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Category Archives: Thoughts
Identifying the cause of breast and nipple pain during lactation
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
Identifying the cause of breast and nipple pain during lactation
Skin allergy tests and breastfeeding
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.
Medication
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/
Skin allergy tests and breastfeeding
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, 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.
Certolizumab pegol (Cimzia) and Breastfeeding
Certolizumab pegol is anti TNF alpha drug used to treat rheumatoid arthritis, Crohn’s disease, psoriatic arthritis, and ankylosing spondylitis. What makes it different is that it is the first drug I can remember which has been licensed for use in pregnancy and in breastfeeding. This means that the manufacturer in applying for marketing authority has accepted that it is safe. www.medicines.org.uk/emc/product/7387/smpc
Recently I have found myself suggesting it to mothers who are at the point of needing methotrexate to control their symptoms and therefore needing to stop breastfeeding.
I have to congratulate the manufacturer UCB Pharma on taking this very positive step and hope others follow suite. Please note I have no links financial or otherwise with them.
This is the study
A very special day in my life – awarded an MBE and presented with it by Her Majesty The Queen
On Friday March 22nd I had one of the most wonderful, magical days of my life – I was presented with my MBE by Her Majesty the Queen at Windsor Castle. I was lucky enough to have all 3 of my amazing daughters and my wonderful husband there to share it with me as they have shared my journey.
Lots of people asked me in the week up to the Investiture if I knew which member of the Royal Family would be performing the ceremony. I didn’t know until about 5 minutes before I entered the Castle when one of the members of staff told me – tears immediately sprang to my eye (why did I use mascara!). This was beyond my wildest dreams as I am a Royalist and have been hoping that this would happen. I knew Prince Charles was abroad and that Prince William had presided over one earlier in the week but wasn’t quite sure. Only 2 Investitures a year are held in Windsor Castle so that in itself was a privilege. We were booked into a hotel literally opposite the Castle and it seemed unreal as I woke up on Friday that in a few hours I would be inside with all the magical pomp and ceremony that Great Britain does so well.
We drank champagne in our room that morning with our 3 wonderful daughters Kerensa, Beth and Tara who had travelled to be with us and with 2 sons in laws as well as Isaac and Elodie (and Tara’s bump!). The other 2 grandchildren were at school.
We joined the queue of people awarded honours and their families to enter the Castle at 9.45 and were directed up through the grounds which I had watched during the wedding of Meghan and Prince Harry. To see the history unravelling before us as we entered through this beautiful building and to see the wonderful art was quite spell binding.
I was directed into a room with other nominees to mingle and drink apple juice. All the staff were so supportive and kind, no doubt used to witnessing the nerves. I met several people from Hampshire and listened to their stories but what struck me was how “ordinary” everyone was, all of us still astonished to have been given the awards. Mine was for services to mothers and babies. We were given clear instructions on the ceremony and how to bow or curtsey as well as address Her Majesty, we filed nervously through rooms to the Waterloo Room where we were to receive our medals.
As I stood there, I tried to take it all in, that I had come to be here seemed truly amazing. I just follow my dreams and do what means the world to me which is help mums and babies continue their breastfeeding relationship when mum needs medication short or long term.
I managed my curtsy and approached the Queen who smiled encouragingly at me and asked about my role. She even laughed at my description of what I do and commented that it must be very interesting. She held out her hand to shake mine and I walked backwards to curtsy again and leave. My moment was over but will be etched in my memory for all time. I even got to say “breastfeeding” to the Queen!
We had professional photographs taken and took others outside which I will share with you
Thank you to everyone who supports what I do, those who signpost, mums who find their way here and professionals too who try so hard to provide information. Mary Broadfoot and Phyll Buchanan who made this all possible initially and who encouraged me. BfN for continuing to support me. Last but very much not least my family who listen support, encourage me and take on my passion too, This has been an amazing journey for me, and I feel humble and proud to have been awarded this decoration. I won’t be stopping the work anytime soon. Wendy
Cannabis and Breastfeeding
Cannabis use on a regular basis by breastfeeding mothers concerns me. Cannabis has a long half life (25-57 hours) and it takes 5 times this to be removed from milk. THC crosses the blood brain barrier and it is known to accumulate in body fats. Although it is highly protein bound and subject to first pass metabolism, the milk plasma ratio is 8. We do not know enough about the impact on the developing brain to be sure that the amount passing through breastmilk is safe. Regular use is not recommended in the breastfeeding mother or other members of the family who may expose the baby through passive inhalation.
Breastfeeding and Cannabis factsheet
Terminations of pregnancy and 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! Worth every penny
terminations and breastfeeding
Post operative analgesia for the breastfeeding mother
Having had to support a mum with a fracture this week told that she could have adequate analgesia or breastfeed but not both I have decided to cut this out if the anaesthesia document so that it stands alone. I continue to be frustrated by the lack of understanding of professionals about normal breastfeeding let alone term or extended breastfeeding even where this is below the 2 years recommended by WHO. I’m going to keep on supporting mothers to challenge poor information using the hashtag #usetheevidence. In 2008 NICE issued a recommendation about using specialist sources on the safety of drugs in breastmilk and not relying on the licensing of drugs whereby virtually no medicine can be prescribed to a lactating mother. Buy a specialist text Breastfeeding and Medication!
Prescribing https://goo.gl/VvMxqT
Recommendation 15
Who is the target population?
Hospital doctors, GPs, obstetricians, pharmacists, specialist nurses, dentists and PCT medicine management teams.post op analgesia
Who should take action?
NHS trusts responsible for maternity care and GP surgeries, community health centres, pharmacies and drug and alcohol services.
What action should they take?
- Ensure health professionals and pharmacists who prescribe or dispense drugs to a breastfeeding mother consult supplementary sources (for example, the Drugs and Lactation Database [LactMed] or seek guidance from the Specialist Pharmacy Service.
- Health professionals should discuss the benefits and risks associated with the prescribed medication and encourage the mother to continue breastfeeding, if reasonable to do so. In most cases, it should be possible to identify a suitable medication which is safe to take during breastfeeding by analysing pharmokinetic and study data. Appendix 5 of the ‘British national formulary’ should only be used as a guide as it does not contain quantitative data on which to base individual decisions.
- Health professionals should recognise that there may be adverse health consequences for both mother and baby if the mother does not breastfeed. They should also recognise that it may not be easy for the mother to stop breastfeeding abruptly – and that it is difficult to reverse.
https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/full/10.1111/anae.15179
