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MBRRACE-UK report concern over the safety of drugs in breastmilk in one case

MBRRACE–UK released their 5th report ‘Saving Lives, Improving Mothers’ Care’. It describes the lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity from 2014-2016. Here’s The Breastfeeding Network’s response.

The Breastfeeding Network (BfN) welcomes the report. While the research has found that the number of women dying as a consequence of complications during or after pregnancy remains low in the UK – with fewer than 10 out of every 100,000 pregnant women dying in pregnancy or around childbirth, the report highlights the unacceptable disparity in care for black and ethnic minority women. Shereen Fisher, Chief Executive for the Breastfeeding Network said, ‘The almost five-fold higher mortality rate amongst black women compared with white women requires urgent explanation and action. BfN welcome further exploration into this unacceptable disparity to ensure there is real change for black and ethnic minority women’.

A key concern, is the tragic case of a mother dying several weeks after her baby was born (Commencing treatment, dose and compliance page 39). There were delays in prescribing thromboprophylaxis because of concerns over breastfeeding.

Dr Wendy Jones, lead pharmacist for the BfN Drugs in Breastmilk Information service, said ‘I have long feared such a scenario. Physicians need to be aware how to check that a drug treatment is compatible with breastfeeding quickly, using evidence-based sources. The drugs in this case are widely used in the immediate postnatal period yet emergency medicine teams are often unable to access readily available evidence-based information on medication and breastfeeding as quickly as they need. The information should have been readily available in guidelines or a reference source including specialist information. The wording of the BNF: “Due to the relatively high molecular weight and inactivation in the gastro-intestinal tract, passage into breast-milk and absorption by the nursing infant are likely to be negligible, however manufacturers advise avoid” needs to be updated where the manufacturer is merely not taking responsibility in licensing the product. The removal of the words “manufacturer advises avoid” makes the information read very differently to a busy practitioner’.

Shereen Fisher, Chief Executive for the Breastfeeding Network said, ‘This sad case highlights the need for mothers to be able to access skilled support in their local communities, with staff alert for symptoms needing attention; the mother in question had multiple ‘fainting’ episodes postnatally that were not investigated until day 44. This emphasises the need for health care professionals in all front-line services to understand how to treat pregnant and breastfeeding mothers – until this happens women will continue to be exposed to risk and potentially loss of life. It feels that no-one listened to the mother or observed her and her baby as a dyad as closely as they should have done, possibly because breastfeeding was seen as a barrier to medication. Women should not be disadvantaged in the management of acute illness just because they are pregnant or breastfeeding, and communication needs to be improved throughout the multidisciplinary team.’

To read more you can download the full report, lay summary and the infographic here: https://www.npeu.ox.ac.uk/mbrrace-uk/reports

Breastfeeding and Orlistat for Weight Loss

orlistat and breastfeeding

Breastfeeding and lowering / stopping milk supply

Sometimes mothers want to reduce their breastmilk supply. I’ve provided some information and links on herbs and medications – some things have evidence of effectiveness, many do not.

lowering or stopping breastmilk supply

Progesterone (Cyclogest) and breastfeeding

Mothers who have suffered the trauma of previous miscarriages may be prescribed progesterone pessaries as soon as they become pregnant. This information sheet is designed to ease some of the worries in this situation or in the use of progesterone in IVF where a mother continues to breastfeed

progesterone (cyclogest) and breastfeeding

MRI, gadolineum and breastfeeding

There are ongoing queries about the use of gadolineum as a contrast agent for MRI procedures. This is the research I have accessed which suggests there is no need to interrupt breastfeeding at all

MRI and breastfeeding

MRI and breastfeeding

Breastfeeding and Inflammatory Bowel Disease

Many people know that I have had Crohns disease since I was 22 years old  – that was when it was officially diagnosed but probably from 4 years before when I was 18 years old. It has had an immense effect on my life firstly medically – I have had 3 bowel resections and been on medications since the last one in 2002 which very nearly killed me. The only times when I was really fit in and well were when I was pregnant and breastfeeding which sparked my interest in becoming a breastfeeding counsellor 31 years ago. It meant I fed my second and third daughters for much longer (I became very ill soon after I weaned my first) and became passionate about supporting women to breastfeed. As a pharmacist that rolled into an interest and then passion about drugs in breastmilk.

When I regularly had contact with mums with IBD asking about their medication I decided to set up the Facebook group as a mutual support group. Mums who understood the urgency of toilet visits when out shopping, understood how debilitating it was to be in constant pain, that we could discuss anything in a private forum with others in the same situation. Coincidentally it has become a place where people ask each other about drugs and look to me to provide evidence of safety in breastfeeding – that wasn’t the original intent but an excellent spin off.

 

I havent set up any other specialist interest groups – this is out of my personal interest. Unsurprisingly the diagnosis and treatment of inflammatory bowel disease has taken up a lot of space in my book Breastfeeding and Medication and I am keen that professionals understand that breastfeeding protects our babies but is also something which we value above many things.

As of this morning we have 556 members from all over the world, climbing steeply recently.

Specialists seem to be very concerned about the safety of the drugs – which are strong admittedly and breastfeeding. But we also need to bear in mind that IBD is at least partly linked with being formula fed so we want to maintain breastfeeding and use specialist sources.

Live vaccines may be delayed or omitted – particularly the rotavirus vacc. However, this is as much to protect the mother who may contract the illness from the viral particles shed through the faeces, Exclusively breastfed babies are at low risk if contracting rotavirus in any case.

I am going to admit that I am passionate about the subject – this is the core of my life

https://www.ncbi.nlm.nih.gov/m/pubmed/29857090/

CONCLUSIONS: In a study of women receiving treatment for IBD and their infants, we detected low concentrations of infliximab, adalimumab, certolizumab, natalizumab, and ustekinumab in breast milk samples. We found breastfed infants of mothers on biologics, immunomodulators, or combination therapies to have similar risks of infection and rates of milestone achievement compared with non-breastfed infants or infants unexposed to these drugs. Maternal use of biologic therapy appears compatible with breastfeeding.

IBD and breastfeeding

Breastfeeding and Neuropathic pain – gabapentin and pregabalin

On my mission again today to write information on the frequently asked questions by mothers and professionals. Neuropathic pain affects many mothers with chronic conditions and the data is not easy to find. I hope this information, much taken from my book, is useful.

If these fact sheets are proving helpful in your practice maybe you need a copy of Breastfeeding and Medication – available from Amazon and Routledge

neuropathic pain and breastfeeding

 

Terminations of pregnancy and Breastfeeding

I have had 6 mothers contact me in the past 72 hours asking about continuing to breastfeed an older child after a termination. It is hard enough to have to make the decision to terminate without having to lose the current breastfeeding experience. So here, without judgement, is the information that mothers, their family and professionals may need to protect that relationship.

This is data taken from my book. Why not buy a copy! £30.73 on Amazon today and worth every penny

terminations and breastfeeding

Opiates and the breastfeeding mother

I’m not sure how many ways I can provide this information. Multiple times EVERY day I hear of breastfeeding mothers being sent away with prescriptions and told to stop breastfeeding or are told they cant have strong pain killers if they are breastfeeding – so it is their choice! NHS why cant you understand that there are opiate options for breastfeeding mothers. Opiates should not be used as freely as they are or put onto repeats prescriptions without fully informing the patient that they are addictive. But sometimes we all do need help short term.

Opiates and the breastfeeding mother

If you are finding these fact sheets useful maybe you would find buying my book a valuable investment! £30.73 on Amazon today !

Breastfeeding and pain relief for acute back injury

So many mums seem to injure their backs – maybe we need antenatal classes on how to lift your baby (and equipment!) or more assessment of post-natal damage. When pain has not resolved with simple painkillers (paracetamol and ibuprofen (taken regularly and at full dose) sometimes further treatment is necessary from professionals. This may help the mother access physiotherapy or other mobility treatment.

Information here on how to treat the pain of acute back injury and relieve the spasm. I hope that it aids mothers and professionals.

Breastfeeding and pain relief for acute back injury