To expect not to be told to stop breastfeeding in order to take a drug that has been classified as SAFE for breastfeeding

[BeyondTheLimitsOfAcceptability]

I have a rheum appt coming up and am psyching myself up for it. I have psoriatic arthritis and need to start DMARDs asap, however consultant refuses to prescribe them while I am breastfeeding. The paperwork I was given by the hospital says sulfasalazine is safe for BF, directly contradicting the consultant!

DS2 is 15m and on one feed a day now. I'm half tempted to say I've stopped, I won't as I don't tell lies to HCPs, but IABU to think the consultant is BU? I went in last time saying "but it says its safe" and was told I was wrong

And, what do I do? If it were a GP, I could get a second opinion easily, yes? How do I do that with an NHS specialist?

Actually the evidence is quite the opposite.

Star an 18 month old does't need to drink formula or cows milk they could um eat cheese and yog.

Why should they? If mum and child are happy to continue breastfeeding, why should they make do with cheese and yogurt? Which has no relation and compares in no way whatsoever to breastfeeding?

Mrbuttercat you obviously have your ideas issues about breastfeeding, and that's fine, you are entitled to them. However please don't keep blurting these inaccurate facts on a public forum. Granted the op seems to know her stuff and won't be influenced by it all, by some other mums without previous knowledge may be misinformed. At least state they are only your opinions if you are not willing to find out the facts.

I have a 10 month old. If I stopped breastfeeding now I would have a nightmare. As others have said it's not just about nutrition. She depends on it for comfort too.
If lac med says its safe than it, s fine.
Today I needed antiobiotics for a uruine infection. The gp checked her book and was able to prescribe a particular drug. Yet on the patient leaflet it doesn't advice it.
It's alll about manufacturers and medics protecting their backs even when drugs are reported to be safe.

Mrs issues err how so?

Really don't appreciate the ishooooos baloney to belittle posters out of having an opinion.

And sorry I've seen no opinions on here that will make me change my opinion.

MrButtercat you are talking out of your arse all of the credible bf evidence contradicts everything you have posted.

OP you sound like you have a good workable plan there. Best of luck with it. I was told by my GP that you couldn't treat a breastfeeding woman for thrush when my little man was 5 days old. Showed him the publication provided for health professional by our version of the NHS and he still said he wouldn't be comfortable with that - the useless bastard. Easy to change gp here but joyfully I had to pay the useless beggar ?50 for that 'sound' advice. My next gp did not hesitate because he was up to date.

But you're not stating it as your opinion, you're stating it as fact. When actually, factually, you are completely wrong.

And a PP is correct; that is unfair of you. The OP seems to know her stuff, but there may be other new mums reading this who are not so aware, and will be influenced by the crap you are sprouting.

You keep making these odd statements MrButtercat, but don't seem to be able to back them up at all?

Who recommends breastfeeding till 2 I believe. Also there is really good article listing all the benefits week by week. This doesn't stop at 12 months but 2 years.

But, all the rest of this nonsense aside, they can easily know if the drug passes into bm by, err, checking.....

But as someone else said, if your bar for dangerous when BF is Paracetamol (which you'd directly give to a child if they needed it) then you set the bar rather low, and I'm surprised you let your children leave a little padded room to be honest!

MrButtercat you say "It's been pretty wildly reported...."...typo or the truth? 'Wild" reports might well indicate no benefits to breastmilk after 1 - but it doesnt make sense!

What happens to breastmilk at a year? Does it turn to dirty dishwater ?

Or does it remain as breastmilk, with the same nourishing constitutents as ever?

And moreover, it's delivered in a way that mothers and babies/toddlers enjoy and which enhances their relationship.

What's not to like??

And while for some individual babies, traces of flavourings and proteins which get into the breastmilk may cause problems, this does not affect the quality of the breastmilk. There's no evidence that oranges are a problem - and no plausible biological reason why they would be. However, rarely, I suppose the occasional baby might seem to have a reaction.

You are spouting opinion about breastmilk, food and drugs as if it was fact and in a judgemental way. It doesn't say a great deal in your favour.

I read that it is very hard to get a big enough study to properly be sure that there are no side effect of most drugs in breast milk. For things like paracetamol studies have been done over a fairly long time period but lots of drugs are less common or newer and so less likely to have had in depth research. That said, they must analyse the quantities in breast milk and have done some research to say that it is probably safe. Most likely it would be fine but maybe your doctor thinks that there is some risk that doesn't need to be taken. I do feel for you as must be horrid being in pain / being forced to consider giving up bf before you want.

There are plenty of nutrionally good reasons to start breast feeding.

There are no nutritional reasons to stop breast feeding.

The op has made it clear her and her child wish to continue.
There is medical evidence from the hospital to ptove the drug is not harmful to even tiny baby's whilst breast feeding.

So why exactly should she not challenge this? Why should she stop breast feeding?

The problem is not with the size of the study, the problem is you cannot ethically give a bunch of bf women a drug they don't need to see what the effect is on the baby....however, you can take samples of breastmilk from women who are using the drug and see what trace if any of the drug is in the milk. You can also see how long the 'half life' of the drug is ie how long it stays active in the body before being reduced to nothing. A short half life means the body deals with the drug quickly and it disappears. A long half life means it hangs around.

You can also see how the drug behaves in blood, how well it can mix with a fatty substance (like breastmilk - some meds don't mix at all), and you can do this in the lab, without it coming near the baby.

You can then draw a scientific conclusion, and adjust advice accordingly.

Vijac that is why so few drugs are approved as safe for breastfeeding. It has no impact on the validity of safety claims of the drugs that are approved - the burden of proof being as high for any other relevant sub-group of patients.

It's not like they say, "well this is difficult to study so fuck it lets just say it's safe".

It was the alpha parent timeline of a breastfed baby. Makes interesting reading.

This thread has made me giggle

btw no my children don't eat cheese, yogurts (or beef actually) nor do they drink cows milk). I'm only bf the younger toddler though so I wonder what harm the older one is going to come to.

My youngest also broke his leg when he was 1 from that risky climbing malarkey.

Doctors don't always know. I had an extremely painful condition after DS2 was born, and consultant said the medication (in this case cream) wasnt safe when breastfeeding. I was in a very difficult situation (ie I wanted to keep on feeding BUT I was in so much pain)... but when I called the BF Network they said it was fine so I could kept on feeding. Same thing at 15 months as 3 months - why can't baby have benefit of breastmilk due to a non existance or minor risk.

Cream, being a topical preparation, can't really get into the breastmilk. It's really only systemic meds that cause a problem, and even then most are just fine.

good luck for meeting :)

Tiktok, I'm interested in what you said about half-lives of drugs/substances in the body. I've been wondering about this for ages - if I drink a big glass of wine in the evening after DC's last feed, and don't feed again until the morning, does the alcohol in the milk remain at the same level overnight (unless I express and discard, obviously) or does it gradually decrease just like the alcohol in my bloodstream?

Sorry to hijack!

JacqueslePeacock firstly there is no need to 'pump and dump'. Your final point is correct, the levels decrease gradually overnight. Also the levels of alcohol that pass into your milk are tiny, so if you did have to feed overnight, it wouldn't be a drama, though obviously best avoided with very young babies. The level of alcohol peaks in your milk at around 1-1.5hrs after ingesting (obviously depending on several factors).

Thanks for the answer - I'm just curious really. DS is nearly 2 now so definitely no pumping & dumping for me anymore, and thankfully night feeds are very rare (finally!). I was just puzzling over the biology of it. :)

wow there is some bullshit being perpetrated on here today.

Some things are transferred in small or even large quantities to breast milk. Other things are not transferred at all.

Some things have a lower safe limit below which they have no physiological effect, others don't.

All of this is found and out and measured before a drug is declared safe for BF. So...if it says it is, then it is.

I have exciting news for buttercat, there are DRUGS in COWS MILK. ARGHHHHH nooooooo.

There is also a small but identified risk of serious allergic reactions to cows milk. So I personally would not be bandying cows milk around as the 'safe' alternative to Bfing while taking a demonstrably safe drug.

In this case the BF+drug is almost certainly safer than cows milk.