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Depression and breastfeeding
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 wendy@breastfeeding-and-medication.co.uk
More information: depression and breastfeeding factsheet
Breastfeeding and Chronic medical conditions
I’m very proud to announce the arrival of book 5 “Breastfeeding and Chronic Medical Conditions”. It is an accumulation of the knowledge which I have gained over the past 25 years in supporting breastfeeding mothers and answering their questions.
It has been my “brain dump” so that hopefully I can move forward gradually to spending more time with my family than answering questions. The latter has rather taken over my life now. COVID has made me think about my priorities but lockdown gave me the opportunity to write this whilst I was shielding,
I hope that it helps mothers and professionals make risk benefit decisions on how to help mums with chronic conditions manage their lives and breastfeeding.
My book is available in paperback or kindle format on Amazon https://www.amazon.co.uk/Breastfeeding-Chronic-Medical-Conditions-Wendy-ebook/dp/B08HWZRVVT/ref=sr_1_1?dchild=1&keywords=breastfeeding+and+chronic+medical&qid=1600085418&sr=8-1
Bi polar disorder and breastfeeding
This is one section of the new book that I am currently working on and should hopefully be available in kindle format shortly
bipolar disorder and breastfeeding fact sheet
Colonoscopy and Endoscopy in breastfeeding women
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.
colonoscopy and endoscopy in lactating women factsheet
Breastfeeding and pain relief after a c section
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/dihydrocodeine-and-breastfeeding)
- 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
Anaesthesia and 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 women 2020
Infographic guideline on anaesthesia and sedation in breastfeeding women
My Story
this is the background to why I am so passionate about breastfeeding and drugs in breastmilk
Who am I and how did I come to set up this website?
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.
Books to buy
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, or Praeclarus Press. 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.
Glucosamine and chondroitin supplements during breastfeeding
Again I wonder if this is a consequence of the Lockdown but more breastfeeding mums seem to have taken up running again or for the first time. We have all needed to take exercise in this strange world the past few months.
This is the information on glucosamine and chondroitin during breastfeeding – enjoy your running. Yes it is safe in breastfeeding : https://kellymom.com/bf/can-i-breastfeed/lifestyle/mom-exercise/
Glucosamine
Glucosamine is either derived from shellfish or synthetically produced. The shellfish derived product should be avoided by anyone with a shellfish allergy.
It is most commonly used to treat osteoarthritis and joint pain or to prevent joint damage. A glucosamine derivative, N-acetylglucosamine, is a normal component of human breastmilk. Glucosamine occasionally causes stomach discomfort in adults but is generally well tolerated. There are no studies on levels in breastmilk but it is poorly absorbed and metabolised in the liver so levels absorbed by the breastfed baby are likely to be very low.
Chondroitin
Chondroitin is a mixture of large glycosaminoglycans and disaccharide polymers, usually derived from shark or bovine cartilage. It is most commonly used to treat osteoarthritis because it acts as a flexible connecting material between the protein filaments in cartilage.
Chondroitin is poorly absorbed orally with a bioavailability of about 10%. Its molecular weight averages 50,000 Daltons so is unlikely to be absorbed by breastfed babies at all.
It is well tolerated in mothers with occasional gastrointestinal upset reported. Although no studies exist on the use of chondroitin sulphate supplements during breastfeeding, small amounts occur naturally in breastmilk. Mothers of preterm infants excrete greater amounts of chondroitin into breastmilk than mothers of fullterm infants.The use of chondroitin by a nursing mother is unlikely to adversely affect the breastfed infant.
References
Coppa GV, Gabrielli O, Zampini L et al. Glycosaminoglycan content in term and preterm milk during the first month of lactation. Neonatology. 2011;101:74-76. https://pubmed.ncbi.nlm.nih.gov/21934331/
Hale TW Medications and Mothers Milk