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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
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.
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
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.
If you are finding these fact sheets useful maybe you would find buying my book a valuable investment! £30.73 on Amazon today !
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.
Using cocaine when breastfeeding is obviously not a good idea, apart from being illegal. But from messages I get almost every week it seems not uncommon. Everyone says that they are embarrassed and regretful and promise not to do again but need to know how to maintain milk supply and keep baby safe. In my quest to provide information to frequently asked questions this is detailed research on cocaine and the breastfeeding mother taken from an article I wrote for The Practising Midwife (Jones W Cocaine use and the breastfeeding mother. Pract Midwife. 2015 Jan;18(1):19-22.) as well as my book Breastfeeding and Medication
Every year there are many questions on coughs, colds and sore throat so thought I would pre-empt them this year by recording a live video as well as the links and fact sheets
Hope everyone has a healthy winter !
Lots of coughs and colds starting already so some information to pre-empt the questions which come every year
Posted by Breastfeeding and Medication on Thursday, September 13, 2018
Having had to support a mum with a fracture this week told that she could have adequate analgesia or breastfeed but not both I have decided to cut this out if the anaesthesia document so that it stands alone. I continue to be frustrated by the lack of understanding of professionals about normal breastfeeding let alone term or extended breastfeeding even where this is below the 2 years recommended by WHO. I’m going to keep on supporting mothers to challenge poor information using the hashtag #usetheevidence. In 2008 NICE issued a recommendation about using specialist sources on the safety of drugs in breastmilk and not relying on the licensing of drugs whereby virtually no medicine can be prescribed to a lactating mother. Buy a specialist text Breastfeeding and Medication!
Who is the target population?
Hospital doctors, GPs, obstetricians, pharmacists, specialist nurses, dentists and PCT medicine management teams.post op analgesia
Who should take action?
What action should they take?
- Ensure health professionals and pharmacists who prescribe or dispense drugs to a breastfeeding mother consult supplementary sources (for example, the Drugs and Lactation Database [LactMed] or seek guidance from the Specialist Pharmacy Service.
- Health professionals should discuss the benefits and risks associated with the prescribed medication and encourage the mother to continue breastfeeding, if reasonable to do so. In most cases, it should be possible to identify a suitable medication which is safe to take during breastfeeding by analysing pharmokinetic and study data. Appendix 5 of the ‘British national formulary’ should only be used as a guide as it does not contain quantitative data on which to base individual decisions.
- Health professionals should recognise that there may be adverse health consequences for both mother and baby if the mother does not breastfeed. They should also recognise that it may not be easy for the mother to stop breastfeeding abruptly – and that it is difficult to reverse.
Continuing to work down the list of frequently asked questions and adding information from Breastfeeding and Medication 2018
If you are a professional or a volunteer frequently encountering questions from mothers or other members of the family maybe you would like to treat yourself to a copy!
The ear drops I am asked about most frequently asked about are OTOMIZE and LOCORTEN VIOFORM but this fact sheet contains many others. Hope it puts everyone’s mind at rest. I remember a consultant many years ago telling a mother she couldn’t breastfeed for 2 weeks after using anti inflammatory ear drops. Unless she was going to drip excess out of the ear canal onto her nipples I could see no logic for this. I hope things have moved on but the patient information leaflet still causes concern.
I’m trying to build fact sheets on the drugs I am most frequently asked about. One that comes up frequently is propranolol to prevent migraines, to relieve anxiety and to remove symptoms of over active thyroid. Propranoolol can be used by breastfeeding mothers so long as they are not asthmatic.
Lots of people seem to be interested in using CBD oil for chronic pain and/ or for anxiety. Sadly there is no research on the amount that passes through into breastmilk so I am unable to say whether it is safe for a breastfeeding mother to take or not at this time