Following on from the information on miscarriage I decided I needed to carry on talking about the hardest topics for mothers and think about the unthinkable – stillbirth, a baby born sleeping, and how to deal with the subsequent milk supply. I could fervently wish this never needed to be read but I hope that it provides information for mothers, families and professionals in this awful situation.
This is one of the chapters of the new book I am just finishing and about breastfeeding with a chronic condition. So many people told not to breastfeed or to stop for medication. Hope this changes some of those concepts. Any queries please feel free to email firstname.lastname@example.org
I’ve realised that the information I wrote long ago now, on loss of a pregnancy and breastfeeding is not very detailed so today I have written a more detailed factsheet. My heart goes out to everyone who has to go through the loss of a baby through miscarriage. We dont talk about it openly often enough considering how common it is .
Sending hopeful rainbows for the future
Constipation in the neonate is a topic apparently rarely discussed in medical sources and may be seen as the domain of the health visitor or midwife. However, many “constipated” babies may be seen by their GP and be the cause of concern for their parents.
This factsheet is designed to provide information for parents and their professionals on what is normal with regard to baby poo and where interventions are required be that referral to breastfeeding expert or medical treatment.
Turmeric is a supplement recommended for the relief of inflammation in many chronic conditions. It is, of course, a spice used in curries.
When taken as a supplement levels are significantly higher than those used for culinary purposes.
This is the information on compatibility with breastfeeding that I found in LactMed https://www.ncbi.nlm.nih.gov/books/NBK501846/ (the emphasis is my own) :
Summary of Use during Lactation
Turmeric (Curcuma longa) rhizome contains curcuminoids such as curcumin. No data exist on the excretion of any components of turmeric into breastmilk or on the safety and efficacy of turmeric in nursing mothers or infants. Turmeric is “generally recognized as safe” (GRAS) as a food ingredient by the U.S. Food and Drug Administration. Turmeric is generally well tolerated even in high doses, but gastrointestinal side effects such as nausea and diarrhea, and rare allergic reactions have been reported, and it may increase the risk of bleeding in patients taking warfarin and antiplatelet drugs.
Because of a lack of data, turmeric in amounts higher than those found in foods as a flavoring should probably be avoided during breastfeeding.
Turmeric has been used as a galactogogue in India; however, no scientific data support this use. In Thailand it is reportedly used as part of a topical herbal mixture to shorten the time to full lactation and also part of a topical herbal mixture used for breast engorgement. Galactogogues should never replace evaluation and counseling on modifiable factors that affect milk production. In India turmeric is a component of a paste applied to the breasts for sore nipples. Contact dermatitis has been reported after contact of the skin with curcumin-containing products.
References from LactMed https://www.ncbi.nlm.nih.gov/books/NBK501846/
1.Sayed NZ, Deo R, Mukundan U. Herbal remedies used by Warlis of Dahanu to induce lactation in nursing mothers. Indian J Tradit Knowl. 2007;6:602-5.2.Chaudhuri RN, Ghosh BN, Chatterjee BN. Diet intake patterns of non-Bengali Muslim mothers during pregnancy and lactation. Indian J Public Health. 1989;33:82-3. [PubMed]3.Dhippayom T, Kongkaew C, Chaiyakunapruk N et al. Clinical effects of Thai herbal compress: A systematic review and meta-analysis. Evid Based Complement Alternat Med. 2015;2015:942378. [PMC free article] [PubMed]4.Ketsuwan S, Baiya N, Paritakul P et al. Effect of herbal compresses for maternal breast engorgement at postpartum: A randomized controlled trial. Breastfeed Med. 2018;13:361-5. [PubMed]5.Brodribb W. ABM Clinical Protocol #9: Use of galactogogues in initiating or augmenting maternal milk production, second revision 2018. Breastfeed Med. 2018;13:307-14. [PubMed]6.Amuthavalluvan V, Devarapalli J. Indigenous knowledge and health seeking behavior among Kattunayakan: a tribe in transition. Glob J Human Soc Sci. 2011;11. http://socialscienceresearch.org/index.php/GJHSS/article/view/198/161.7.Chaudhari SP, Tam AY, Barr JA. Curcumin: A contact allergen. J Clin Aesthet Dermatol. 2015;8:43-8. [PMC free article] [PubMed]
Collagen seems to be another frequent supplement I get asked about . Collagen is found in connective tissue and can be used during exercise routines but also in the prevention and treatment of wrinkles as well as to strengthen hair I believe.
There are no studies on passage into breastmilk and it would therefore be unethical for me to comment.
Sorry – another of the increasing number of natural products which seem to be attracting attention during lockdown and as we emerge.
With the launch of a new beauty cream containing retinol advertised as reducing wrinkles, the questions about beauty products similar to it have increased. Or maybe we all just need something to cheer us up during Lockdown.
There is no research on the use of topical retinols and the best information I have sourced is “Because it is poorly absorbed after topical application, it is considered a low risk to the nursing infant” (Lactmed accessed June 2020 studies referenced below.)
Hale (Medications and Mother’s Milk accessed June 2020 states “Tretinoin is a retinoid derivative similar to Vitamin A. It is primarily used topically for acne and wrinkling and sometimes psoriasis. Used topically, tretinoin stimulates epithelial turnover and reduces cell cohesiveness. Blood concentrations measured 2-48 hours following application are essentially zero.
I have been unable to access the full papers and so would recommend caution
- Leachman SA, Reed BR. The use of dermatologic drugs in pregnancy and lactation. Dermatol Clin. 2006;24:167-97. [PubMed]
- Zip C. Common sense dermatological drug suggestions for women who are breast-feeding. Skin Therapy Lett. 2002;7:5-7. [PubMed]
- Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation: Part II Lactation. J Am Acad Dermatol. 2014;70:417.e1-417.e10. [PubMed].
- Zbinden G. Investigation on the toxicity of tretinoin administered systemically to animals. Acta Derm Verereol Suppl(Stockh) 1975; 74:36-40.
- Lucek RW, Colburn WA. Clinical pharmacokinetics of the retinoids. Clin Pharmacokinet 1985; 10(1):38-62
Betahistine (Serc ) is prescribed for dizzines and vestibular problems. There is little research available on it, because it isnt marketed in USA where most of the research studies are conducted. Anecdotally it is quite widely used without apparent problems. Observe the nursing baby for signs of drowsiness/ poor feeding in case
This is the entry I made for Breastfeeding and Medication 2018
“Betahistine is prescribed for vertigo, tinnitus and hearing loss associated with Ménière’s disease. There is no data on the amount that passes into breastmilk . It is an analogue of histamine and is believed to work by improving the microcirculationn of the labarynth. Side effects are reported to include gastro-intestinal disturbances, headache, pruritus and rashes. Prochlorperazine or cinnarazine would be the preferred to drug to treat dizziness. If betahistine use is perceived as essential the baby should be observed for drowsiness, GI disturbance and rash. There are no animal studies on use during lactation. Plasma levels of betahistine are very low. Plasma protein binding <5% (manufacturer SPC) Anecdotally it has been used without problems in breastfed babies “
The BNF entry (online access May 2020 is ” Use only if potential benefit outweighs risk—no information available”.
Botox injections are used for many medical purposes including migraine, anal fissures. The amount of botox getting into milk is low based on the research on one mother who caught botulism from eating fermented salmon eggs. She continued to breastfeed. No botulinum toxin or botulism was found in the breastmilk or the baby. The doses that are used medically are far lower than that which would have caused the mother’s botulism so the amount in breastmilk is assumed to be too low to produce adverse effects.
Hale also comments that when Botox is injected into the muscle, it produces a partial chemical denervation resulting in paralysis of the muscle. When injected properly, and directly into the muscle, the toxin does not enter the systemic circulation. Thus levels in maternal plasma, and milk are very unlikely. Waiting a few hours for dissipation of any toxin would all but eliminate any risk to the infant. Also, avoid use of generic or unknown sources of botulinum toxin, as some are known to produce significant plasma levels in humans. (Hale TW Medications and Mothers Milk online version accessed May 2020)
It is normal during lactation to notice that your hair becomes thinner or may even appear to drop out in significant levels. In pregnancy we grow more hair and the apparent loss is usually just a return to normal.
It may however, be a sign of thyroid deficiency so always worth checking with your doctor and requesting a blood test to check levels, just in case.
Most of the commercially available products which claim to thicken, strengthen, promote growth of hair contain biotin in addition to the normal vitamins and minerals.
Symptoms of biotin deficiency include thinning hair, skin rash, and depression. The recommended daily dose of biotin for a lactating woman is 35 µg/day. Levels of biotin in human milk range from 5 to 9 µg/L, indicating that there is active transport of biotin into milk. No adverse effects have been found. (Hale Medications and Mother’s Milk)
Biotin (vitamin B7) is needed in very small amounts to help the body break down fat. The bacteria that live naturally in the bowel synthesise biotin, so it’s unclear whether supplements are necessary if a varied and balanced diet is eaten.. Biotin is also found in a wide range of foods, but only at very low levels. There’s not enough evidence to know what the effects might be of taking high daily doses of biotin supplements. Taking 0.9mg or less a day of biotin in supplements is unlikely to cause any harm. ( NHS Vitamin B https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-b/)
Vitamin and Mineral content compatible with breastfeeding https://breastfeeding-and-medication.co.uk/fact-sheet/breastfeeding-and-multivitamin-and-mineral-supplements