Very hard decision to make, please help!

[WiiUnfit]

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.

Just to play Devil's Advocate - while it's true that children need a healthy mother, they also need to be healthy themselves.

What if stopping breastfeeding him happens to be the difference between him being healthy in later life and developing some chronic/fatal disease? Perhaps the potential damage to your kidneys is less than the potential damage to your son. There is plenty of peer-reviewed scientific evidence to show the clear superiority of BM over F as regards long-term health.

And if your consultant said 'change drugs once you stop BF' not 'stop BF immediately so you can change drugs', why are you more worried than he was?

But yes of course the best way would be to find a drug which is OK during nursing.

Or you could get him wet-nursed/privately donated milk.

You are getting this out of proportion mate. Can the breastfeeding now and look after yourself

Hale is the bible for drugs and bf, yousr is an L3 Moderately Safe:

No controlled studies, however, risk of untoward effects in a breastfed infant is possible; or controlled studies show only minimal non-threatening adverse effects. Drug should be given only if the potential benefit justifies the potential risk. All new medications with no published data go automatically into this category regardless of how safe they may be.

It goes on to say that there is no data on this drug levels in breastmilk and some caution is recommended in the neonatal period andparticularly when used by mothers of prem babies.

Some other ACE inhibitors are more compatible eg captopril, enalapril.

The other categories are
l1 safe
l2 safer
l3 moderately safe
l4 possibly hazardous
l5 contraindicated

sc2987
presuming the poster is a uk resident we don't have private milk banks nor would it be at all likely that a wet nurse could be found.

Quattrocento not at all. There are many, many reasons why BFing is very important to both babies and mothers from a physical and mental health perspective and this is balanced with the risks to this mother of not taking the kidney drugs. Because WE don't know the details of her illness and the potential risks of not taking the drugs then we CANNOT make a judgement over whether this mother "should" or "should not" "can the breastfeeding". IF the risks of kidney damage are very tiny, she may well decide that the risks of not breastfeeding are higher. Conversely, if the risks of kidney damage are significant, or for that matter just not "very tiny", and the drugs are not safe, this will perhaps lead her to decide to stop breastfeeding and this will be the right decision for her.

We cannot, nor should we, make a judgement either way. We can only give the OP some ideas of things she might want to consider when she makes the decision herself.

well said carrotcake

Morning all, sorry for the late reply - we went to see DP's Grandmother yesterday :)

sc2987, as pizzaman said - I'm a UK resident so I doubt this would be possible. And the points you have made about whether that will be the difference between him developing any disease later in life is one that has played on my mind trust me, so you really don't have to remind me of that one. :( I know bf'ing is the best for him but as others have said, I'm stuck between doing the best for him through bf'ing or the best for him by actually being healthy & being around for him. My Consultant asked me how long I was planning to bf for & in the usual automatronic state I seem to get in whenever I see a HCP I said 'I don't know really'. I was hoping to bf for 12 months.

Queen & thisisyesterday, thanks for the link to Hale's. I found a little bit of info on there but it now says it's closed to new questions! :(

Tomorrow morning I am going to ring my Nephrologist's secretary to ask if I can contact him at any point to ask him about ACE inhibitors. I'm going to book in with my GP too & have a chat with him. My questions so far are:

1. What is the risk to my kidneys if I were to continue breastfeeding on Labetalol until 12 months (June 2012)?

2. Has Candesartan been found to be unsafe? I know it has been deemed unsafe during pregnancy but is it really unsafe for breastfeeding? If so, how has this been found?

3. Are there alternative medicines such as ACE Inhibitors (safe for breastfeeding & similar to Candesartan) that will offer the same protection for my kidneys as Candesartan?

Have I missed anything?

I've not had a reply from the BFN yet but eagerly checking my inbox!

that sounds like a good list of questions.

i would maybe also ask whether, if you continued on the kidney damaging drug until next June, whether that damage could be undone or if it's permanent damage.

pregnancy and breastfeeding are different IIRC because during pg the drugs can cross into babies bloodstream via the placenta.
With breastfeeding it's a different process entirely and the amount of drugs taht end up in milk is usually very small.

It's also worth noting that often the risks of a drug via breastfeeding are more applicable to a very small baby, and the bigger the baby gets the less the effects of the drug.

Brilliant, thanks!

I am very pro bf but would switch to formula.

I think it is lovely that you are thinking about this so much but I agree that if keeping BF is going to damage your health in any way then you should switch to formula 100% guilt free. You have done so well at 3.5 months anyway. Obviously I love BF so I would see if you can get drugs that are compatible with BF but if you can't then you will still be a great mother without BF!

Keeping my fingers crossed for you re BFN. I have had excellent advice from them in the past. I hope they are able to respond soon.

WiiUnfit - I'm not going to comment on whether you should or shouldn't continue to bf. That's a decision for you to make (hopefully with all the facts and lots of unbiased guidance).

The reason Hale's on-line forum is shut for new questions is it has been closed down as Hale launched the new Infant Risk Center last eyar which is a US based centre for pharma. & medical issues with pg & bfing. You can apparently call their help line with a Skype phone or download their App if you have £20 to spare. There is also a forum for mothers (the old forums were for HCP to ask on behalf of their patients/clients) but I'm not sure how much Hale is involved with that.

I hope the the Drugs & Breastmilk helpline gets back soon. I have always found I got a quick reply and they are very very good at what they do. Between Hale & Wendy Jones they have saved my bfing relationships many, many times.

Wii - hope you find support and information to make a confident decision.

It's good to see posts on here reminding people that no one should tell someone what they should or shouldn't do in these cases - no one can ever have the full facts, or know if any individual poster should stop bf or not.

Good morning all,

Still no word from the BFN so fingers crossed I will hear something soon. I have just spoken to my Nephrologist's secretary who didn't fulfil me with confidence, she said it is a common issue they come across & she doesn't think there is a drug that is safe for breastfeeding that protects the kidneys. She also said that my Consultant is doing ward rounds at the moment & clinics later so he is unlikely to be able to get back to me today but will get back to me when he can. At least I will have, hopefully, heard from the BFN so will have a fair bit of information behind me when I talk to him & will have some useful questions for him that will allow me to make a confident, informed decision.

Another question I thought of was how long does the drug stay in the system (& therefore the breastmilk), as the doseage of Candesartan is one a day, would it be in my system all day or will it be flushed out the way other drugs, alcohol .etc would be? So in theory, could I take my dose at night, FF through the night & BF in the day?

And what are the risks to DS if I were to take Candesartan while bf'ing? The risks are high for early pregnancy I know but there seems to be little known about the risks during bf'ing, other than it being highly unrecommended for bf'ing young babies (how young is young?) or premature babies?

Can I just thank you all again, you have all been so supportive & helpful. :) I will be sure to keep you all informed when I find out more!

May well be worth giving the drugs line another ring just in case your message has gone astray.

The BfN is all volunteers so not always possible to get quick responses esp at weekends.

Your question about timing the medication is a good one, Wii - what you are after is info on the 'half life' of the med, ie the time in which it is pharmacologically active in your body (or your milk).

Some women using epilepsy meds do indeed time their dosage to minimise the baby's exposure to it.

Worth exploring this with your doc.

This is worth a look at as it is a layman's guide to how drugs can get into bm.

For a drug to get into bm a whole load of criteria need to be fulfilled.

Some medications have too large a molecular weight to be present in breast milk e.g. insulin has a molecular weight of 6000 and the molecular weight of a drug to be present in breast milk needs to be lower than 300 so insulin would be impossible to get into breast milk.

Some medications only work if injected or applied topically as they are not able to be ingested. This means no matter how much is present in the mother's milk, if the drug can only be accessed by the body if injected into a vein it will not affect the baby.

Some medications are bound into the mother's blood (known as protein binding) have less 'free' drug available to be present in breastmilk. Conversely drugs with a high lipid solubility (dissolvable in fat) are more likely to be present in breastmilk so drugs with a high lipid solubility may be less suitable for breastfeeding mothers.

Plasma levels of medication is also important as a drug which has a high plasma level will have a high milk level (with very few exceptions) so the lower the plasma level the more suitable the drug may be. This is also true for drugs with short half lives, though drugs with long half lives may be suitable if the drug has a low oral bioavailability or are highly protein binding.

Also, the infant's age, exclusivity of breastfeeding and health status should be considered as an older toddler who only breastfeeds 2 times a day at set times (so medication could be taken at a time so as to minimise exposure to a drug with a short half life), eats lots of foods and is in good health might be able to take a 'riskier' drug than a premature infant breastfed exclusively on demand with health concerns.

Sorry to blind you with science but I know people (even some HCP) think that if you take a drug, any drug, it will end up in the baby and cause harm even if it is a drug that can't be taken by mouth, can't pass into the milk ducts, has a short half life and is given to children of the same age as the nursling. That really isn't the case!

Fingers crossed for a DIBM helpline answer soon.

Fantastic news! I've just had a phonecall from my Consultant's Secretary. He 'flew' into the office & she managed to explain my query to him, he has said that I should be able to bf DS until he is 12m on Labetalol with little damage to my kidneys so the benefits to DS far outweigh the slight damage to me! Very happy & DS clearly celebrating with a very noisy bf!

TruthSweet, thank you for that, very interesting read!

TikTok, next time I see my Consultant I will query the half-life on Candesartan.

Thanks again all, you're all brilliant! :)

Oh that is great news

Wii, that's great....be sure to tell your docs how upset you have been, and how unnecessary it was to be so confused and distressed.

half life is 9 hours, it peaks after 3-4 hours, molecular weight is 611 and protein binding 99%, oral bioavailability 15%.

This info is correct afaik and was released by the manufacturers. wendy jones from bfn is the person to interpret it though:)