can answer it.

Fear and shame are often the real barrier

Here is something the panel and I agreed on strongly. The hardest part of these conversations is frequently not the pharmacology. It is the fear and the shame.

Some parents are afraid to say they need a medication, because they have absorbed a message that a good parent sacrifices everything, including their own health, to breastfeed. Others are afraid to say that breastfeeding is not working, or that they do not have the support around them to keep it going, and they carry guilt as if that were a personal failing. That guilt can keep them from seeking out the support they deserve. Sometimes they have not realized that the parents who look like they are doing it on their own have a robust system of support quietly humming in the background. All of these parents deserve support, and none is failing.

I build my practice to make room for whatever is true for you. I use the words you use for your body and for feeding your baby. I work in English and Spanish. I want you to feel safe enough to tell me what is actually on your mind, including the parts you feel guilty about, because we cannot solve a worry you are too afraid to say out loud.

Combination feeding often needs more support, not less

Many people assume that families who use both their own milk and formula need less help. In my experience it runs the other way. Combination feeding adds layers of complexity to things like milk production and storage. Some parents have also quietly absorbed the idea that fewer ounces of human milk in their baby's diet means less need for a lactation consultant, which is not the case. If your body makes about 70% of the milk your baby needs, that does not mean you only need 70% of the support. You need and deserve all of it.

You are allowed to reopen a closed door

I want to share a story from my practice, because it changed how I work. A client filled out my intake form and, next to the question about her current medications, she bravely added two more that she wished she could take. Her provider had told her those two were off the table while she was breastfeeding.

When we looked them up together in Hale’s Medications and Mothers’ Milk, those two medications sat in the same risk category as one she was already taking every day without concern. I asked whether she might feel comfortable reopening the discussion with her provider, this time with the reference in hand.

That client made me want to change my intake form. I now ask every family, what medications do you wish you could take? It tells me where the quiet worries are, and it sends the message I most want to send: this is a safe place to talk about medications.

Good information sometimes means going back and asking again. You are allowed to do that.

You do not have to carry this alone

The clearest message from the episode was that this is a team effort, and that no single clinician is expected to know everything. Neither are you. A few resources worth knowing about:

• The InfantRisk Center at Texas Tech. They research how medications transfer into human milk and run a help line for both parents and clinicians. What your baby drinks in a day, whether it is a combination of formula and your milk or all your milk, is one of the things your prescriber and the InfantRisk Center can take into account. Many families and even many providers do not know this resource exists, and you can find out more at infantrisk.com.

• An IBCLC. A board-certified lactation consultant can help you protect your feeding hopes through a medication decision, and can be part of the conversation with your medical team.

• Postpartum Support International. A national nonprofit with a help line in English and Spanish, online support groups, and a directory to help you find a perinatal mental health clinician. Their resources are for the whole family, including partners, not only the birthing parent. Reach them at postpartum.net.

Asking for help is part of how good decisions are made: the kind that fit both your hopes and your real life.

You can hear the full conversation, including Dr. Krutsch on the maternal health benefits of lactation, on ACOG's Compassionate Conversations podcast. Listen to the episode

Let's talk it through

If you are weighing a medication question while breastfeeding, or thinking ahead about it before your baby arrives, I would be glad to sit with you and work through it. I see families in their own homes across Barrington, Cary, Fox River Grove, and the surrounding Northwest Suburbs of Chicago. For families farther out, I also offer virtual visits.

You bring the question. I will help you find the clearest path to an answer you feel good about.

If you would like to work together, reach out through my contact form or send me a text. I read every message myself.

Katie Koll, MSEd, IBCLC, is the owner of Treasure Chest Lactation and provides in-home lactation support across the Northwest Suburbs of Chicago. She serves as vice president on the board of Breastfeeding USA. She was a panelist on ACOG's Compassionate Conversations podcast episode on breastfeeding and medication management.

© 2026 by Treasure Chest Lactation LLC. All rights reserved.

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