The weeks after delivery (often called the fourth trimester) can raise just as many questions as pregnancy itself. From pain management and supplements to beauty treatments and mental health medications, many parents are unsure how different exposures may affect breastfeeding.

In this episode of The MotherToBaby Podcast, host Chris Stallman, MS, CGC, is joined by Kirstie Perrotta, MPH, and Angela Messer, MS, Teratogen Information Specialists from MotherToBaby California, to discuss some of the most common postpartum questions they receive from parents and healthcare providers.

Together, they explain how exposure information is evaluated during breastfeeding and how factors like dose, timing, and route of exposure influence what may reach breast milk.

In This Episode, You’ll Learn:

• What the fourth trimester is and why exposure questions continue after delivery
• Common postpartum concerns, including pain medications, stool softeners, and laxatives
• How prescription pain medications, including opioids, are evaluated during breastfeeding
• Why route of exposure matters when considering topical products
• What to know about hair dye, Botox, manicures, facials, and salon treatments
• Why supplements, herbal products, and proprietary blends raise additional questions
• Which over-the-counter medications are often discussed in the breastfeeding period
• How medication guidance can differ between pregnancy and lactation
• Why addressing postpartum mental health conditions is essential
• Common breastfeeding myths and misconceptions
• Practical tips to reduce direct infant contact with topical products

Key Takeaways:

• Many medications have data available for use during breastfeeding
• Topical products are typically evaluated based on how they are applied and absorbed
• High-dose supplements and proprietary blends often lack breastfeeding data
• Postpartum pain, mental health, and chronic conditions deserve appropriate treatment
• Feeding decisions are personal, and there is no single approach that works for everyone

Resources Mentioned:

• MotherToBaby.org – evidence-based fact sheets, Baby Blogs, podcasts, and educational resources
• Over 300 fact sheets in English and Spanish on medications, exposures, and health conditions
• One-on-one support via phone, chat, text, or email
• MotherToBaby Pregnancy Studies – helping expand knowledge about medications, conditions, and exposures in pregnancy and lactation

Concerned about medication use during pregnancy? You’re not alone. 
In this episode of The MotherToBaby Podcast, host Chris Stallman, MS, CGC (genetic counselor, mom of four, teratogen information specialist) sits down with Dr. Judy C. Morrow of Harvard Medical School to break down how FDA REMS (Risk Evaluation and Mitigation Strategy) programs help reduce the risk of birth defects and protect pregnant patients.

Together, they discuss:
✔️ What REMS programs are and why they exist
✔️ How REMS programs support safe medication use
✔️ The role of manufacturers, prescribers, and pharmacists
✔️ Common medications with REMS programs (including isotretinoin/Accutane)
✔️ Pregnancy testing requirements & pharmacy restrictions
✔️ Why some drugs don’t have REMS (even if risks exist)
✔️ What patients should ask if they’re prescribed a REMS-covered medication 

Dr. Morrow shares how researchers use real-world data to identify medication-related adverse events in pregnancy, how REMS programs try to prevent exposed pregnancies, and why communication between patients, providers, and pharmacists is essential. 

If you’re pregnant, planning a pregnancy, breastfeeding, or support patients in these settings, this episode offers clear, practical insights to help guide informed decision-making.

🔎 Key topics: pregnancy, REMS, FDA, teratogens, isotretinoin, Accutane, birth defects, pharmacy programs, medication safety, pregnancy data, registries

🎧 Listen now to learn how REMS programs help protect pregnant women and their babies.