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 feeling over awed by the fact that the amazing MP Alison Thewliss put down an early day motion about my Points of Light award https://www.parliament.uk/edm/2017-19/1307 …
I’m emotional and inspired Thank you @alisonthewliss from the bottom of my heart
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
The development of anaesthetic data was prompted at least in part by the questions from mothers are diagnosis, treatment and surgery for gallstones whilst pregnant. Women are more likely than men to have gallstones and they are more common after the birth of several children so unsurprisingly this frequently covers breastfeeding mothers.
So here are my thoughts and a fact sheet on the topic
On a daily basis mothers are being told that they have to stop breastfeeding if they have a general anaesthetic. No consideration seems to be given to the risks of not breastfeeding it feels, nor that women breastfeed as normal after a caesarian section (although I admit this is less common than under a spinal block). There is no evidence in any of the papers I have found that says anything other than that a lactating woman can resume feeding as soon as she is awake and alert following the operation. If she is drowsy she needs to consider the risks of co sleeping.
I have drawn up a table from the recommendations in the 2 expert sources Lactmed and Hale in the safety of the commonly used drugs for anaesthesia and post operative pain relief. I hope this helps mothers and professionals to work together to protect, promote and support breastfeeding as long as mother and baby wish.
Hoping this helps some of the difficulties experienced by mothers who are already stressed at the idea of needing surgery.
Hoping to see lots of you at the BfN Conference in Birmingham on October 6 2018
So many contacts recently about thrush and breastfeeding I have decided to record a presentation I have made many times over the years. I will in a few days record one with detailed prescribing information for doctors and pharmacists . A copy of the slides will go onto my website www.breastfeeding-and-medication.co.uk. Hope this helps everyone. I have found it necessary to leave several social media groups for my own sanity after reading threads where non evidence based practice seems to get perpetuated. This is my view after looking at thrush and breastfeeding for the last 20 years.
Posted by Breastfeeding and Medication on Friday, July 20, 2018
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.