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Table 4 Examples of enquiries received and answers given

From: Enquiry analysis and user opinion of the Drugs in Breastmilk Helpline: a prospective study

Enquiry Helpline response Resources used by Helpline
‘At around 37 weeks pregnant I had assumed that as I had been told to continue my medication (antidepressant) during pregnancy that it would be ok to breastfeed too, but I raised the query with the registrar at my clinic just to double check. He said he thought it would be fine but would check in a book; he did this while I waited and then told me the book said I should not breastfeed. He said he would check with the hospital pharmacy and let me know. I received a letter informing me it was ok for me to breastfeed whilst taking the medication about 4 weeks after my baby was born. Luckily enough I had contacted BfN rather than wait for the hospital to let me know!!’ Information of studies carried out were supplied and an explanation was given that it was important for the patient to continue to take the medication so that she remained well, and that the benefits of breastmilk to her child far outweighed any risk to the baby through her taking medication. The amount of drug passing to the baby was discussed with the mother along with any potential side effects to look out for. Information was provided using: · Hale· Lactmed (http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT)
‘Got a bad back and wanted to know if it was safe to take naproxen or co-codamol (combination paracetamol/codeine product). Both the doctor and chemist said it was ok to take the medicines’. The mother was provided with information from Hale on the half lives of the drugs and how long the drug would remain in the mother’s breastmilk. Naproxen has a half life of 12–15 hours and the amount passing into breastmilk is more than other non steroidal anti-inflammatory drugs such as ibuprofen or diclofenac. This makes it less preferable if the baby is under 6 weeks of age before which time hepatic and renal function is lower. There have been concerns raised about the safety of co-codamol during breastfeeding following the death of a baby in Canada. The mother was counselled to watch for signs of unusual drowsiness and poor feeding in the baby. If she noticed these responses she was advised to stop the drug and seek medical advice. Information was provided using:  · Hale · Lactmed (http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT) · http://www.breastfeedingnetwork.org.uk/pdfs/Analgesia_and_breastfeeding_March_2010.pdf
http://www.breastfeedingnetwork.org.uk/pdfs/Codeine-in-breastfeeding-June-08.pdf
Have bleeding cracked nipples, slight inversion so using nipple shields. Want something for pain and also want to know what formula to use as concerned about milk supply. Spoke with GP, pharmacist and nurse but none gave a very clear answer. Discussed moist wound healing and the need to feed or express milk more frequently. Tried to arrange a home visit from a breastfeeding supporter to help with optimising attachment of the baby at the breast, thereby preventing further nipple trauma. Mother was contacted again that evening; she was applying Vaseline to the cracks to prevent scab formation and taking paracetamol. She reported feeling better and will go back to the breast support clinic the following week Used information from:
· BfN leaflet on moist wound healing plus breastfeeding support
http://www.breastfeedingnetwork.org.uk/pdfs/Cracked_Nipples_and_Moist_Wound_Healing_2002.pdf
Patient called about general anaesthetic as she was scheduled to have an ovarian cyst removed (planned operation not emergency). Consultant said to stop breastfeeding for 48 hours. Baby was 5 months old. Mother was informed about short half life of drugs used in general anaesthetic and that some of the drug would remain in fat cells of the body, to be released slowly over the following 48 hours, which might make her baby drowsy. It was suggested that she breastfeed as soon as she felt awake enough to do so. Information on the effect of any anti-emetics, which might be given was also discussed (could increase milk supply). Also discussed how the mother would manage feeds whilst in hospital, and whether she needed to have a breast pump available. Information was provided using:
 ·Hale
 ·Lactmed (http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT)
http://www.breastfeedingnetwork.org.uk/pdfs/Day_Surgery_and_Breastfeeding_March_2009.pdf