to think that unnecessarily breast feeding an infant whilst on IV morphine and against medical advice may constitute abuse

[MollyPapa]

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.

[xstitch]

molly if you read the thread you will find out that evidence based medical advice is that you can still bf while on morphine. See my links and the bits I have copied and pasted. What I and another poster (who is a dr) have said is that bf issues don't really form part of their training.

I personally took it upon myself to learn more about drugs in breast feeding as very little time is spent on it in compulsory training.

Personally when it comes to medication and pharmacological issues I know I know more than the average dr. I bow to their superior knowledge on surgery, procedures and diagnosis though.

[confuddledDOTcom]

Another one who had morphine after two sections of premature babies so lots of pumping. With the baby I'm in with now I was given it for awhile when I pumped as the after pains were making it difficult. I've also been on codiene since I was pregnant with #2 3yrs ago. They've been worrying about it on the ward and we were discussing it when the pharmacist was on her rounds, she said it was fine.

Your analogy of heart surgery doesn't work. If your ENT told you you needed heart surgery because your tonsils were enlarged and they can do it next week, would you accept their opinion or ask to speak to a cardiac surgeon first? Another example, S have an autoimmune disease that's fairly common but not well understood by drs. I need to inject myself through pregnancy to be able to carry my baby until a good enough gestation fairly healthy but I've had to fight my case to get them! I've also had comments that I'll be ok now it's a pregnancy condition - I'm sure the men and old ladies in my support group will be pleased to know! It also affects my treatment in other ways and I have to be on top of what's happening because my Dr may not be. Or another example is taking a premature baby home! Community medical staff don't understand premature babies and you end up being referred on because of failure to thrive when actually they're doing everything they should. I've been briefing the lady opposite me on being in the community because even the best Health Visitor will have problems when faced with a premature baby. Apparently, a specialist midwife was telling me yesterday, they say to treat them like a term baby which is a dangerous attitude and they're trying to stamp this motto out.

Most birth professionals get a half day of breastfeeding training, I've done the course our PCT puts on to give them extra training - it's a week long. It's not looking at drugs just how breastfeeding works and how to support common problems. Wasn't even a good course TBH I was getting annoyed at some of the myths going around. So what makes you think someone in a completely different area would know about breastfeeding? If they've trained to look after sick adults they're not specialists in babies. The ward I'm on is staffed by midwives and nursery nurses, it needs to be because their training is in different areas and one can't do the other's job.

Wrt your question about proof that the toddler still needs it psychologically, would you think it acceptable to take a toddler to another country, take Mummy away then say you can't have your dummy until Mummy gets home? Would you need proof of how damaging that would be?

[TandB]

Very strange thread. OP - if this is indeed a real case then you have given a lot of very specific detail bearing in mind this is a matter with which social services are apparently involved. What is your interest in this matter and is it your place to be putting this sort of potentially identifying information on the internet?

I don't really understand the "need for debate" that you assert. You approached the topic with some screaming misconceptions that could have been corrected with the most basic of research. For example, your analogy of someone sticking a needle of morphine in a child has absolutely no relevance to the issue of morphine in breast milk as the quantities and method of absorption are clearly massively different. And the guidelines re: length of time of breastfeeding are pretty well known in my experience.

As someone with very minimal knowledge of breastfeeding, what is your intense interest in this case that would lead to you posting this very detailed information on the internet?

[Knackeredmother]

Op, are you one of the medics involved?

[cory]

MollyPapa Thu 23-Jun-11 00:37:10

"What seems clear however is that there is an odd split between where we trust medics. If they tell us we need a heat by-pass we say yes.... if they 'interfere' with how we raise our children do we seem to decide their medical knowledge is worth f-all and we know best?"

It is not odd at all. It is based on our knowledge of what parts of medical knowledge doctors are likely to have covered in their training. You may have noticed earlier on that a qualified doctor posted to point out that she had had no training whatsoever on breastfeeding issues. This agrees with my experience, which is that many doctors know very little about recommendations on breastfeeding; it is not considered an essential part of their training. On the other hand, you would expect a cardiologist to have had training on bypasses. Good doctors recognise their limitations and seek external advice. Insecure doctors are afraid to admit their ignorance and will go for the easiest option, in this case banning breastfeeding.

My children have a comparatively rare condition which is not covered in medical school. Some paedicatricians have not even heard of it (or have forgotten), some have read it briefly as a small part of their wide-ranging training, I otoh have read the relevant scientific articles. Not because of some precious mother's instinct, but because this is a bigger part of my life than of the life of a doctor who may never come across the condition.

So whether I trust a doctor or not will depend on whether I think they are likely to know what they are talking about.

[Tortoiseonthehalfshell]

How about you do some research yourself, MollyPapa, rather than requiring us to prove our argument to your required standard? The breastfeeding relationship isn't exactly an obscure topic, there's loads out there.

[chickenlickin]

YABU. The poor women was doing her best to keep up her milk supply. WHO recommend bf for 2 years and beyond. Women BF every day with newborns (some women take worse drugs than that, that we don't even know about)! Can't beleive SS were involved - crazy. Where I work we take babies to HDU or intensive care to BF if the mums are ill.

[PiousPrat]

I'd like to know which hospitals you lot were going to to get morphine after a C-section. I've had 2 of the buggers and only got diclofenac and paracetamol after both. I feel cheated out of my opiates

[ensure]

Poor mother having to discharge herself from hospital and leave the country, when she must have been in terrible pain, to get away from all this nonsense! She sounds like a great mum and a strong lady.
I hope she is ok now. I imagine she won't be visiting the grandparents again soon.

[AnyFuleKno]

Mollypapa you have never explained your relationship to this case. I'm finding your postingbstyle patronising to be honest.

[DuelingFanjo]

There's loads of academic evidence online. You can google it really easily but as Curly says Kellymom is a good place to start.

[CurlyGirly2]

Incidentally, my dd was admitted to hospital at around 16mths, and all the nurses were shocked that I was still bf (along with normal solid food). That is sad too...

[CurlyGirly2]

Very interesting thread. Glad the OP had been put right on the morphine front. I can only give you my own experience of bf to 16mths and beyond.

I bf my youngest child to 26mths and i can assure you it wasn't for my benefit. She loved it, and simply didn't want to give it up. I had only planned to bf for the first year (as I had my older 2 children), but she had other ideas!

There is a fair bit of evidence regarding the health benefits of breastmilk and toddlers - I can't link, but check out Kellymom on the subject - it's very beneficial.

On reading this thread I initially thought, oh no, an extended-bf basher! THink the responses have been very restrained.

[MollyPapa]

Have to agree with Spudulika...

I raised this issue both to get information, inform myself and raise a debate...the vat majority of the posts I feel have been well though out, considered and tempered (there are alway the slightly mad ones).

And, as I think is usual in most debates, there is room to agree to disagree.

What I have learned tonight is that the risk to the child through breast feeding on morphine was probably minimal... and that there were potential psuychological benefits to the child form that breast feeding relationship (though I would be more convinced if those proposing that argument had an references to evidence).

What seems clear however is that there is an odd split between where we trust medics. If they tell us we need a heat by-pass we say yes.... if they 'interfere' with how we raise our children do we seem to decide their medical knowledge is worth f-all and we know best?

I wihs I had more details about the concerns... I suspect there were some...all I can do is extrapolate what I know to raise what I think is quite an importnatn discussion

[xstitch]

It is a long half life though some are even longer.

[spudulika]

Have just read OP and skimmed through thread.

Mumsnetters - you're bloody fantastic.

Where else could you post a comment like this and get such well informed and non-tabloidy responses?

[Knackeredmother]

I too was disgusted, more so by the fact that the police could just 'decide' it was wrong based on their own ignorance.
I advised my friend to seek independent medical advice and the case was dropped, but not without distress to the mother first.
The woman was also bf on medics and midwife's advice. Shocking.

[KilledBill]

Ahh, now I understand

Thats a bloody long time though isnt it.

[xstitch]

It takes 5 half lives for a drug to be considered out of your system so with a half life of 34 hrs dihydrocodeine would take a week to clear your system. Some of these tests also test for metabolites of the active drug so although there is no active substance in your system they can detect it for a bit afterwards.

[KilledBill]

I know knackered, im glad you disagreed with what they were doing. If it had been illegal drugs thats a different matter, but methadone prescribed by a doctor with no heroin use on top should, IMO, be treated the same as a mother on prescribed morphine.

Still waiting for OP to confirm if this is infact about Spain mother

[xstitch]

knackered I am disgusted by that tbh. The only reason I have known for a mother on methadone to be actively discouraged from bf was if she had some other medical problem such as being HIV positive or something like that.

[KilledBill]

Really xstitch? Im suprised, I believe you obviously I know you are a pharmacist, but I believed it was much longer (once had to do urine sample and came back positive for opiates - last taken dihydrocodeine 4 days before!)

[Knackeredmother]

Killed I'll, I completely agree. Hence my issue with my police friend trying to prosecute bf methadone user earlier in thread.

[xstitch]

Morphine's half life (plasma concentration) is 2-3 hrs in the first 6 hours after administration then 10-44hrs (a lot of individual variation)
Methadone mean 15hrs
Codeine 3-4hrs
Dihydrocodeine 34hrs