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Breastfeeding and Antidepressants Facebook Live Session.
I am delighted that, as part of the UK Maternal Mental Health Matters Awareness Week,I will be hosting a Facebook live session to highlight which medications used to treat maternal mental illness can be taken while breastfeeding. The session will be from this Facebook page and will take place 2nd May at 7pm.
We know this can be a difficult and confusing subject and we often hear that both mums and professionals are unsure of the correct guidance.
I won’t be able to answer any personal medication queries during the session but you can contact me afterwards should you require further information.
Today alone I have had email contacts from Peru, the Netherlands, USA and Italy. It shows how the problems around breastfeeding on medication are the same all round the world. It is sad that so often breastfeeding mums are told they have to stop breastfeeding in order to be treated for chronic or acute illness – usually unnecesarily and not using evidence based resources
it seems that more people ask about the use of codeine than any other drug. The changes in guidance following the MHRA report in 2013 and 2015 seem to cause much confusion. We need to be aware as mothers that if we take codeine and our babies become sleepy (sleep longer or more frequently) then this is a sign that we may have the metabolism that concentrates the drug in breastmilk and should stop taking the drug. It takes 15 hours to be clear from the system but unless the baby shows signs of breathing difficulties it isnt a reason to panic . If there are breathing difficulties medical help should be sought urgently.
Codeine should only be used if paracetamol and ibuprofen/naproxen/diclofenac are providing insufficient pain relief or are contra indicated.
Dihydrocodeine has a cleaner metabolism and as such is preferred as the opiate painkiller (co-dydramol when combined with paracetamol) . This generally requires a prescription. In some areas codeine is still prescribed to breastfeeding mothers, in others it is totally forbidden. In this fact sheet I have tried to provide the full research history so that you can make an informed decision about what is right for you and your baby. We should also be alert to the fact that codeine is very addictive to us as adults so longterm use unless under medical supervision should be avoided
Delighted to see the second of my babies published – UK and US versions and Kindle edition
This is a blog which I wrote for the new Human milk page Tailor made for Tiny Humans http://human-milk.com/
Wendy Jones Blog – Breastfeeding for Dads and Grandmas
I’ve just spent the Christmas holidays with my daughters, their partners and 3 grandchildren, two of whom are still being breastfed (21 months and 6 months). Having just had a new book published called Breastfeeding for Dads and Grandmas it made me think how different our holidays were in a very pro breastfeeding family than they might be in other families?
The son in law who has yet to have children, is totally comfortable with sitting next to his sisters in law as they breastfeed (on occasion let it all hang out!) and has been immeasurably supportive to his own sister. She was going to “give breastfeeding a go” but is now as committed as our family and doesn’t understand why anyone would feed in any other way.
However, the number of emails and Facebook messages from mothers suffering from anxiety since Christmas has reached unbelievable levels – on average 3 a day every day. Why might that be I wondered?
I suspect that for many other mothers spending longer than usual in close proximity to the extended family can be stressful. The emotions seem to run at fever pitch in the Festive Season – everyone wants it to be perfect. Most of us spend too much, eat too much, drink too much, don’t exercise as much and generally suffer from “liverishness” as my Grandma used to term it (usually with an added “everyone could do with a good dose of syrup of figs!”).
Nevertheless in this hot pot of emotion, parents try to manage their babies needs for quiet to feed or sleep, not to be cuddled by Great Aunt Ethel when they want Mum, don’t want to eat the rich offerings of solids suitable for babies (really?).
Inevitably the subject of infant feeding gets raised at some point during the visit. In our very pro-breastfeeding house the mums were supported. But what if you are with mother-in-law who formula fed your partner and makes no secret of her distaste of breastfeeding? How does your partner feel? How do you feel/ Desperate to keep the peace he might seem to agree with his mother. Neither of you wants to get into an argument but you are both secure in your decision to breastfeed. It is difficult isn’t it? If the baby cries you hear the comment “is he hungry again? Your milk can’t be good enough”. You are feeding quietly “what again? Surely you can’t have enough milk”. Feeding late at night/overnight/co-sleeping “When my children were babies they were in bed by 6pm and we didn’t hear from them again till 8am”. And Heaven forfend that you should dare to continue breastfeeding into toddlerhood!
It is no surprise that come January these new mums are anxious and more than a little depressed. Being a mum isn’t easy, these babies don’t read the books and don’t abide by any rules. Each baby is an individual and will reach his/her milestones in their own sweet time. Cherish every milky moment, every snuggle, every smile as all too soon they will grow up. When you feel that someone is criticising you smile sweetly, acknowledge the comment but then LET IT GO. This is your baby, you make the decisions. The advice on timing of feeds, weaning, sleeping has all changed dramatically in the fast 35 years (I know because I have been a mum in this time and gone on to support lots of others). It’s ok to breastfeed for comfort as well as nutrition, there is no such thing as using the nipple as a dummy, it is ok to co sleep if you want, it’s equally ok not to if you choose, it is also ok to ignore the advice of your mother, mother in law or Great Aunt Ethel!
Oh, cleaning and scrubbing will wait till tomorrow,
But children grow up, as I’ve learned to my sorrow.
So quiet down, cobwebs. Dust, go to sleep.
I’m rocking my baby. Babies don’t keep.
Song for a Fifth Child (Babies Don’t Keep)
by Ruth Hulburt Hamilton
I get asked frequently abvout breastfeeding after surgery to remove ingrowing toe nails. This involves the injection of a local anaesthetic and a couple of drops of phenol or sodium hydroxide to kill the area. Women are told they cant breastfeed for anything up to 3 days after this, sometimes that this means the end of their braestfeeding journey. Why? Every local guideline that I have sourced says no breastfeeding for at least 24 hours. So I looked for the evidence and research. It doesnt seem to exist. But nor is there evidence of harm and indeed I know of many mums who have breastfed asd normal with no reaction in their baby.
So this is what I beieve:
Ingrowing toenail removal using phenol to kill the nail bed in breastfeeding women
There appears to be no information in the literature on the use of liquified phenol to ingrowing toenails of a lactating woman. The following is reproduced from Martindale
Ingrowing toenails. Liquefied phenol (88%) ablation has been performed as an alternative to surgical avulsion in the treatment of ingrowing toenails.1,2 A systematic review3 concluded that simple nail avulsion combined with treating the nail-bed with phenol was more effective at preventing symptomatic recurrence of ingrowing toenails than cutting out the nail-bed. However, there was a significant increase in postoperative infections when phenol was used.
1. Bostanci S, et al. Chemical matricectomy with phenol for the treatment of ingrowing toenail: a review of the literature and follow-up of 172 treated patients. Acta Derm Venereol 2001; 81: 181–3.
2. Andreassi A, et al. Segmental phenolization for the treatment of ingrowing toenails: a review of 6 years experience. J Dermatol Treat 2004; 15: 179–81.
3. Rounding C, Bloomfield S. Surgical treatments for ingrowing toenails. Available in The Cochrane Database of Systematic Reviews; Issue 1. Chichester: John Wiley; 2003 (accessed 15/03/06).
Solutions containing phenol should not be applied to large areas of skin or large wounds since sufficient phenol may be absorbed to give rise to toxic symptoms. Phenol should not be used as a throat spray in patients with epiglottitis, or in children aged under 6 years.
Phenol is absorbed from the gastrointestinal tract and through skin and mucous membranes. It is metabolised to phenylglucuronide and phenyl sulfate, and small amounts are oxidised to catechol and quinol which are mainly conjugated. The metabolites are excreted in the urine; on oxidation to quinones they may tint the urine dark brown or green.
Adverse Effects: When ingested, phenol causes extensive local corrosion, with pain, nausea, vomiting, sweating, and diarrhoea. Excitation may occur initially but it is quickly followed by unconsciousness. There is depression of the CNS, with cardiac arrhythmias, and circulatory and respiratory failure, which may lead to death. Acidosis may develop and occasionally there is haemolysis and methaemoglobinaemia with cyanosis. The urine may become dark brown or green. Pulmonary oedema and myocardial damage may develop, and damage to the liver and kidneys may lead to organ failure. Severe or fatal poisoning may occur from the absorption of phenol from unbroken skin or wounds and suitable precautions should be taken to prevent absorption. Applied to skin, phenol causes blanching and corrosion, sometimes with little pain. Aqueous solutions as dilute as 10% may be corrosive. Toxic symptoms may also arise through absorption of phenol vapour by the skin or lungs. Phenol throat spray may cause local oedema.
However there is no reference to systemic effects or adverse effects following the application of the small amount of phenol applied to the nail bed in the short time scale necessary.
Further in a Public Health Statement issued by the Environmental Protection Agency in Canada (www.atsdr.cdc.gov/ToxProfiles/tp115-c1.pdf ) it is reported that “Vomiting and lethargy were the main symptoms observed in children following accidental ingestion of a disinfectant containing phenol. We do not know whether children would be more sensitive than adults to the effects of phenol. Two studies of women exposed to phenol and other chemicals during pregnancy did not provide evidence of birth defects. Some birth defects have been observed in animals born to females exposed to phenol during pregnancy. This generally occurred at exposure levels that were also toxic to the mothers. There is no information on levels of phenol in human breast milk.
Safety of phenol in drinking water
The EPA has determined that exposure to phenol in drinking water at a concentration of 6 milligrams per liter (mg/L) for up to 10 days is not expected to cause any adverse effects in a child. The EPA has determined that lifetime exposure to 2 mg/L phenol in drinking water is not expected to cause any adverse effects.
Absorption of topical products into breastmilk is restricted (Stoukides C Topical Medications and Breastfeeding. J Hum Lact 1993; 9(3) :185-7) so the limited quantity of liquid phenol applied to the nailbed during the procedure is unlikely to penetrate into breastmilk in any significant quantities. Considering the different biological membranes/systems which would have to be traversed before absorption from breastmilk, the application is unlikely to affect the breastfed baby in my professional opinion.
Local anaesthetics are poorly bio available and have a short half life and should not preclude normal breastfeeding after the procedure.
Anecdotally I am aware of many women who have undertaken the procedure and breastfed as normal without adverse effects on their breastfed infants.
Wendy Jones PhD MRPharmS