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.

the recommendation is that you breastfeed for years so it's not strange for someone to still be breastfeeding at 19 months. Why are you unsure about the baby's age?

Is your worry more to do with extended breastfeeding than the medication the mum is on?

I think the grandparents have behaved atrociously and would be interested in what conclusions social services came to.

Good for the mother for taking her baby and leaving.

Clearly I must stand corrected... the general opinion seems to be that the doctors and medical staff in the situation and with the facts knew shite and that any concerns they had about the childs health or welfare and misguided and that the mother always knew what was best... or am I reading this thread wrong?

tiy - totally agree you cannot force a child to bf.

So if the mum offered a bf and the toddler started to nurse, the toddler wanted to nurse.

Nothing to do with how much the mother wanted it or for her bonding but for the toddler to have some sense of normality/comfort/closeness with their mother.

Don't see what is so difficult to understand about that

that's right mollypapa.

several people have pointed out that morphine is NOT contra-indicated during breastfeeding.
HCP's tend to err on the side of caution, and many know next to nothing about what is and isn't safe for a breastfeeding mother.

Op, we have sidetracked into the methadone discussion after a story i posted about to illustrate the general lack of understanding re breastfeeding mothers and medication (specifically opiates).
Also i couldnt disagree more with your assertion that Breastfeeding was not strictly necessary for the child's welfare. In the situation you describe it would have significant positive effects on the child's psychological welfare.
Similarly breastmilk continues to have physical benefits at this age. As many have already said the WHO advocates bf until at least 2 years.
I applaud you for seeking out and listening to other experiences and opinions. I hope you are in a position to support this mother and her daughter now.

Dueling Fanjo

I'd be interested if you could give us a link where the recommendation is to breast feeed for years.... 6-12 months I beleive is the recommendation.

My concern is the morphine. I don't think anyone here would think it was acceptable for a mother to stick a needle of morphine in a child...so why is it acceptable to do it via breastmilk? Against medical advice.

That is my query, and the topic of what I cainly hoped would be rational discussion.

mollypapa, I disagree with what you say in the title of the thread. This is not abuse.

What conclusions did Social Services come to?

the world health organisation recommend exclusive breastfeeding for the first 6 months, and then continuing alongside solids until the child is at least 2 years old, for optimal health and nutrition

It's actually very appalling that this poor woman hadvto leave hospital prematurely due to lack of support of herb parents and hcps. I'm shocked.

here

I would like to know how on earth you know all this. Because if you've found it out from the HCPs involved they were being very naughty in telling you about it in this level of detail.

link to the WHO recommendation for breastfeeding.

My doctor told me that being Tongue tied would make no difference to a baby breast feeding, my experience is doctors know fuck all about it.

Mollypapa, your posts read as if you believe that the mother of a 16 month old is only feeding their child for their own benefit. Trust me, you cannot force a child to feed and it's sounds to me as if all involved were more disapproving of an over 6 month being fed not solely for the sake of nutrition (shock horror!!!!) and didn't bother to consider that, as other posters have pointed out, mothers feed tiny newborns while taking morphine every day across the country.

Poor mum and baby :(

Molly - Not that they had the facts because if they were objecting to bfing on morphine grounds they clearly didn't know a great deal about lactation and medicines.

Not many Drs do to be honest.

I have had to explain to junior Drs that a non-oral drug (i.e. on that can only be delivered by IV/IM) poses no risk to a baby via BM as if I can't absorb it through ingesting it why would my baby be able too even if all of the drug some how ended up in my milk

Also, molecular size (above 300 and it just won't fit through the outside of the milk ducts), protein binding ability, lipid solubility, plasma levels and the length of the half life of the drug all come in to play in deciding whether a drug is safe for all bfing mothers, some bfing mothers or only those in a certain subset.

A good example is Insulin - molecular size of 6000 and it's unabsorbable from ingesting it (hence why diabetic have to inject insulin rather than swallow a tablet).

this goes into more depth.

in fact, this is fascinating reading for anyone actually...

" Strategies to improve developmental and
growth outcomes in children should include interventions to improve the nutritional status of pregnant
and lactating women; delayed umbilical cord clamping to improve the infant?s iron status; early initiation
of and exclusive breastfeeding for 6 months; support for continued breastfeeding along with appropriate
complementary feeding from 6 months up to 2 years and beyond"

I've BF on morphine several times - twice post c section and once after gall bladder surgery. All fine. Is this someone's college project? The bit about "been on solids for weeks" at "16-19 months" is especially bollocks. Pie dinners, for the best part of a year, more like. And social services involved? Crap, in my opinion.
Hope you get a good grade.

I think a lot of MNers have probably BF while under the influence of morphine. I know I have BF under the influence of a shedload of heroin - great stuff that diamorphine! It may well have been linked to already, but the BFN factsheet on Analgesia and Breastfeeding is quite clear that for short periods there's no problem.

In a child of that age also receiving solids the likelihood of them ingesting sufficient morphine to cause any effect is very small. Add to that the important but often overlooked point that opiates have a really wide safety margin, and I think this is a non-argument. It sounds like a load of panic from ill-informed HCPs.

I can well imagine if I had been separated from my BFing baby for an extended period of time during a hospital stay then the first thing my baby would want when brought to see me would be a BF, and in these circs that's exactly what I would have done.

Some of my best memories of childbirth and my children's early days involve morphine, and a few other choice drugs I got to sample.

I am so shocked that the grandparents refused to bring the baby in to see the mum - that is abuse IMO. :( so sad.

Just because you're a doctor, doesn't mean you know about bfing and medication. Most doctors wouldn't and why would they. It's not a specialism or requisite knowledge.

BFing is recommended for 2 years, with solids introduced gradually from 6 months.

BFing beyond exclusivity is about more than nutrition, though nutrition is actually still important.

Many, many, many mothers, including myself, have and will confirm that bfing whilst using morphine is safe.

What do you want op? To talk about morphine in particular? Or if a hcp's word is gospel regardless of its veracity? Of whether bfing beyond 6 months is important? Come on, out with it. If you're just messing about then that's fine too. I like messing about.

Thanks for the WHO recommendations. This raises of course further questions as to whether hospital staff in two HDUs did not know these, or whether they had other concerns. Unfortunately I do not know, other than they asked the mother not to breast feeed in the circumstances she was in.

Its hardly surprising that the grand parents witnessing this were concerned... after all, most of us trust the opinion of medical professionals... it is what the NHS relies on. Yes people get it wrong sometimes and make mistakes... quite often. Inevitabl with the number of people involved.

When's your deadline OP?

I'd like to know at what age it IS acceptable for a baby to bf from a mother on morphine?

I get the feeling that you must be the child's father, MollyPapa.

I'm no expert but agree with what's been said about mothers breastfeeding under morphine following a CS without a problem. Surely if there was a risk (and in such cases any risk would be greater to newborns) these mothers wouldn't be permitted/advised to do so?