to think that unnecessarily breast feeding an infant whilst on IV morphine and against medical advice may constitute abuse(117 Posts)
This is not a hypothetical question but based on a real case. Clearly I am not going to identify the people involved but I am interested in wider Mumsnetter opinions, as I have come across different opinions relating to this.
A mother who lives abroad visits the UK to spend some time with her infant child's grandparents. The child is approx 16-19 months old, a delight, doing well and weaned.
Suddenly the mother is taken ill and rushed to hospital, leaving the child in the care of her grandparents. She's admitted to the High Dependency Unit. Naturally, the grandparents take the child to visit the mother in hospital. The mother is apparently in so much pain, doctors have put her on an IV drip for morphine.
On arrival at the hospital the mother insists on breast feeding her child, despite the fact that she has been on solid foods for weeks. This causes alarm amongst medical staff including the ward sister who make it very clear to her that she should not do that due to the high risk of her milk being contaminated with morphine. This reaction of course alarms the grandparents as well. The mother refuses to stop breast feeding and points out to the staff that they cannot stop her, and that it is her opinion that no harm will come to her child. The staff continue to protest, the mother continues to maintain her right to breast feed and that no harm will come of it.
Sometime later the mother is in another hospital in the same area. Again a High Dependency Unit. Once more, when her child is brought in to see her she immediately attempts to breast feed and medics raise objections because of the IV morphine. The mother, showing remarkable strength of spirit for someone in a HDU, refuses to desist.
Eventually the grandparents refuse to take the child in to visit the mother because they are so concerned about her behaviour. Social services become involved (it is assumed alerted by the hospital staff) but once the mother is made aware of their visits to the grandparents she seems to immediately recover, discharge herself and within 24 hours is leaving the UK to her residence in Europe with her child.
The mother is not a medic or medically qualified. The quantities of morhpine she was receiving are not known. I am not a medic, and whilst I am relatively confident that morphine passes easily from breast milk to the child, I could not say what the potential harm would be to that child.
The mother's main argument was that she did not want her milk to dry up - yet the child was 16-19 month old and weaned. Is this an acceptable argument? Even if the risk to the child was minimal was this an acceptable way to behave?
I'm a parent but not a mother. Obviously a Dad S. My view at the moment is that to expose a child to a risk of contamination by such a powerful drug as morphine when it was entirely unnecessary and against medical advice must border on a form of abuse.
Perhaps others would think that the mother's wish to maintain her milk supply, or her rights to breast feed and that any harm, in her view, would be minimal, justify her actions.
I'd be interested to hear what other Mumsnetters think.
from the BNF - "therapeutic doses are unlikely to harm the infant" YABU
If the child was 16-19 months why had she only been on solids for weeks?
I spent the first 24 hours after both of my children's births on morphine and breastfed them.
Don't mums who have a c section have large amounts of pain killers (with a tiny newborn)?
Do you understand how little of a drug is transmitted into the milk? It is not like the infant getting a full direct dose
The amount of any particular substance - be it morphine, alcohol or anything else - in breastmilk is negligible. I wouldn't worry about it.
Does the child appear healthy? Sleeping well?
Seriously though you might like to consult Doctor Hale on BF and medication. He seems to be the oracle.
Op seems to indicate the child only bf in HDU
I would imagine the mum knew full well that anything she was given would result in the people around her insisting she was doing the best thing for her child by stopping - no matter what the evidence shows.
Not saying she was right to do so - I have NO idea - but can see why she would seem so rebellious.
Hope she is OK though - sounds like she is very sick I would imagine both the baby and mother are getting a lot of comfort from bf (emotionally and physically). The fact the child is also eating food has very little to do with it.
YANBU if the healthcare staff had consulted Briggs or Hale and found out whether the morphine would pose a risk to the child via the mother's milk.
However I suspect the chances of them bothering to do this when the child was 16 months old would be near to zero.
It could well be that in the past the mother had been given incorrect information by doctors about whether medication was contraindicated when bf (she wouldn't be the first). It could be that in this instance the mother did actually know more than the doctors. You don't know this, and without knowing the circumstances I don't think any of us can really say.
But, taking it on face value my first comment would be that this seems like a very horrible thing to post, unless you are the mother or the father involved. Then I would say that the situation described is all about the mothers needs and not the childs, and mothers like that, who use their children to satisfy their own needs, are really quite repulsive.
the HDU should of givn her a diffrent medication, knowing she was a BF'ing mother
if i can find this on a quick google search, then surely the medical staff could of got the medication book out
I've bf a 6m DD3 on IV morphine (and oramorph, buscopan, diclonfenac, fentanyl, medazolam.......) all fine to bf with though fentanyl/medazolam require a 4 hour abstinence from bfing after dosing. If DD2 would have bf whilst I was in hospital I would have nursed a 2 1/2 y/o too (yes she was on solids).
16m is young to be weaned from bfing (I'm assuming you are using 'weaned' to mean on solids) WHO recs are bf to 2y on demand or beyond.
Don't understand why the big fuss. Check out www.infantrisk.com/ for accurate evidenced based information.
thinking about it, being on HDU it is unlikely that she wasn't on anything else, drugwise. You don't need specialist text books to know morphine is ok - every ward has a BNF but there are plenty of antibiotics etc that are less good in BF
Only today I witnessed a HCP giving incorrect advice on breastfeeding and medication, so I have no doubt than on occasions mothers do know better than doctors and nurses. As others have said, morphine is compatible with breastfeeding and if they were concerned they should have changed her medication.
Doctors on average know very little about breastfeeding. It isn't a big part of their curriculum at medical school - barely covered at all. Even midwives may only have a couple of lectures on it.
So often an informed mother DOES know more about b/f than a doctor, especially if that doctor isn't a paediatrician (but even paediatricians are sometimes woefully ill-informed). Dr Hales is the guru here - the exception to the rule, as the leading source of expertise in drug interactions and b/f.
When you have a topic where even doctors get it wrong 75% of the time, and where bystanders and nosey parkers often don't understand the first thing about how b/m is made but assume anything the mother consumes directly translates into b/m, it is very very often the case that anyone who comments on the subject is a. wrong and b. doesn't even appreciate the depths of their ignorance.
YABU - I was on morphine following my csection & was positively encouraged to bf my dd1.
The Healthcare team should have ensured that the mother was given meds to enable the mother's breastfeeding relationship to continue with her child rather than obstructing it as you seem to describe.
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