To be annoyed with pharmacists whilst breastfeeding...probably unreasonably

[Meshy23]

I’ve been breastfeeding for 5 months but in that time I’ve had colds, aches, travel sickness and now quite severe constipation. In that time I’ve gone to the pharmacist for advice (in a bid of easing pressure on GPs) but without fail the minute I tell them I’m breastfeeding they refuse to give me any medicine.

I totally get this but what grated me most was I suffer badly from travel sickness and before a flight I wanted travel sickness medicine. I told the pharmacist that I can give my baby formula and pump and dump until the meds’ were out of my system which they calculated (i give DD a bottle of formula at night so have no issue with this). The pharmacist flat out refused and said they cannot dispense the medicine as I am breastfeeding even if I don’t give my milk to the baby. End of - no alternative advice in either situation.

I love pharmacists but I do feel quite alone suffering (mildly) without any medicinal help for symptoms.

Maybe I should not want any medicines. Maybe I should be happy that there is a stringent level of protection for young children. But I just feel a bit annoyed especially as it’s not like pregnancy where medicines can go straight through the placenta and I can avoid giving my breast milk if necessary. It feels like another example of a new mum being ignored!

But I’m being unreasonable and feeling sorry myself about a first world problem right?

There is a disconnect though isn't there? On the one hand we're told not to go to a GP with minor ailments, on the other hand pharmacists aren't using their discretion and want to send you to the GP (3 weeks later, by which time if you had a bad cold you will probably be over it anyway). If there is solid information on the internet (someone mentioned a pharmacist who has put out information about safety of drugs for breastfeeding mothers) then why can't they access that, too?

It’s a morality issue with babies. You can’t test medications on babies due to the unknown risks so nobody has been able to do the usual evidence based research on how medications react on a baby. I think the only things that can count as research are drugs that a mum simply cannot stop taking for her own life such as inhalers.

Grumpy, I don’t want to send anyone to the GP unnecessarily. It’s a balance between using your clinical judgement but keeping on the right side of what is legal and ethical.

I’ve no issue with people using the right websites to help them but it seems everyone on the internet is an ‘expert’ these days and a lay person may not necessarily know what is correct information or not.

The breastfeeding network is a great resource to people to start with but it appears to be run by one woman (or at best a small team), as I said earlier if suddenly it becomes apparent that drug x is dangerous and she’s on holiday or unwell it may not get updated for weeks.

The problem is the primary care system is underfunded. Surgeries could have prescribing nurses and pharmacists for this very thing but the funding isn’t there.

@JenniR29 I completely get where you're coming from and if I was in your situation I wouldn't dispense the drugs either.

The problem is where does that leave those of us who need medication and are bf? If you can't buy the drugs in the pharmacy and you can't get a GP appointment (and let's face it, they're not easy to get!) you are effectively being denied medication.

I take ibuprofen when needed (given that is was the drug I was told to take post section by the hospital). I'm not going to go to the GP because I have a headache or something.

I'm not blaming pharmacists because it's not their fault but the system does prevent breastfeeding women from accessing medication and so people don't have a lot of choice but to do their own research and lie or go without.

Jenni, I do understand but when it actually says on the nhs website that a drug is considered safe whilst breastfeeding and a pharmacist says it’s not recommended it does make you feel like they are not that well informed.

This is a very unfair accusation. The NHS web site is not an authoritative source. The following is from the listing for ibuprofen in the British National Formulary, the official resource for drug information for healthcare professionals:

Breast feeding
With oral use:
Use with caution during breast-feeding.
Amount too small to be harmful but some manufacturers advise avoid.
With topical use in adults:
Patient packs for topical preparations carry a warning to avoid during breast-feeding.

Again, the issue is that if the manufacturer has recommended to avoid, the pharmacist is taking on responsibility if a baby comes to harm. You might reasonably say the manufacturers are giving advice that is unhelpful and probably incorrect but it is unfair to accuse the pharmacist of being "not that well informed".

(I'm not a pharmacist, by the way, but I do work closely with pharmacists in parts of my job.)

See when I was refused medication I just assumed that it was inherently harmful when breastfeeding and that there wasn't any point seeing my GP because how would a signature from a GP change the nature of the drug.

It get that people have to cover themselves but I think over the top health and safety precautions in general just lead to people taking them less seriously.

I remember suffering from horrendous cystitis along with laryngitis and having to get XH to phone for me and ask what I could take. When he told them I was BFing the answer was essentially ‘nothing’, even though they admitted there wasn’t anything in cystitis meds that would be dangerous if transferred to breast milk.

I’d tried all the cranberry and stuff with no result.

In the end I was so desperate for relief I took a couple of sachets of cystitis relief anyway and gave DS formula for a day. I felt terrible and XH was so cross with me, but I was in agony.

I know nobody wants to test medication on pregnant women to see what impact it will have, but there must be ways to assess whether a medication will transfer to milk and whether the amount would affect a baby.

*Sorry that should say pregnant or BFing women

I have to admit this has been an eye opener in terms of going to the GP - as I would never ordinarily go to them for any of these conditions if not breastfeeding.

As an aside though, I haven’t been able to get an appointment until next Tuesday so I will have to suffer until then or will most likely just get better without any medicines to help symptoms (other than prune juice). So I do agree that there is a risk of breastfeeding women suffering in silence or lying.

But I completely understand that my original post was entirely unreasonable and this is no fault at all of pharmacists. It again sounds like it’s due to lack of central funding.

Decongestants and other cold remedies can dry up breast milk supply. I learned this the hard way by taking it against medical advice when my son was weeks old.

I agree, I can see why the pharmacists act as they do, but it’s completely unacceptable that breastfeeding mothers are left to suffer without adequate medical treatment because of this overly-precautionary attitude (and lack of GP appointments). I do wonder why the desire that infants receive exclusively breastmilk is elevated over and above the mother’s wellbeing. If it’s so important that women breastfeed, why has this issue not been addressed?

You aren't unreasonable OP. You are suffering and need something to help but seem to be getting told there's nothing you can be given to help.

It is an issue, but not the pharmacists issue as you've said further down. I just don't know what the drug companies can do to solve the issue? They would have to try certain medications on breastfeeding mothers and see if it had any bad effect on their baby or them. I just can't see anyone volunteering for that at all. It's easy to test medications in general as there's always people willing to try them (and get paid) but no one wants to put their child at risk and rightly so.

Perhaps the best way they can go about this is to get women that are not breastfeeding to take the medications then express their milk (the little amount they can) and test the milk to see what volume of the drug is in the milk if any?

At the end of the day, women are pregnant for 9 months on average and averagely breastfeed for 2 years. That's almost 3 years being denied basic medications. Something needs to be sorted with that. We could all go the pregnancy suffering I suppose but the length of breastfeeding too?

I said about a natural alternative i.e certain juices, foods, herbal remedies that can be taken while breastfeeding which would be totally safe if you looked in to it and read the packets

I have had these battles regularly with pharmacists.
Older daughter got threadworms. obviously you have to treat the whole family. Told me I can’t take them as I’m bf. tried to explain that bf toddler was over 2 so would be being treated with the same meds anyway. Still no I can’t sell you the tablets as you have told me you are bfing!

I have also had issues buying stuff for my daughter which she should get on prescription.
Her eczema cream costs less than £2 to buy over the counter. But I’m expected to waste the drs time and money getting it on prescription as she is under 12.
I now just lie and say it’s for me. My gp knows I do this and is fine with it.

I understand why pharmacists are unwilling to risk regulatory problems for themselves but there's no way I'm either going to waste the nhs's money by booking an entirely pointless gp appointment or go without medicines and suffer because booking that appointment will take weeks. It's just passing the buck to am already overstretched nhs because pharmacists need to (understandably) cover their backsides. It's time their regulatory body took a more sensible approach. At the moment there are three options open to women:

A) suffer
B) go to the gp for a minor ailment, which costs the nhs money, may require a long wait and inconveniences mother and child.
C) they lie. Which for most drugs and most cases is fine, but for the time when it isn't, could be serious.

If people were able to have honest conversations with pharmacists and make up their own mind on otc medications, babies would be safeguarded, women wouldn't be forced to suffer, lie or waste nhs money and time. The current system isn't in the best interests of anyone. It's time for some common sense.

Ps: no people shouldn't be doing their research on forums etc, but by looking at the bnf, nice guidelines etc as well as information sheets provided you can get a pretty good idea of safety.

Ideally I would like there to be a waiver form that a woman can sign once I’ve explained any potential risks so that the liability is at very least shared.

Jenni I really don't see what's wrong with people doing their own research. People are generally not dumb. I am a midwife and I am delighted when women do their own research. Also, the breastfeeding network fact sheets are written by a pharmacist- Wendy Jones, arguably the most knowledgeable pharmacist in the country on this topic- so I trust them completely.

Phoenix, I never said anyone was dumb but surely as a healthcare professional you recognise the dangers of reading around a field you are not formally trained in? I find people often double down on their own research because they don’t want to be wrong even when confronted with the truth.

I had a quick google search last time my car broke down, doesn’t mean I’m a mechanic. When my actual mechanic disagreed I was happy to trust him. He also said he’d had to fix many a ‘I’ve watched a YouTube video so now I’m an expert at fixing cars’ jobs! Glad it’s not just me though.

Also I am sure Wendy is very knowledgeable indeed but she will not assume liability if something goes wrong, however the pharmacist who sold you the medication will.

It's not reasonable to expect BF women to suffer needlessly for someone else's benefit. I'm sorry if it makes me sound selfish but that isn't our burden to bear. There needs to be a better system because this must put a lot of women off breastfeeding.

‘It's not reasonable to expect BF women to suffer needlessly for someone else's benefit. I'm sorry if it makes me sound selfish but that isn't our burden to bear. There needs to be a better system because this must put a lot of women off breastfeeding.’

I’m not benefiting from refusing sales, quite the opposite in fact. I completely agree with you that the system is not fit for purpose but that’s not our burden to bear either.

The system has always been notoriously crap at allowing us to use sensible clinical judgement. Regardless I’m never going to agree that untrained people should be doing their own medical research and lying to healthcare professionals.

It shouldn’t be this complicated. What works for a cold? Not much, paracetamol and ibuprofen. Can they be safely given to breastfeeding mothers? Of course, we give babies paracetamol and ibuprofen all the time. What works for travel sickness? Ondansetron is pretty good. Used for hyperemesis in pregnancy and given to infants, so safe for breastfeeding mothers. Needs a script though. What works for constipation? Lactulose, various forms of macrogol. Can they be given to breastfeeding mothers? Of course, they don’t get absorbed at all. So for the complaints the OP has, there’s no reason she should be continuing to suffer. If we give the medication to a baby, the mother can have it. Not many occasions there needs to be over caution, rapid metaboliser of codeine in an Ethiopian breastfeeding mother for example.

JenniR29 I do agree with your point that reading around a bit isn't a substitute for qualified professional advice. But to take your car repair example - if every mechanic you took the car to said "ooooh, don't want to touch a car, funny things cars, you can't absolutely guarantee there isn't a 0.000004% chance it'll explode" you might actually end up giving it a go yourself. You probably wouldn't just let the car rust away on your drive for four years.

I don't blame individual pharmacists (although I'm still at the hospital pharmacist who needed me to explain why I wouldn't just switch to formula before even looking at the bf-safety of alternative medications). They're in the system they're in. But it's a rubbish system if you're breastfeeding and need medicine. It's not even a case of just getting a GP appointment because even when you can get one, this same issue comes up with GPs as well, they don't get much breastfeeding training and many of them prefer to play it safe. Also nurses, dentists, midwives...

If the NHS wants to encourage breastfeeding it needs to do better at this. No use telling women how important it is to breastfeed when we're pregnant but then expecting us to manage all medical issues with paracetamol and a smile for the next few years.

I'm sorry I haven't read the whole thread but I do remember having the worst hayfever of my life while breastfeeding a baby and having a toddler and the young male pharmacist saying 'it's safer to suffer' like it was his mantra and wanting to punch his smug face in. So while it probably is unreasonable I do sympathise.

‘If the NHS wants to encourage breastfeeding it needs to do better at this. No use telling women how important it is to breastfeed when we're pregnant but then expecting us to manage all medical issues with paracetamol and a smile for the next few years.’

Agree.

As for the mechanic thing it would be more like if they said: ‘I’m not happy fixing this as I don’t have the right equipment and I wouldn’t be legally covered, you should take it to the dealers garage instead’. Not convenient for me at all and I’d have to wait longer but I’d be getting the right help and I wouldn’t be angry at the individual mechanic.

This sounds like such unecessary bullshit, I'm not surprised you're pissed off. The UK has a culture of panicking and shifting blame in these kinds of scenarios. It's so U helpful.

I live in Australia and the pharmacist I go to actually knows which meds are and aren't suitable for breastfeeding, and will act accordingly. That's their job. There certainly isn't a blanket policy of saying no to pretty much anything "just in case". Pharmacists aren't stupid, they do quite a demanding degree and have lots of training to make sure that they understand things like this.