I spend on average 4 full hours across every day providing info to mums told they HAVE to stop breastfeeding to take medicines. Do more people know about the drugs in breastmilk service or are professionals less willing to take risks so stopping breastfeeding seen as best option? How can we change the conversation ?
Where does it make sense to tell mothers stop breastfeeding to take medicines when we have specialist support texts and services? Breastfeeding has HUGE advantages for mums, babies and the economy. We need to listen, support and provide evidence based info for all mums breastfeeding and formula feeding not rely on manufacturers
There are economic savings for the health economy. Renfrew (2012) provided a detailed cost analysis of potential savings, reductions in hospital admissions and GP appointments:
Assuming a moderate increase in breastfeeding rates, if 45% of women exclusively breastfed for four months, and if 75% of babies in neonatal units were breastfed at discharge, every year there could be an estimated:
- 3,285 fewer gastrointestinal infection-related hospital admissions and 10,637 fewer GP consultations, with over £3.6 million saved in treatment costs annually
- 5,916 fewer lower respiratory tract infection related hospital admissions and 22,248 fewer GP consultations, with around £6.7 million saved in treatment costs annually
- 21,045 fewer acute otitis media (AOM) related GP consultations, with over £750,000 saved in treatment costs annually
- 361 fewer cases of NEC, with over £6 million saved in treatment costs annually.
In total, over £17 million could be gained annually by avoiding the costs of treating four acute diseases in infants. Increasing breastfeeding prevalence further would result in even greater cost savings”
In addition, if half those mothers who currently do not breastfeed were to breastfeed for up to 18 months in their lifetime, for each annual cohort of around 313,000 first-time mothers there could be:
- 865 fewer breast cancer cases with cost savings to the health service of over £21 million, 512 breast cancer-related quality adjusted life years (QALYs) would be gained, equating to a value of over £10 million.
This could result in an incremental benefit of more than £31 million, over the lifetime of each annual cohort of first-time mothers.
Tickets booked and I’m off to Belfast on 4th August. 3 sessions planned – need to do some work after a few months off for surgery and healing!
Most people know of my involvement with BfN Drugline. This is a poster designed to be used publicly to spread awareness of the service
It seems form social media that many babies are now being diagnosed and treated for reflux (GORD). Before labelling a baby as having a medical condition it is often useful to seek input from a breastfeeding expert and consideration of the position the baby is in after a breastfeed. Not all babies who throw up need treatment!
This fact sheet covers the medication used to treat reflux and GORD in babies and the preparation of PPI drugs for babies
Saturday 6 October – I’m doing a workshop with my wonderful daughter Beth. May have to take turns holding baby Elodie
Routledge offering a discount on the second edition of my book. Useful for healthcare professionals who care about supporting breastfeeding or peer supporters who get the questions or parents who want to be informed by the evidence
Sadly our family has recently experienced the tragedy of an ectopic pregnancy and the loss of a very brief dream. This has made me much more aware of the incidence and risk of this condition over and above the post I wrote in April. So some more facts – as my friend commented today I hate to waste any opportunity to educate!
Ectopic pregnancy is a common, occasionally life-threatening condition, that affects 1 in 80 pregnancies. An ectopic pregnancy is when a fertilised egg implants itself outside of the womb, usually in one of the fallopian tubes. Symptoms usually develop between the 4th and 12th weeks of pregnancy. Women with an ectopic pregnancy may still be breastfeeding and wish to continue which can be supported.
- Ongoing bleeding that is sometimes red or brown/black and watery (like “prune juice”) should be investigated. The bleeding may be heavier or lighter than usual, but pregnancy test is still positive
- One-sided pain in your tummy which may be persistent or intermittent or a generalised discomfort with bloating and a feeling of fullness (not associated with eating) when lying down.
- Shoulder tip pain which is often described as pain unlike any you have ever experienced before. (Ectopic Pregnancy Trust)
Your GP will refer you urgently to the early pregnancy unit at your local hospital. You may have your Human Chorionic Gonadotropin (HCG levels) measured over a period of several days. If you are having a normal pregnancy these should double approximately every 48 hours. A smaller increase can indicate a risk of of this being an ectopic pregnancy but this will be confirmed with ultrasound scans, initially across your tummy. It is likely that a transvaginal (internal) ultrasound scan will be required where a specialised probe is placed into the vagina to get a more detailed look at the reproductive organs.
Unfortunately, if it is confirmed over a period that you have an ectopic pregnancy it is not possible to save the pregnancy and it must be removed either by surgery or the use of methotrexate. The cells have not been able to be nourished and can never develop into the baby you thought you were expecting which can be hard to deal with.
Rupture of ectopic pregnancy
In a few cases, an ectopic pregnancy can grow large enough to split open the fallopian tube. This is known as a rupture which can be very serious, and surgery needs to be carried out as soon as possible.
Signs of a rupture include a combination of:
- a sharp, sudden and intense pain in your tummy
- feeling very dizzy or fainting
- feeling sick
- looking very pale (NHS Choices)
Methotrexate and breastfeeding
Mothers who are currently breastfeeding an older child can continue 24 hours after the methotrexate is administered.
“It is apparent that the concentration of methotrexate in human milk is minimal, although due to the toxicity of this agent and the unknown effects on rapidly developing neonatal gastrointestinal cells, it is probably wise to pump and discard the mother’s milk for a minimum of 24 hours post dose if given as a single dose (e.g. 50 mg/m2 IM for ectopic pregnancy)” (Hale 2018).
Infant Monitoring: Should patient resume breastfeeding more than 24 hours after the last dose of maternal therapy, monitor the infant for vomiting, diarrhoea, blood in the vomit, stool or urine. Lab work could be drawn if clinical signs of liver or renal dysfunction, anaemia, thrombocytopenia or an inability to fight infection.
Lactmed reports a study of one mother who was given a single intramuscular dose of 65 mg (50 mg/square meter) of methotrexate for ectopic pregnancy. Six milk samples were obtained from 1 to 24 hours after the dose. Methotrexate was undetectable (<22.7 mcg/L) in all milk samples (Tanaka 2009). In some 20% of cases more than one cycle of methotrexate is required to expel the products of conception. For each cycle breastfeeding should be avoided for 24 hours.
Hale quotes a milk plasma ratio of > 0.08 and relative infant dose of 0.13% – 0.95%. Peak serum concentrations appear 30-60 minutes after intra muscular dose (Jones 2018). Pharmacokinetic data is very variable as there in considerable inter individual variation (Martindale 2017).
For more information on methotrexate administration, side effects and monitoring see www.ectopic.org.uk/patients/treatment/
Ectopic pregnancy and breastfeeding fact sheetBreastfeeding after surgery
After surgery breastfeeding can continue as normal as soon as you are awake and alert. If your nursling is unable to stay in hospital with you, you may need to express to avoid engorgement/blocked duct and to maintain your supply. Your expressed milk can be given to your baby at home. There is no need to pump and dump.
Breastfeeding and Antidepressants – Facebook Live Session with Wendy Jones tonight at 7.30 via the Perinatal Mental Health Partnership Facebook page at https://www.facebook.com/PerinatalMHPartnershipUK/
It’s the UK Maternal Mental Health Matters Awareness Week 30th April until 6th May and our theme today is how to access support from health care professionals.
The subject of breastfeeding and anti depressants often comes up with there being lots of misinformation about what medications are safe . Wendy held a similar session during last year’s awareness week and it received 15,000 views and was a great source of information.
Do tune in at 7.30pm.
One of the main messages we want to give mums and families is to empower them with information on how to access support to help their recovery from maternal mental illness.
One of the main areas of concern from mums is if they can take antidepressants if they are breastfeeding. There are medications you can take whilst breastfeeding, so tonight, the pharmacist Wendy Jones will deliver a Facebook live session providing information
on what anti depressants can be taken.
This session will be a great source of information for mums and health care professionals.
To join the session, simply come to the PMHP Facebook page at 7.30pm.
This is my blog written for the Breastfeeding Network for maternal mental health awareness week. Perinatal mental health and its impact on breastfeeding and vice versa is becoming a specific passion of mine. So sad that women are repeatedly told you cant have medication UNLESS you stop breastfeeding. Incorrect and unhelpful
Sadly recently I have heard from several mothers who have been diagnosed with an ectopic pregnancy. They have variously been told that they cant breastfeed again for 2 months and 3 months. One distraught mother planned to pump and dump her milk for 3 months with the hope that she could return to breastfeeding later.
We should be using evidence based information sources as NICE PH11 recommended originally back in 2008. NICE Guidelines – prescribing
So here is the information based on research. A mother administered methotrexate 50 mg/m2 IM for ectopic pregnancy can breastfeed as normal after 24 hours, In the meantime she should pump and dump to maintain her supply. She should not attempt to conceive for 3 months.