breastfeeding on medication would you consider it?

[Bumplovin]

Hi,

Im just posting for a general opinion as im really struggling to decide what to do. I' m taking medication for my mental health that ive been advised not to stop because of risk of postpartum depression. My baby is due in dec and Id always planned to bottle feed as the drug leaflet says to avoid breastfeeding however I have recently been diagnosed with gestational diabetes and ive read breastfeeding helps reduce risk of me and baby going on to be diabetic in future. ( plus obviously all other benefits) . Someone suggested contacting the breastfeeding network and I have emails from their pharmacist saying that although it is known to pass to breast milk she thinks my baby would only get very low levels as my tablet has to be placed under the tongue and is not effective if you swallow it as the stomach doesn't absorb it well. Her theory is that as the baby swallows the milk it's stomach wouldn't be able to absorb the medication in the milk. Nobody else can advise me as there are no studies on the drug yet as its new. I kinda think she may be right but I'm scared if she's wrong, would this kind of advice reassure you and would you breastfeed if you were on medication? Sorry for the long post but was hard to explain. Not looking for medical advice as such but just really how other people would decide? Many thanks in advance x

[ShowOfHands]

Would depend on the drug, the lactmed and breastfeeding network advice and whether there was a more breastfeeding friendly alternative.

[AidingAndAbetting]

On balance, I don't think I would. I don't think I could risk harm to my baby now to reduce the chance of something that may or may not happen in the future.

[InTheDessert]

I would trust the bfn advice, but also consider other drugs which may benifit you as much as the current drug, and have further information on the transfer rate to breast milk.

[TheHubblesWindscreenWipers]

What's the drug? Impossible to say unless we know that. All drugs have official advice on use in pregnancy and BF. I assume it's safe in pregnancy if you're on it now?

[Bumplovin]

It's called asenapine, it's not classed as safe as such in pregnancy but I was told the benefit to me outweighed the risk as I wasn't well when tried to stop it to conceive, we have had extra scans to check on her through foetal medicine throughout the pregnancy and she's perfect although I'll prob worry with every milestone. Im wondering if I should go back to the idea of bottle feeding but when the pharmacist to me levels would be minimal I thought that she would get lots of other benefits from the breastmilk. I just want to do the best for her.

[Bumplovin]

Im not sure if the other drugs that are similar are any better but there is more research on them, consultant worried about me swapping drugs tho.

[geekaMaxima]

It's always worth asking your GP (or whoever prescribes it) whether there's an alternative drug that would be effective for you but whose effects during bf are better understood.

Lactmed makes some suggestions of alternative to asenapine here https://toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/~5cSAS4:2 (if that link works), namely Haloperidol, Olanzapinee_, Risperidone. It might be worth printing out those pages to bring along when you talk to your GP as not everyone knows about Lactmed.

And if it turns out you need to stay on asenapine, then it's a personal judgement call. The BfN pharmacist knows her stuff so if she says the risk is small then it probably is. Your mental health comes first, though - your baby needs a well mother.

Would you worry so much about taking asenapine while bf that it could negatively impact your mh? If so, then the costs seem to outweigh the benefits and going with formula rather than bf might be the best all-round choice. On the other hand, if you tend to be okay with a decision once you've taken it (if you did decide to bf while taking asenapine) - and wouldn't keep stressing about it - then the benefits might make bf the best all-round choice. What does your gut say??

[Bumplovin]

geekamaxima thanks thAts very helpful. Unfortunately ive tried haloperidol once and had to come off it after 2 days as it made me feel odd and olanzapine didn't suit me either. The only other drug Id consider is quetiapine I'll look thAt up on lactmed. Consultant seems me to stay on this drug tho as im oy on half the starting dose as it suits me well im completely a symptomatic on it you would never know I had an illness . I wAnt to believe the pharmacist on the breastfeeding network because if it wasn't for my medication I wouldn't have wanted to formula feed at all. I guess I'm just trying to battle out how I would feel, im thinking about maybe doing it for 3 or 4 weeks so she gets a bit of immunity from it and gets the colostrum which is full of goodness and then maybe switch to formula? I was thinking of asking if there was a paediatrician I could speak to at the hospital or whether they would just direct me back to the breastfeeding network.

[museumum]

If the medication is destroyed by adult stomach acid then I'd be asking the paed if there's any significant difference between baby stomach acid and adult stomach acid.

[nonicknameseemsavailable]

I had to go on different medication after having my baby and whilst it was "probably safe" to BF whilst on it I chose not to take the risk. personal decision that only you can make x

[Bumplovin]

musemum that's the question I want to ask a paediatrician ie could it build up in her system.

[Bumplovin]

nonicknames although I was initially excited that the pharmacist believes it to be ok, I am now starting to think bottle feeding (my original plan) may be best. I can't bear the thought of harming her and it's already been very hard to accept ive had to take it while pregnant. There have been a lot of prayers said this last 7 months x

[VikingChallenger]

I wouldn't do it and also wouldn't advise changing medication at any point from now on. Stick to this one if it suits you.
Basically what Aiding said

[geekaMaxima]

Mixed feeding could be an option also. The lower the milk volume, the less of the drug (if any) passes across.

A newborn takes in so little milk volume in the early days that very little of the drug will transfer. If you were comfortable with a small amount of potential drug transfer but not with fully bfing, then you could keep bfing a few feeds a day while using formula in increasing amounts to deal with baby's creasing appetite.

It might be tricky to keep it up long term as its harder to maintain your supply at low volumes, but lots if people do it. There's advice on Kelllymom about combination feeding, and a bf counsellor from NCT or BfN should also be able to advise.

[PurplePidjin]

Medication passes directly through the placenta - which is why alcohol in pregnancy is a bad idea - whereas milk is made from blood (well it's a bit more complicated but I'm not very technical!)

Be advised by the experts, and do ring the Drugs In Breast milk helpline for expert advice, but I would think the risk was lower through feeding than through the placenta

Your health is equally as important as your baby's, and whichever way you feed S/he will know they are loved

[Batteriesallgone]

I would have thought if a foetus can cope with the exposure to the medication given the blood exchange going on with the placenta, then a term healthy baby would be able to cope with the reduced exposure via breastmilk.

Could you maybe ask the pharmacist - is the exposure to the drug higher in pregnancy than when breastfeeding?

I think I would breastfeed. But it's a very personal choice.

[Bumplovin]

batteriesallgone ive been told for definate that levels in breast milk would be lower than through the placenta. They just can't tell me what the levels would be as no studies yet. Ive thought about bottle feeding through the night as I take the tablet at night time so wondered if levels would wear off a bit during the day

[Bumplovin]

batteriesallgone ive been told for definate that levels in breast milk would be lower than through the placenta. They just can't tell me what the levels would be as no studies yet. Ive thought about bottle feeding through the night as I take the tablet at night time so wondered if levels would wear off a bit during the day

[Bumplovin]

Thanks for all your replies by the way, they have all helped me in some way. I guess as im getting closer to having her I just want to do everything right by her

[SpeckledyBanana]

I have used the pharmacy service you have used, and I chose to trust her advice (was it Wendy?).

[SpeckledyBanana]

That is - I carried on BF.

[happypotamus]

I am on a different medication for a different condition. It isn't recommended by the manufacturer for use when pregnant or breastfeeding, but most drugs aren't because it isn't ethical to test them on babies to prove it. The specialists in my condition in pregnancy advised that it is one of the safer medications for my condition in pregnancy compared to some of the alternatives, it was more of a risk to both the unborn baby and me for me to stop taking medication, and breastfeeding would not put the baby at any extra risk as they had been exposed to the drug via the placenta already. My oldest child is now 5 and does not seem to have any problems that could be attributed to the drug. Of course, this all might not be the case for your drug and your condition, but it appears that you have consulted the experts on these issues and got the best advice possible.
I work with paediatricians and I don't think they would know any more about this than the pharmacist you have asked.

[Bumplovin]

happypotanus that is very helpful advice thankyou, It is very hard to weigh up benefits but this pharmacist seemed to be the most knowledgable person I could ask. My cpn says her other clients have breastfed on larger doses than me (albeit not the same drug but the same principle) and have not worried about it but I like to be well informed and research everything to make the best choices. I registered myself in an American clinical trial on the type of drug I take when I found out there were no studies on it and no official register for these drugs in pregnancy in the U.K. Hopefully on the future other mums will be ae to have more advice based on the results of the study

[5madthings]

I would go with what bfeeding network say if they think.its safe and bmilk has so many benefits for baby that even if they still get time quantities of medications benefits outweigh risks

But whatever you choose is fine and don't best yourself up, your mh is important. You could always do both. Do they know the half life of the drug so maybe bfeeding at the part of the day leading up to raking it and a bottle for when the highest dose will be in your system?

[StiginaGrump]

Wendy Jones is as expert as anyone is and if this drug had a long half life and could accumulate then she would have mentioned this. That specific enquirery would be better directed back to her rather than to a paed. It's hard to make these decisions but you have already accessed the best source of info we have in the uk.
Personally I would bf if it felt like it would work for me - there are benefits to both of you.