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One of the hardest questions I have to answer. I want to help but I need to keep the breastfed baby safe too
Avoid if possible. Use for as short a time as possible. Observe baby for drowsiness. Avoid falling asleep with the baby in bed, on a chair or sofa
Committee on Safety of Medicines advice
1 Benzodiazepines are indicated for the short-term relief (two to four weeks only) of anxiety that is severe, disabling or subjects the individual to unacceptable distress, occurring alone or in association with insomnia or short-term psychosomatic, organic or psychotic illness.
2 The use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate and unsuitable.
3 Benzodiazepines should be used to treat insomnia only when it is severe, disabling, or the individual is caused extreme distress.
Bisoprolol use seems to be increasing from the queries I receive. It is difficult to assess safety as published information relies on one study where the level in milk was undetectable BUT the baby was not given any of its mother’s milk. If other beta blockers are not suitable then the baby should be monitored closely for side effects and particularly hypo-glycaemia if newborn.
BNF ” With systemic use in the mother, infants should be monitored as there is a risk of possible toxicity due to beta-blockade. However, the amount of most beta-blockers present in milk is too small to affect infants.”
Sometimes mothers want to reduce their breastmilk supply. I’ve provided some information and links on herbs and medications – some things have evidence of effectiveness, many do not.
Mothers who have suffered the trauma of previous miscarriages may be prescribed progesterone pessaries as soon as they become pregnant. This information sheet is designed to ease some of the worries in this situation or in the use of progesterone in IVF where a mother continues to breastfeed
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