I asked for feedback on this question 12 months ago about pain during breastfeeding and finally time to write it up. Reading it again makes me sad. The pain of breastfeeding for some people cannot be ignored. I hope that this facilitates a discussion amongst professionals who see breastfeeding women. It’s important for mothers, for partners and for babies and time we stopped ignoring it.
This is the data that I extracted
Some links that may help everyone
A few weeks ago I asked on my facebook page for experience of using contraception whilst breastfeeding using a googledoc survey. I had just under 80 responses in 24 hours and here I have tried to analyse the results. Five mothers reported that their supply was affected by the use of contraception. Many more were unhappy with the information that was given before prescription of the contraceptive. Food for thought
Please see https://www.breastfeedingnetwork.org.uk/contraception/ for information on the contraceptives and https://www.breastfeedingnetwork.org.uk/ehc/ on emergency hormonal contraception which I wrote for BfN.
In November 2015 we set up the BfN drugs in breastmilk facebook page with the help of a small group of admins to signpost to factsheets. The page has grown and grown in popularity and takes thousands of questions every year. I have been supported by Amanda a fellow pharmacist over the last 5 or maybe more years giving me one evening and then one day a week off and some much needed support. But last year I made the decision that I wanted to stop. I wanted my life back, evenings not checking my phone, a holiday without answering queries – something I havent had since 1998! I. I’ve been answering questions on the compatability of drugs in breastmilk since 1995. I’ve had 2 days totally off since then – my 65th birthday and the magical day at Windsor.It’s brought many joys, and some sadness but proudly for me an MBE for services to mothers and babies.
So began a plan to recruit and train some more pharmacists to help and keep the support going. Eleven lovely young pharmacists volunteered and in May ten of them finished the training and are ready now to take over in a rota.
This weekend I will be leaving the BfN facebook page although I will continue to answer emails whilst the team settle over the next few months.
I’M NOT GOING AWAY THOUGH – I’m just pulling back to my own facebook page and this website. So will still be available to answer questions in either place https://www.facebook.com/breastfeedingandmedication/ or email@example.com
A podcast recorded with Boobingit and pharmacist Sarah Robinson
Another chapter from my book Breastfeeding and Chronic Medical Conditions today on the treatment of migraines which affect so many people. Migraines are miserable, when you have to continue to deal with a baby or toddler or older child and cant go and sleep in darkened room they can break the best. This factsheet goes through some of the treatments for breastfeeding including sumatriptan. Hope it helps. Maybe time to buy the very reasonably priced book available from Amazon ? https://www.amazon.co.uk/Breastfeeding-Chronic-Medical-Conditions-Wendy/dp/B08HTG6LBK/ref=sr_1_1?dchild=1&keywords=breastfeeding+and+chronic+medical&qid=1622820951&sr=8-1
I am very proud to support all the breastmilk banks in the UK who provide milk to mothers of neonates. I was intensely grateful just over a year ago when my youngest grand daughter was born early, weighing just 3 and a half pounds. My daughter had fed 2 other children and like me is passionate about exclusive breastfeeding. However, she was exhausted trying to pump and stimulate her supply for our little wee scrap to keep her blood sugars up. She was given the gift of a small volume of donated breastmilk which took the pressure off for a few hours to allow her to sleep. Of course this was all during the height of the pandemic and she was seperated from her husband and children. She described it this way: ” It was if the donor mums were holding both of us safe, they were feeding my baby for just a few hours whilst I regained my strength. I can never thank those mums enough for that relatively small amount of milk (24ml), which was worth so, so much to me. By the following morning I had enough milk to provide the supplements through the NG tube“
Milk from donating mothers has to be free of medication which might affect the health of the tiny, vulnerable pre-term. I have drawn up this list but it seems to change regularly . Thank you to every mum who makes the precious donation of breastmilk
In the final of the sheets on antidepressant / anti anxiety SSRIs is fluoxetine. It is often looked on as the least compatible with breastfeeding because of its long half life and greater passage into milk. However, it is often used in pregnancy because there are a significant number of studies https://www.medicinesinpregnancy.org/Medicine–pregnancy/Fluoxetine/. What is perhaps less well known is that if a mother has taken it throughout pregnancy the baby MAY be very drowsy in the first few days after delivery as it withdraws from the higher levels achieved through placental transfer.
My recommendation for any mother taking fluoxetine during pregnancy and wishing to breastfeed is to learn hand expression in preparation https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/breastfeeding-resources/hand-expression-video/ and to maybe discuss antenatal expression of colostrum with the midwife, just in case the baby is sleepy and taking time to latch effectively. Colostrum can raise blood sugars in very small amounts. (This is really helpful info for the red flags of low sugar and in my opinion explains everything well https://www.guysandstthomas.nhs.uk/resources/patient-information/maternity/protecting-your-baby-from-low-blood-glucose.pdf)
So you can breastfeed after delivery if you have taken fluoxetine but you may need a little help and support. Seek this antenatally so you are well prepared.
I would also add that if fluoxetine has been the SSRI that you have used and found effective in the past, then that would make it the first choice in breastfeeding. Some babies are colicky, some are drowsy, some vomit, some have loose diarrhoea – but we cant tell in advance.
I remember the very first study I looked at on fluoxetine some 25 or more years ago that the mother and the baby’s paediatrician thought the baby hadnt changed behaviour when exposed to fluoxetine via his mother’s breastmilk. The baby’s father (also a paediatrician) perceived it as more irritable and on that anecdotal basis back then it was said that fluoxetine made babies irritable. I cant find the report any more but if we had been able to see into the family unit we may have seen a dad trying to help his partner whilst working and feeling stressed himself. Who knows?
I hope this information is useful to anyone taking fluoxetine whilst breastfeeding