Very hard decision to make, please help!

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I'm sorry if this is a bit ramble-y, I have kidney problems that cause high blood pressure that increases the kidney problems. I am under the care of a Renal Consultant who today told me that the blood pressure pills I am currently taking (labetalol - because I am breastfeeding) don't protect the kidneys so I need to come off them as soon as I stop breastfeeding to protect my kidneys.

So now I have a decision that has already caused a fair few tears. Do I do what's best for DS & carry on breastfeeding? Or do I do what's best for my kidneys & put him on formula? :(

DP & I have talked about the idea of bf'ing DS until he is 6m. He is 3.5m now.

Presuming you have looked into the possibility of other drugs, I think you have already done what you can against all odds, and now is the time to look after your medical condition.
This comes from a staunch lactivist, btw, but there are cases and cases..

You've done really well feeding for 3.5 months, do what you need to look after your health so you can look after your little boy. xx

I'm presuming the medication you'd take if you weren't breastfeeding is something you've had before and it does protect your kidneys? Why is it unsafe for breastfeeding, is there actual data or research to support that?

I am still breastfeeding DS and I find most consultants and GPs just look up in the drugs handbook and say 'oh, not recommended for breastfeeding'. Most drugs aren't, but it doesn't mean you can't take them anyway, if you judge that the risk is minimal.

The best person to check with would be the pharmacist that runs the Drugs In Breastmilk helpline at Breastfeeding Network. Give her a ring and tell her what drug it is they want to put you on when you stop breastfeeding. It may be that you could take it and not have to give up breastfeeding when you don't want to. Link here.

Failing that, if it's down to your health, you must stay healthy to care for your DS, and part of that is protecting your kidneys

Your Ds needs a healthy Mummy. You have already given him a fabulous start well done you. Don't get hung up on the breast versus formula debates just remember what's best for Mummy is best for your DS too.
Only you can decide what to do over the next 2.5 months but please take bf guilt out of the equation.

I am usually in favour of keeping bf going as long as possible, in but in your case, it sounds like it might be more sensible for you to stop. The only thing you could try is perhaps talking to someone about finding another medication which is still compatable with bf.

But 3.5 months is really good - as I understand it, although 6 months is optimum, the earlier months are more important than the later ones, so he's really benefitted from the bm he has already had.

You're obviously a lovely dedicated mummy to be giving this so much thought!

i will second yankncock and say just check out all the drug alternatives and their compatiility with breastfeeding.
definitely definitely ring the BFN, or see if you can find anyone with a copy of Hales medication and mother's milk

I would also be asking what the actual risk to the kidneys is, how long you could afford to take the medication for, what will happen if you take it longer etc etc and just get the full picture before making any decision

if it comes to giving up you can do so knowing that you've fully researched it and made the right decision for you and your son. and know that you have given him the absolutely best start in life. all that breastmilk he has had still counts even if you formula feed now.

Wow, thank you all for such lovely supportive replies. Welling up again now!

Before pregnancy & breastfeeding I was on 4mg Candesartan daily which, according to my Consultant has kidney-protecting properties. I was only on a small dose but that was enough to keep my bp normal, without it it tends to sit around the 160/100 mark.

A quick google says this about Candesartan:
Summary of Use during Lactation
Because no information is available on the use of candesartan during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. It is not known if Candesartan is found in breast milk. Do not breast-feed while taking Candesartan.

I hadn't even thought of ringing the BFN or even asking my GP if there are any alternatives! I will definitely check out both options before I made any decisions. Thank you all so much! I would absolutely love to find a solution that suits both!

I'm just so :( about the thought of having to give it up, I love the bond it creates. But of course, there will still be a bond with FF too.

I will also give my Consultant's secretary a ring to see if I can have a chat with him in more detail about the damage level my kidneys would face if I were to feed until 6m or even longer .etc. Thanks again all!

lactmed here says what you already have found, but gives 4 different alternatives. I wonder if you could also discuss those with your consultant if you decide that it would be unsafe breastfeeding with the candesarten

I would email or ring the BFN drugs in breastmilk helpline www.breastfeedingnetwork.org.uk/drugs-in-breastmilk.html they are very good.

A lot of time you can carry on BF even with a drug that hasn't been tested it's always worth a phone call.

[url=books.google.co.uk/books?id=OIgTE4aynrMC&pg=PA192&dq=Candesartan+breastfeeding&hl=en&ei=6bd8TraJE82r8AOkm7mKAQ&sa=X&oi=book_result&ct=result&resnum=1&ved=0CC0Q6AEwAA#v=onepage&q=Candesartan%20breastfeeding&f=false]This[/url] book says Candesartan is counterindicated. It recommends ACE inhibitors. Is Lalbetalol one of those? It's a beta blocker, isn't it?

Please do talk to the BFN folks, they are very helpful, I find they answer emails pretty quickly.

Oh blah. The link I wanted is this. Sorry.

thisisyesterday, thank you so much for that link. I've just been having a nosey at the alternatives to Candesartan. I'm unsure if it's because Candesartan is an 'Angiotensin II Type 1 Receptor Blocker' that is protects the kidneys. So I will ask the question as to if there are any alternatives. I'm crossing my fingers but part of me thinks the Consultant may have suggested some if there were but then again he may just be trying to cover his own back IYSWIM?

NotQuiteCockney, again, thanks for the link, very useful. From what I can gather, ACE inhibitors are 'closely related' to Candesartan so may be better than Labetalol which is just a beta-blocker.

Either way, I'm definitely going to explore every option before giving up bf'ing as I do love it & the extra time while I do my homework so to speak won't hurt, so I'm going to start writing a list of questions I need to ask each person / organisation, email the BFN now & ring my Consultant on Monday.

Thank you all so much!

I've emailed the BFN! :)

excellent, i hope they can find something that will allow you to carry on breastfeeding AND protect you as well, that would be great

sometimes HCP's err on the side of caution a little too much, and sometimes they are just woefully uninformed so it's always worth double checking and researching when you're told you can't breastfeed on certain drugs.

and as I said earlier, even if it comes to having to give up breastfeeding in order to take the drugs you can do so knowing that it is the only choice, a fully informed decision.

Although there might not be much information available about candsartan there might be more info with some of the older similar drugs, eg Valsartan, so it could be worth considering an option to swap for a while.

Look here too

Good luck

oh good old Hale who i mentioned earlier!

and use?

might be worth posting on there too though about your specific situation

I'm really sorry you are in this position :(

I know nothing about the drugs or the options you have with them (but thankfully you have already had a lot of good advice on that!!) Having read your post I couldn't not reply... if you can't find a drug that is compatible with breastfeeding whilst protecting your kidneys then you need to stop bf & look after your kidneys as best you can.

Breast is best - but not at any cost.

The difference between breast & formula is not enough to warrant you damaging your kidneys. Your child/ren need you for as many years as you can possibly give them, knowing you breastfed them for another few months wouldn't be any consolation if you died younger than you had to because you didn't do all you could to protect your kidneys would it :(

I hope you can find a drug that allows you to do both.
Good Luck!

Surely your DS needs a healthy mum more than anything else?

Hi. I faced this dilemma a few weeks ago and was very shocked at how bf was affecting me both emotionally and mentally!! Tears, sadness heartache at the thought of stopping. Once pharmacist checked on drugs in bm website we managed to find one that suited . In a rush do haven't read all the posts but just wanted u to know that I know the agony u are in and really hope it works out. Fwiw I think you need to get yourself sorted as you've been brill to get this far- sooo many babies don't even get bm fir nearly as long and ff is not so bad xo

My understanding is that drugs cannot actually say, 'safe' for breast feeding because testing drugs on breast feeding women is not allowed. The same goes for pregnant women. Check with a pharmacist about this, but is what I've been told by my nephrologist. I also suffer from a kidney problem that gets worse in pregnancy.

So, the questions you need to ask is whether the drug passes through breast milk. And how has this been determined.

Hi, I also agree that getting more info should help you make your decision easier to make.

The cost of testing a drug in pregnant or lactating women (or newborn babies) is high, plus its difficult to get people to sign up to the trial and it can be unethical to even set them up (because this may mean putting people in a category that is known to be sub-optimal, e.g. imagine asking women to smoke / avoid fruit & veg just to quantify the result). So yes, few drugs are officially tested and safe. Far more common is that people happen to do stuff while pg/ BFing etc, then statisticians say "oh look, there's a possible link... And investigate further.

Put it this way, what's the chances that your shampoo is certified safe for pg/BFing women? Just to illustrate the point.

So, I'd get more info on the possible options plus the known risks and efficacies of each. It doesn't sound like you have enough info to make an informed decision yet.

Good luck

Just to clarify-

few drugs are officially safe I am referring to in pregnancy / breastfeeding. All drugs are tested in the general population! Some drugs will be taken by women who don't (yet) realise they're pregnant, or who choose to continue the drug anyway. So there'll often be some data, just not necessarily the usual level of testing.