How to Discuss Pregnancy and Breastfeeding Plans for Medication Safety

When you're pregnant or planning to breastfeed, taking any medication-whether it's for depression, high blood pressure, or even a common headache-can feel overwhelming. You’re not just thinking about yourself anymore. You’re weighing risks for your baby too. And yet, too many people are left guessing, scrolling through Reddit threads or asking friends instead of getting clear, evidence-based answers from their provider. This isn’t just about fear. It’s about safety. Every year, thousands of pregnant individuals take medications without fully understanding the risks because no one took the time to talk through it properly.

Why This Conversation Matters More Than You Think

In the U.S., about 90% of pregnant people take at least one medication during pregnancy. Seven out of ten take prescription drugs. That’s not rare. That’s normal. But here’s the problem: 3% of birth defects are linked to medication exposure-and nearly all of them are preventable. The key? Talking early, often, and with the right tools.

The old A, B, C, D, X pregnancy risk categories? They’re gone. Since 2015, the FDA switched to a more detailed labeling system that explains risks in plain language: fetal development risks, maternal health benefits, and breastfeeding considerations-all in one place. But if your provider still says, “It’s Category B, so it’s fine,” they’re using outdated info. You need more than a letter. You need context.

When to Start the Conversation

Don’t wait until you’re 12 weeks along and already on a medication. Start before you conceive.

• Preconception: If you’re trying to get pregnant-or even thinking about it-review all your meds with your doctor or pharmacist. Some drugs, like isotretinoin (for acne) or certain seizure medications, need to be stopped months before conception. Others, like metformin for PCOS or SSRIs for depression, may be safe and even necessary.
• Prenatal visits: Every time you see your OB/GYN or midwife, ask: “Is everything I’m taking still safe?” Don’t assume they remember your list. Bring a written list of all prescriptions, supplements, and OTC meds. Even that herbal tea you think is harmless might not be.
• Postpartum: Breastfeeding changes everything. A drug that was safe in pregnancy might not be safe while nursing. LactMed, a free database from the National Library of Medicine, has data on over 5,000 drugs and their effects on breast milk. Ask your provider to check it with you.

The Four-Step Framework for Safe Discussions

Top clinics use a simple, proven structure. You can use it too.

1. Assess your current meds. List every pill, patch, injection, or supplement. Include doses and why you take them. Don’t leave anything out-not even melatonin or CBD.
2. Review risks using trusted sources. Avoid Google. Use MotherToBaby (1-800-733-4727) or the TERIS database. These are run by scientists, not advertisers. Their advice matches clinical guidelines 98% of the time. Google? Only 43% accurate.
3. Discuss alternatives. Is there a non-drug option? For pain, paracetamol (acetaminophen) is the only recommended analgesic in all trimesters. For anxiety, therapy or mindfulness may be as effective as medication-with no fetal exposure. For high blood pressure, some beta-blockers are safer than others. Ask: “What’s the safest option that still works?”
4. Document and follow up. Your provider should document your discussion in your chart using ICD-10 codes like Z33.1 or Z34.00. Get a printed fact sheet from MotherToBaby. Schedule a follow-up in 4 weeks if you’re pregnant, or 2 weeks after birth if you’re breastfeeding.

What Providers Should Be Doing (But Often Aren’t)

A 2023 survey of 15,000 patient stories found that the most appreciated providers did three things:

• They gave numbers: “The chance of a problem is about 1 in 1,000-not ‘rare’ or ‘maybe.’”
• They talked about what happens if you stop the drug. Untreated depression or asthma can be riskier than the medication.
• They gave you something to take home: a printed page, a QR code to MotherToBaby, or a note for your pharmacist.

Too often, patients report being told: “It’s probably fine,” or “Just stop it if you’re worried.” That’s not care. That’s avoidance. And it’s dangerous.

What to Do If Your Provider Won’t Talk

If your OB/GYN brushes off your concerns, or your pharmacist gives conflicting advice, here’s what to do:

• Ask for a referral to a maternal-fetal medicine specialist. They’re trained in complex medication use during pregnancy.
• Contact MotherToBaby. They offer free, confidential consultations with teratogen specialists. You don’t need a referral.
• Request a dedicated medication review appointment. Many clinics now offer 15-20 minute slots just for this. If yours doesn’t, ask why.
• Bring a trusted friend or partner. Two ears hear more than one.

Special Cases: Mental Health, Chronic Illness, and Polypharmacy

If you’re on antidepressants, antihypertensives, or multiple medications, your risk profile is higher. About 28% of pregnant people have chronic conditions requiring ongoing meds. Stopping them suddenly can cause seizures, preeclampsia, or postpartum depression.

For depression: SSRIs like sertraline are among the safest options during pregnancy and breastfeeding. The risk of untreated depression-including preterm birth or low birth weight-is higher than the medication risk.

For diabetes: Insulin is safe. Oral meds like metformin are often continued. But sulfonylureas? Avoid them in late pregnancy.

For migraines: Triptans are generally avoided. But acetaminophen with caffeine is often fine. Always check LactMed if you’re breastfeeding.

What’s New in 2026

This year, the FDA launched a new initiative requiring all new drug labels to include a clear fetal risk summary. Epic’s EHR system now integrates MotherToBaby’s database directly into its mobile app, so your provider can check a drug’s safety during your visit.

Telehealth medication consultations have doubled since 2020. If you live in a rural area without a teratologist nearby, you can now get a video consult with one through your hospital’s telehealth portal.

And starting in 2025, all OB/GYN residents in the U.S. will be required to complete training in medication safety communication. That means the next generation of providers will be better prepared.

Bottom Line: You Have the Right to Ask

You are not being difficult. You are being responsible. You have the right to know: What does this drug do to my baby? What happens if I don’t take it? Is there a safer option? Can I get this in writing?

The data is clear: structured medication safety discussions reduce adverse outcomes by 30%. But only if they happen.

Don’t wait for your provider to bring it up. Bring it up yourself. Bring your list. Bring your questions. Bring your fear. And if they don’t have the answers, help them find them-with MotherToBaby, with LactMed, with facts, not guesses.

What to Say Next Time

Next time you’re in the office, try this:

> “I’m taking [medication name] for [condition]. I want to make sure it’s safe for pregnancy and breastfeeding. Can we go over it using MotherToBaby’s resources? Can you show me the data?”

That’s not asking for permission. That’s claiming your right to safe care.