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AIBU?

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

116 replies

MollyPapa · 22/06/2011 20:53

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.

OP posts:
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Firestone · 22/06/2011 22:18

BFN information on codeine here prior to the Canadian case morphine/codeine were considered compatible with breastfeeding. In this specific case I imagine that there was no risk as mum seems to have bf on morphine previously (??) and would therefore know her child hadn't developed complications in the past.

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DogsBestFriend · 22/06/2011 22:19

Good point, Starchart. The child's father or someone doing research! :)

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xstitch · 22/06/2011 22:20

OP this is what the BNF says about breast feeding and morphine:

"Breast-feeding therapeutic doses unlikely to affect infant; withdrawal symptoms in infants of dependent mothers; breast-feeding not best method of treating dependence in offspring"

I am more concerned about potentially what other medication the mother may have needed to be given if she was that ill as some medication is very bad in bf.

What you have to remember is the child would not have received an equal dose to the dose the mother received. When a drug is absorbed into a persons' system it is distributed around the body. They degree to which it enters different organ systems depends on many factors including the solubility of the drug in water and fat and therefore the drug's ability to pass different barriers in the body. What I am saying is only a percentage of the morphine in the mother's system would appear in the milk.

Actually I would say that the potential impact of any medication excreted in breast milk will normally lessen as the child gets older. An older child will have a greater body mass and body surface area meaning for the same amount ingested a lesser concentration in the body will result. Lower concentration in the system means less effects. Furthermore the fact the child is older and has been weaned means they are taking less breast milk daily, especially if only one feed at visiting time and consequently less overall exposure.

One thing to note is that sometimes infants clear drugs from their system faster than adults do due to differences in their metabolism.

There may have been other reasons the HCP's on the ward advised against bf but we can't tell from the information in the OP.

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duchesse · 22/06/2011 22:22

I was given morphine for 48 hours after my C section, whilst expressing milk for my little 7 lber in the NICU. If they prescribe it to new breastfeeding mothers in maternity and postnatal wards, I'm just going to assume that they (with a better handle on the drugs that are safe to use around tiny babies) are better equipped than standard ICU staff to judge what is and is not safe for a breastfeeding mother to be given. In my experience there is very little knowledge among standard medical staff of the mother-child breastfeeding relationship and what does and does not cross through into milk. That is one issue.

Another whole issue is that the baby would have been traumatised by the sudden cessation of the breastfeeding relationship whilst its mother was in ICU. Breastfeeding the child in that situation probably reassured it and normalised the situation for the baby. Breastfeeding is about a whole lot more than mere food.

So on balance I would say that YABU.

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delusionsofadequacy · 22/06/2011 22:23

Was the mother only any other drugs op? or just the morphine? or does your project/informant not have those details?

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TruthSweet · 22/06/2011 22:23

That wasn't a mistake though it was willful ignorance of the facts. If they weren't sure they should have taken it up with the pharmacist (you know the one who checks everyone's meds once a day whilst they are admitted to hospital) who would have a copy of Hale's Medications and Mothers Milk to refer to.

If they weren't sure about the safety of the drug and bfing then they should have checked BEFORE administering it to the mother. What would have happened if it was a drug which ceased lactation or was toxic if ingested?

I expect though it was assumed that even if the mother was bfing she would throw a parade at being given a legitimate reason to wean - 'sorry darling mummy's milk will make you sick no more nursing '.

I've been in intolerable pain due to to gall stones/pancreatitis and still managed to check the safety of medication before taking it. And guess what sometimes the Drs were wrong the first time and when they checked Hale's it was safe Hmm

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edam · 22/06/2011 22:23

hospital staff in HDUs should know this but maybe they don't come across breastfeeding women very often.

It's one sign of a far bigger problem, which is that knowledge of breastfeeding amongst healthcare staff is minimal at best. Most of them get fuck-all education. And many of them don't confess 'actually I know sod-all about this', they just assume.

Given breastfeeding is such an important public health issue, you'd think medical and nursing staff would have to know the basics. Or at least be aware of the limitations of their knowledge.

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Knackeredmother · 22/06/2011 22:24

Molly, I am a qualified doctor.
I learnt nothing about breastfeeding at medical school.
All my knowledge is derived from personal experience of breastfeeding my children. Incidentally until 3 years.
I have encountered many cases of ignorance with regard to extended breastfeeding in my colleagues so highly possible the hp involved here are misinformed.

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LiegeAndLief · 22/06/2011 22:25

Not only did I express milk for my prem baby whilst on morphine, but he was on morphine too. Obviously not an ideal situation, and no, you probably wouldn't want to stick a needle of morphine into a toddler for no reason, but I would imagine the amount of morphine transferred to breastmilk is pretty low. Many many women all over the country will have been given morphine post cs and then encouraged to bf. And if a 5lb baby can receive iv morphine over several days with no ill effects, presumably a very very small amount ingested orally by a toddler is ok.

Apologies for a post containing a large dollop of assumption and extrapolation..

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TheFowlAndThePussycat · 22/06/2011 22:32

Just wanted to say I have also bf whilst on IV morphine (in fact expressed bm for prem daughter) with the positive encouragement of paediatricians & nurses. I would say that in a 'normal' ie not maternity unit they may well not have a clue about breast feeding as they probably don't see very many breast feeding mums. When I was on intensive care I was basically the only person there not receiving 'end of life care' to put it nicely Sad. Doctors can't be experts in everything, but they should have taken advice. I feel very sorry for mum & baby in this scenario.

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TheFowlAndThePussycat · 22/06/2011 22:35

Sorry, x-ed quite a few posts there.

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KilledBill · 22/06/2011 22:35

So then, is it fair to assume this OP is related to the mother in Spain?

Because it has alot of similarities to the (small amount) of info we have heard on that case?

And im watching this thread now to see any opinions regarding opiates in general. Im suprised actually at the amount of support for the mother and the amount of women who have BF whilst using morphine, I genuinely didnt know. Which is why im even more suprised at the villification I have often heard of ex drug users BF. Codiene, Methadone, Morphine, its all the same basically. Im obviously not referring to people using drugs whilst pregnant and BF, just opiate substitutes. Interesting.

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LiegeAndLief · 22/06/2011 22:39

I guess mothers who are given morphine after cs will be taking it very short term, which may make a difference - although I was given several weeks worth of codeine to take home with me, which is essentially the same thing isn't it?

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xstitch · 22/06/2011 22:41

Here is information produced by the UK Medicines information. There is a table in there.

As I said in my previous post I don't know what other medication she was on or what other medical reasons there may have been for her advising her not to feed so can't judge anything else.

IME drs are very bad at knowing about drugs in breast feeding. They don't get proper training on it as standard. I would like to see them receive more training if only enough to prompt them to check the resources available/

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KilledBill · 22/06/2011 22:42

Yes it is, infact im no chemist but I believe codiend and dihydrocodiene have a longer half life than morphine, methadone and definitley herion.

The argument is that addiction can be formed in a very short time though. Whilst im agreeing with what others have said (eg that only tiny amounts pass through according to research and it is safe) Im pointing out the discrepency between how one mother can breastfeed and another cannot, yet they are effectively doing the exact same thing.

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Honeydragon · 22/06/2011 22:49

Another who has bf on morphine here. I also know anecdotal cases of mothers who have been due into hospital and told to give up. It is often considered a nuisance so the mother is told it's unnecessary Hmm

I am disgusted dislike that the op appears to see bf beyond 12 months as for the mothers indulgence, in such traumatic circumstances I should think it is the best way for the child to feel safe and connect to her mother.

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xstitch · 22/06/2011 22:50

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

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Knackeredmother · 22/06/2011 22:51

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

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KilledBill · 22/06/2011 22:52

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!)

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xstitch · 22/06/2011 22:53

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.

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KilledBill · 22/06/2011 22:55

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 Hmm

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xstitch · 22/06/2011 22:56

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.

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KilledBill · 22/06/2011 22:58

Ahh, now I understand Blush

Thats a bloody long time though isnt it.

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Knackeredmother · 22/06/2011 22:58

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.

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spudulika · 22/06/2011 23:01

Have just read OP and skimmed through thread.

Mumsnetters - you're bloody fantastic. Smile

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

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