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Yearly Archives: 2020
Virtually every day I get messages from mothers and health visitors querying whether mothers can continue to breastfeed after CT and MRI scans. I was told that the national guidelines had been updated some years ago to align with RANZR guidelines . Sadly guidelines dont seem to have been updated by all radiology departments from my experience despite an update on 25.1.22 (see below)
I was lucky enough to work with Dr Gabrielle Cronin on this paper which was published in the Irish BMJ
Most mothers are advised to stop breastfeeding for 24 hours but there is no evidence for this as most contrast media are not orally bio available and have half lives which do not justify this duration.
On 25 January 2022 this was published by the Society of Radiologists :
https://www.sor.org/news/sor/sor-issues-joint-statement The Society has issued guidance to reassure patients after recent research showed a lack of awareness among imaging teams on the most up-to-date evidence and guidance for breast-feeding patients who require a CT or MRI with contrast.The current Royal College of Radiologists (RCR) guidance published in 2019 relating to MR states:While no special precaution or cessation of breastfeeding is required the continuation or cessation of breastfeeding for 24 hours should be at the discretion of the lactating mother in consultation with the clinician.The SoR and RCR refer to the guidance published by The Royal Australian and New Zealand College of Radiologists (RANZCR) regarding CT contrast which says:Cessation of breast feeding or expression and discarding of breast milk after iodinated contrast media administration are not required.The Breastfeeding Network has summarised the advice of a number of expert organisations across the globe which is available on their website .The very small potential risk associated with absorption of contrast medium is considered insufficient to warrant suspending breastfeeding for any period following iodinated contrast agent administration.It is the view of the RCR and SoR that patients who wish to continue breastfeeding after being administered with contrast agent should be able to do so as there is no evidence of risk to the baby/child.Position statement – for patients. The Society of Radiographers (SoR) and the Royal College of Radiologists (RCR) are aware of conflicting opinions about whether patients who are administered with contrast agents – usually as part of a CT or MRI scan– can breast feed as part of their normal routine.It is the view of both the RCR and the SoR that patients who wish to continue breastfeeding after being administered with contrast agent – usually given in advance of a CT or MRI scan – should be able to do so as there is no evidence of risk to the baby/child. If you have any concerns please, speak with your radiographer or radiologist.
I have shared the chapter on ADHD from my book Breastfeeding and Chronic Medical Conditions multiple times this week. Many mothers seem to be diagnosed in later life and are concerned about breastfeeding. Hope this is a useful link.
If this is useful maybe you need the book available on Amazon. I published on Kindle to try to make this more affordable and available to mothers and breastfeeding supporters as well as professionals
Fibromyalgia is incredibly difficult to deal with when you have a baby. The most effective intervention is CBT. Please read this factsheet which is a chapter from my book Breastfeeding and chronic medical conditions available on amazon https://tinyurl.com/mbbebe8x
The rise in the statistics on COVID seems to be exacerbating symptoms of depression for many, many people. I can totally identify with that because I am immunocompromised myself due to medication and have very much gone back into Shield mode.
Many of the queries I have had in the last week relate to mothers who need to begin, increase or change their antidepressant medication but are being advised to stop breastfeeding to do so. There is evidence that stopping breastfeeding in itself lowers mood – you have a baby who wants to be breastfed and is fighting the change, you loose oxytocin, you become engorged – it isnt as easy as “stop now” might sound.
This is the chapter on depression from my new book Breastfeeding and chronic medical conditions. I hope the chapter helps in itself but maybe you would like to buy it and learn more about how drugs get into milk.
I will of course answer any queries you have email@example.com
I am so very tired of breastfeeding mothers who need colonoscopies and endoscopies being told that they need to interrupt breastfeeding. I am currently trying to engage with the national body to update national guidelines. Interestingly it is the same old story – we dont see breastfeeding women needing these examinations. So how come I do?
This is the evidence that I have put together and am desperate to share with clinicians.
This week I posted a link to a recently published paper which concluded that poor pain relief after a C section affected breastfeeding. https://consultqd.clevelandclinic.org/following-cesarean-delivery-postoperative-pain-affects-likelihood-of-in-hospital-breastfeeding/
I was saddened that we even had to think that pain would not be managed well for any mother, let alone when she was trying to initiate breastfeeding. It isn’t always easy to life a baby from a cot side crib when you have had surgery, let alone try to position a baby to achieve the perfect latch.
What surprised and horrified me was the mother’s who replied that they hadnt been given good pain relief when in hospital. They mentioned:
- not being told that more than paracetamol was available
- being offered only paracetamol and ibuprofen even when they needed more
- being forgotten on medication rounds,
- being discharged without sufficient pain relief.
This just isnt good enough and I would hope that everyone to whom this applies contacts the ward directly or through PALS that pain management plans are essential.
Pain relief which should be given to a breastfeeding mum in my opinion:
- In theatre a non steroidal anti inflammatory eg diclofenac as a suppository
- On the ward there should be available oramorph (subject to extensive first pass metabolism so little in milk)
- Regular use of an NSAID – ibuprofen, diclofenac or naproxen (low levels in milk) plus paracetamol
- Codeine is no longer recommended but dihydrocodeine can be offered https://breastfeeding-and-medication.co.uk/thoughts/breastfeeding-and-codeine
- Discharge packs should include the NSAID offered in hospital plus limited number of dihydrocodeine and if necessary oramorph. This may challenge the formulary in the hospital but can be overcome simply with care and thought for the patient.
NO WOMAN SHOULD BE LEFT IN PAIN BECAUSE SHE IS BREASTFEEDING
I have been working with a small team of anaesthetists for some time to develop guidelines so that breastfeeding mothers can have surgery, pain relief etc and continue to breastfeed as normal. The guideline also recommends support for the mother in terms of pumps, information and her baby nearby – not necessarily in that order.
As we begin World Breastfeeding Week 2020 I am proud to share this guideline and infographic
Guideline on anaesthesia and sedation in breastfeeding mothers https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1111/anae.15179
Recently whilst writing the planned book (hopefully coming soon) I decided to update the section on the website about “Who Am I?” It is about how I came to have this passion and to write my books and the inspiration and support of my husband, my girls and my grandchildren.
I hope it explains a little more about what drives me to do this 18 hours a day 365 days a year.
Do you want to buy a copy of one of my books? They are all available on Amazon which is probably easiest. Or direct from the publishers Routledge, Pinter and Martin, Praeclarus Press or Kindle . I’m not going to available as much in the future to answer questions so maybe now is the time to buy the books so you have answers 24/7 365 days a year.