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so proud and delighted to have worked with Lisa, Carmella and Jane over the past year to have this published in the BMJ today. To find out different practices across the world has been fascinating but I so hope this informs clinical practice
Mothers have been reporting that they have been advised to interrupt breastfeeding or even stop altogether in order to have skin and patch allergy testing. This doesn’t seem based on evidence but possibly without national guidelines.
The allergens do not pass into the blood stream let alone breastmilk so there is no reason to interrupt breastfeeding.
Should you react severely to an allergen test and require administration of an antihistamine, an adrenaline injection (e.g. EpiPen) or a steroid that does not stop you breastfeeding as normal
Adrenaline/epinephrine injection e/g/ EpiPen ™. Ingredient present in milk but unlikely to be harmful as poor oral bioavailability . Half life 2 minutes so all gone from the body in 10 minutes.
Antihistamine – https://www.breastfeedingnetwork.org.uk/antihistamines/ Prednisolone – https://www.breastfeedingnetwork.org.uk/prednisolone/
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 firstname.lastname@example.org
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
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
this is the background to why I am so passionate about breastfeeding and drugs in breastmilk
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, 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.
Apple cider vinegar seems the “in” thing for weight loss at the moment, sipped in water and sometimes sweetened with honey. As the pandemic loosens it’s hold it seems that more breastfeeding mothers than usual are looking for an answer to weight loss.
There is no research data on whether it is safe in breastfeeding. It certainly isn’t something I would advocate: not least because there is no evidence, that I found, that it’s effective for weight loss although culinary use is unlikely to be an issue. Back to less in, more out – healthy eating and exercise – sigh!
I would NOT advocate this for any breastfeeding mother – or anyone else for that matter
I found this link interesting https://www.health.harvard.edu/blog/apple-cider-vinegar-diet-does-it-really-work-2018042513703?fbclid=IwAR037-joCZ_XbvfuIv48c3cGekHN6e35U1kP618RLh5tnJ5A-42Q_A5ZL7c from Robert H. Shmerling, MD
Senior Faculty Editor, Harvard Health Publishing. His words not mine:
What is the apple cider vinegar diet?
Apple cider vinegar comes from apples that have been crushed, distilled, and then fermented. It can be consumed in small quantities or taken as a supplement. Its high levels of acetic acid, or perhaps other compounds, may be responsible for its supposed health benefits. Although recommendations for “dosing” vary, most are on the order of 1 to 2 teaspoons before or with meals.
What can the apple cider vinegar diet do for you?
For thousands of years, compounds containing vinegar have been used for their presumed healing properties. It was used to improve strength, for “detoxification,” as an antibiotic, and even as a treatment for scurvy. While no one is using apple cider vinegar as an antibiotic anymore (at least, no one should be), it has been touted more recently for weight loss. What’s the evidence?
Studies in obese rats and mice suggest that acetic acid can prevent fat deposition and improve their metabolism. The most widely quoted study of humans is a 2009 trial of 175 people who consumed a drink containing 0, 1, or 2 tablespoons of vinegar each day. After three months, those who consumed vinegar had modest weight loss (2 to 4 pounds) and lower triglyceride levels than those who drank no vinegar. Another small study found that vinegar consumption promoted feeling fuller after eating, but that it did so by causing nausea. Neither of these studies (and none I could find in a medical literature search) specifically studied apple cider vinegar. A more recent study randomly assigned 39 study subjects to follow a restricted calorie diet with apple cider vinegar or a restricted calorie diet without apple cider vinegar for 12 weeks. While both groups lost weight, the apple cider vinegar group lost more. As with many prior studies, this one was quite small and short-term.
In all, the scientific evidence that vinegar consumption (whether of the apple cider variety or not) is a reliable, long-term means of losing excess weight is not compelling. (On the other hand, a number of studies suggest that vinegar might prevent spikes in blood sugar in people with prediabetes and type 2 diabetes by blocking starch absorption — perhaps that’s a topic for another day.)
Is there a downside to the apple cider vinegar diet?
For many natural remedies, there seems to be little risk, so a common approach is “why not try it?” However, for diets with high vinegar content, a few warnings are in order:
- Vinegar should be diluted. Its high acidity can damage tooth enamel when sipped “straight” — consuming it as a component of vinaigrette salad dressing is a better way.
- It has been reported to cause or worsen low potassium levels. That’s particularly important for people taking medications that can lower potassium (such as common diuretics taken to treat high blood pressure).
- Vinegar can alter insulin levels. People with diabetes should be particularly cautious about a high vinegar diet.
If you are trying to lose weight, adding apple cider vinegar to your diet probably won’t do the trick. Of course, you’d never suspect that was the case by the way it’s been trending on Google health searches. But the popularity of diets frequently has little to do with actual evidence. If you read about a new diet (or other remedy) that sounds too good to be true, a healthy dose of skepticism is usually in order.“
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