How to Discuss Pregnancy and Breastfeeding Plans for Medication Safety

When you’re pregnant or planning to become pregnant, taking any medication - even something as simple as ibuprofen or an antidepressant - becomes a high-stakes decision. It’s not just about whether the drug works for you. It’s about whether it’s safe for your baby. And yet, too many people leave their doctor’s office without clear answers. In fact, 68% of pregnant individuals surveyed on Reddit reported their providers never properly discussed medication risks. That’s not just a gap in care - it’s a preventable risk.

Why This Conversation Can’t Wait

The old A, B, C, D, X pregnancy risk categories were scrapped in 2015 because they were too vague. Saying a drug is “Category C” didn’t tell you anything useful. Was the risk 1 in 10,000? Or 1 in 100? No one knew. Today, the FDA’s Pregnancy and Lactation Labeling Rule (PLLR) requires drug labels to include detailed summaries of known risks, benefits, and data sources. But if your provider doesn’t know how to read them, you’re still flying blind.

The truth is, 90% of pregnant people in the U.S. take at least one medication during pregnancy. About 70% take prescription drugs. Some are for chronic conditions like epilepsy, depression, or high blood pressure. Others are for temporary issues like infections or pain. Stopping a necessary medication can be just as dangerous as taking a risky one. Studies show that 40% of pregnant patients stop their meds without talking to a provider - often because they’re scared, not because they were given good advice.

When to Start Talking

This isn’t a one-time conversation. It needs to happen at three key points:

• Before you get pregnant: If you’re trying to conceive, review all your meds with your provider. Some drugs need to be switched or stopped months in advance. For example, isotretinoin (Accutane) can cause severe birth defects - and you need to avoid pregnancy for a full month after stopping it.
• During prenatal visits: Every time you see your OB/GYN, ask: “Is everything I’m taking still safe?” Even if you’ve been on the same meds for years, your body changes during pregnancy. What was safe at 8 weeks might not be at 32 weeks.
• After delivery, especially if breastfeeding: Many meds pass into breast milk. Some are harmless. Others aren’t. LactMed, a free database from the National Library of Medicine, has data on over 5,000 drugs and their effects on nursing infants. Ask your provider to check it with you.

What to Ask Your Provider

Don’t wait for them to bring it up. Come prepared. Here’s what to say:

• “I’m taking [medication name]. Is it safe during pregnancy?”
• “Is there a safer alternative?”
• “What happens if I stop this?”
• “Can you show me the data? Is this risk 1 in 100, or 1 in 1,000?”
• “Do you use MotherToBaby or LactMed to check this?”

The best providers don’t just say “yes” or “no.” They give context. For example: “This antidepressant has a 1 in 1,000 chance of causing a heart defect - but untreated depression increases your risk of preterm birth by 30%.” That’s real decision-making.

Tools That Actually Help

There are free, evidence-based resources you can use - and you should ask your provider to use them too:

• MotherToBaby: A free 24/7 helpline (1-866-626-6847) and website staffed by teratologists. They’ve answered over 150,000 questions since 1987. Their advice matches expert guidelines 98% of the time. Google? Only 43% accurate.
• LactMed: The go-to database for breastfeeding safety. Available as a free app or website. Updated monthly. Covers everything from antibiotics to anxiety meds.
• TERIS: A research database with risk assessments for over 1,800 medications. Used by specialists in major hospitals.

If your provider says, “I don’t know,” ask if they can call MotherToBaby right then and there. Many clinics have direct lines. If they refuse, that’s a red flag.

What About Over-the-Counter Drugs?

Just because a drug is sold without a prescription doesn’t mean it’s safe in pregnancy. Here’s what to avoid:

• Ibuprofen (Advil, Motrin): Avoid after 20 weeks. It can cause low amniotic fluid and kidney problems in the baby.
• Naproxen (Aleve): Same risks as ibuprofen. Not safe in late pregnancy.
• Decongestants like pseudoephedrine: Can reduce blood flow to the placenta. Use only if approved by your provider.
• Herbal supplements: Most haven’t been tested in pregnancy. Even “natural” doesn’t mean safe.

The only pain reliever recommended for all trimesters? Acetaminophen (Tylenol). The FDA reviewed 28 studies involving over 7 million pregnancies and found no clear link to birth defects when used as directed. That doesn’t mean it’s risk-free - but it’s the safest option we have right now.

What If You’re Already Taking Something Risky?

If you’re on a high-risk medication - like lithium, valproic acid, or isotretinoin - don’t panic. But do act.

• Call your provider immediately. Don’t wait for your next appointment.
• Ask: “Can this be switched to something safer?”
• Ask: “Do I need to see a maternal-fetal medicine specialist?”
• Ask: “Can you connect me with a teratologist?”

The iPLEDGE program for isotretinoin reduced pregnancy exposures by 86% because it required mandatory counseling and pregnancy testing. That’s the level of rigor we should expect for all high-risk meds.

What to Do If Your Provider Doesn’t Take It Seriously

If you’re brushed off - “Don’t worry, it’s fine” - or given vague answers, you have options:

• Request a medication review appointment. Many clinics now offer 15-20 minute slots just for this.
• Ask for a pharmacist consult. Pharmacists are medication experts. They’re trained to check for pregnancy and breastfeeding risks.
• Use MotherToBaby as your own backup. Call them. Print their fact sheets. Bring them to your next visit.
• Switch providers. If your care team won’t prioritize your safety, they’re not the right team for you.

Patient reviews on Healthgrades show that the most trusted providers are the ones who print out MotherToBaby fact sheets, schedule dedicated med reviews, and explain risks in numbers - not just “it’s rare.”

What About Emergency Care?

This is where things get dangerous. Emergency rooms often don’t know you’re pregnant. In one study, 43% of pregnant women were given contraindicated drugs like ibuprofen after 20 weeks because no one asked.

Always carry a pregnancy card or note in your phone: “I am pregnant. Do not give me ibuprofen, naproxen, or certain antibiotics.” Tell every provider you see - even the EMTs. If you’re in pain, ask: “Is this safe for pregnancy?” Don’t assume they know.

What’s Changing in 2026?

Medication safety is getting stricter - and more accessible.

• Starting in 2025, all OB/GYN residency programs must include medication safety training.
• Medicare and Medicaid now require documentation of medication reviews in 90% of prenatal visits for full reimbursement.
• MotherToBaby’s database is now integrated into Epic’s mobile app, so providers can check risks at the point of care.
• The NIH is developing AI tools trained on 300,000+ pregnancy cases to help predict risks faster.

But progress isn’t equal. Only 22% of Medicaid patients get documented medication reviews - compared to 78% of privately insured patients. Rural clinics have 43% higher medication use but only 35% access to teratology specialists. This isn’t just a clinical issue - it’s a justice issue.

Final Takeaway

You have the right to know what’s safe. You have the right to ask questions. You have the right to demand clear, evidence-based answers. Medication safety during pregnancy and breastfeeding isn’t about fear - it’s about informed choice. The goal isn’t to avoid all risk. It’s to understand it, weigh it, and make the best decision for you and your baby - together with your care team.

Don’t wait until something goes wrong. Start the conversation today. Write down your meds. Bring your questions. Use the tools. And if your provider won’t help - find one who will.