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When mothers are asked to stop breastfeeding while on medication
What do you do if a mother on your caseload tells you that her GP has told her to stop breastfeeding in order to have a medical condition treated (see Box 1)? Do you:
* Help her to stop breastfeeding - permanently or temporarily
* Suggest she sees another GP
* Seek out information on the safety of the drug passing through breastmilk and discuss options with the GP
* Refer the mother to alternative sources of information.
With larger and widespread caseloads, it may not be easy to approach a GP to discuss such a scenario, and questioning their advice may feel outside of your remit as a health visitor. This article aims to help you decide how to do this with good results for all.
Advocacy and breastfeeding
An important role for any trained nurse is to act as the patient's advocate. In addition, all healthcare professionals involved in the care of mothers and babies should protect, promote and support breastfeeding.
While nutritionally adequate, infant formula can never replicate the myriad of biological factors of breastmilk that confer health advantages for mother and baby. Breastfeeding is undoubtedly the best way for babies to be fed, it is the biological norm and for mula- feed ing is a clinical intervention. The Department of Health ' recommends that babies should be exclusively breastfed for six months, and beyond as part of a weaning diet until mother and baby decide to stop.
So why might a GP recommend that a mother stops breastfeeding hi order for her to take medication?
Appropriate information
The BNF- advises that drugs are almost invariably unlicensed for use during breastfeeding. This does not necessarily imply a risk, merely thai the manufacturers have not included safety in lactation as part of their licensing application and have not undertaken clinkai trials. Specialised texts and reference sources provide information on studies that have been reported, along with pharmacokinetic information that facilitates assessment of safety.3'7 The BNF for Children* provides information on drug levels passing into breastmilk, along with the licensed or unlicensed use in children. The results of a questionnaire sent to doctors in Australia9 has highlighted the need for simple, reliable, current...