Friend in hosp with DVT, baby is 2weeks (ish), she has been told she must stop bf, are the docs right?

[JustBeBuffy]

OK so i don't know what meds she's on & i don't want to pester her but am sad if she's being given false info.

She says she's spoken to 3 doctors, all of whom have said she must stop bf as the baby could have an internal bleed as he's so small.

She has to be on the meds for 6months.

Her DVT was misdiagnosed as a trapped nerve first apparently , she's been in hosp since Fri so baby has been on a bottle since then anyway.

Having done a quick google i found this that implies she should be ok to carry on?

I don't know how much of a fight she's prepared to put up tbh, but just feeling & for her.

(this is dc2 for her, she bf her first for most of a year as far as i remember - we met at bf group)

If you were talking about the NHS call centre you might have a point though.

good point Frankly.

Tiktok I won't retract my statement. Warfarin supposedly does not make it into breastmilk but I would still assume it to be dangerous and not breastfeed while on it. I have seem warfarin do too many weird unexpected things. Warfarin is not a drug you trust.

There is no evidence that taking warfarin is dangerous when breast feeding. There is no evidence that breast feeding should be discontinued when taking warfarin.

Warfarin is a dangerous drug - it interacts with so many things - alcohol, vegetables,herbal supplements, vitamin supplements, all sorts of over the counter medicines, you name it. But no evidence for stopping breast feeding.

Years ago, women on warfarin were advised not to breast feed - this was based on opinion, not fact.

There is no reason why the lady in question should not ask for an explanation plus evidence from the doctors who have told her she cannot breast feed.

Either the doctors are inexperienced, or there is another reason for their advice that we are not privy to, or we have not got all the relevant information.

Everyone has said it already but here is another anecdote

I was on fragmin 15000units for the first 7 weeks of my (premature) daughter's life and on warfarin for the next 14 months while she was BF.

Have been BFing DS who is 17mo whilst taking warfarin throughout.

Doctors often do not know anything enough about breastfeeding - the vast majority will have had no teaching on it whatsoever.

and I know this because I am one.

Was about to suggest the BNF, but see that it is mentioned lower down.

justbebuffy, hope your friend is ok. what a terrible time
i would be mightly grateful for any friend who did what you have done as i love breastfeeding and wouldn't want someone to tell me to stop unless it was absolutely necessary.
i hope that your friend gets enough information to make the correct decision (in conjunction with her doctors) for her and her baby
sometimes i think docs see breastfeeding as 'just another complicating factor' that they go do with getting rid of.
but of course, if it is genuinely not safe, she must stop.

i haven't had DVT but have had other medical issues and have actually brought 'medications and mothers milk' by thomas hale to medical consultations (docs prob hate me!) you can get it from nct website

Thanks everyone.

Concordia - would you mind doing a quick check for Warfarin & Clexane in your book? esp C as i can't seem to find quite as much online about it.

Wuglet - thanks Doc

I will text her tomorrow to see how she's doing generally, and see if she wants any more info, or if she's seeing a more senior doc/specialist.

Leonie - thanks so much

Tiktok is clearly my consultant professsor of Haematology in disguise . That is exactly how he explained that Fragmin (LMW heparin) is perfectly safe to inject whilst feeding.

The pain of injecting and the bruising was not pleasant but I felt it was something I could put up with in order to continue to breastfeed my DD.

The BfN fact sheet;

Anti-coagulants to Prevent and Treat Blood Clots in Mothers who are Breastfeeding
Blood clots may develop in the calves (deep vein thrombosis/DVT) or the lungs (pulmonary embolism/PE). Risks increase in patients who smoke or who are over weight. They increase if the person is immobile for prolonged periods e.g. during travel or after surgery. Pregnancy increases your chances of getting DVT, with approximately 1 in 1,000 pregnant women developing the condition. The risk is considerably increased if your Body Mass Index (BMI) is over 30
To find your nearest Breastfeeding Supporter call the Supporterline 0300 100 0210
Calls to 0300 numbers cost no more than calls to UK numbers starting 01 and 02 and will be part of any inclusive minutes that apply to your provider and call package
The Breastfeeding Network is a Company Limited by Guarantee Registered in Scotland Company No. 330639 Registered office Alexander Sloan, Chartered Accountants, 38 Cadogan Street, Glasgow, G2 7HF The Breastfeeding Network is a Registered Scottish Charity No SC027007
©Wendy Jones PhD, MRPharmS and the Breastfeeding Network March 2009
The symptoms of a DVT in the leg include:
? swelling,
? pain,
? warm skin,
? tenderness, and
? redness, particularly at the back of your leg, below the knee.
A DVT usually (although not always) affects one leg (NHS Choices www.nhs.uk)
If you have a BMI of more than 30, have a previous history of DVT or develop symptoms of
a DVT or PE you may be given daily injections of heparin or a low molecular weigh
heparinoid (enoxaparin, dalteparin and tinzaparin).
These drugs do not pass into breastmilk in any significant amount as the molecules are very
large and the drugs have very poor oral bioavailability.
Page 1 of 2
To find your nearest Breastfeeding Supporter call the Supporterline 0300 100 0210
You can continue to breastfeed normally but you will probably be advised that your baby
should receive vitamin K injections at delivery. Further Vitamin K is also found in breastmilk
(as well as artificial formula).
You may also receive warfarin tablets to take. Warfarin is an anticoagulant that is taken as
tablets once daily. The dose of warfarin has to be precise to ensure that the blood does not
clot too easily, or that it does not cause excessive bleeding. This may involve regular
monitoring of your INR (a measure of your clotting levels) by blood tests.
You can continue to breastfeed normally whilst taking warfarin up to 12mg daily, as levels
passing through breastmilk are too low to affect your baby?s blood clotting. No adverse
reactions in breastfed infants have been reported from maternal warfarin use during
lactation
References
? Lactmed toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
? Hale T Medications in Mother?s Milk 2008
©Wendy Jones PhD, MRPharmS and the Breastfeeding Network March 2009

Lovesthechaos - are you always like this?

Reluctant to admit you are wrong?

You won't retract your dogmatic statement "If she is on warfarin then breast feeding would be extremely dangerous" because you 'assume' it would be dangerous....because warfarin 'supposedly' does not reach breastmilk in significant quantities.

Have you read nothing of this thread at all?

No one should 'suppose' or 'assume' anything, surely, still less make dogmatic statements based on suppositions and assumptions.

Surely everyone agrees that the way forward is to look at the research, read reputable sources of information, and then discuss with the doctors. I think, combined, this reading and discussing in the context of decent research is a lot more sensible than following the advice of a 'random stranger on the internet' who 'assumes' it would be 'extremely dangerous' to take Warfarin (injected, by the way, because its active ingredients are ineffective taken orally).

The more I think about this, the more I hope that the op and her friend will get to the bottom of it.

This poor lady has had a DVT, a horrible painful thing that is going to take months to treat. She has been told she cannot breast feed - a real double whammey. Unless there is something really unusual about her case and her baby that we know nothing about, this would appear to be unnecessary.

These 3 doctors mentioned here really need to be questioned about this. My gut feeling is that they are new juniors who need to update their knowledge and skills. There needs to be a clear policy in the hospital so that everyone knows the facts about warfarin and heparin. This is really important because post partum DVT is not rare, so obstetric staff do need to be educated.

lovesthechaos - are you medically qualified? You make some sweeping statements about INR levels and warfarin, but they don't make sense to me.

I know we only have second hand information, but I really hope this poor lady is able to ask the right questions so that if the advice she has been given is wrong, it can be put right.

I would have been devastated if I had been told I had to give up breast feeding, and no-one should underestimate the impact this will have.

Although it is not ethical to trial drugs on pregnant /nursing women, a lot of drug safety work is done by huge retrospective drug safety audits.

DVT is a potentially life threatening condition, so it has to be treated - no choice. So records of outcomes are kept and audited to give an idea of the risks and benefits of different treatments, and eventually policy is formulated based on this information. It does take years though.

Hi TikTok. I just got back to this thread. I still wouldn't touch warfarin with a ten foot pole whilst breastfeeding. I once looked after a women who was on it and her baby's INR was raised dangerously, and they don't know why it happened. Granted most studies have shown that it isn't supposed to go into breast milk and it usually doesn't. I conceded this in an earlier post. In my experience warfarin is not a drug you screw with, as it can do unexpected things. I was a militant breastfeeder by the way, breastfed all three of my kids for 18 months.

Warfarin is taken orally. Heparin is usually a sub-cut injection. The amount of warfarin you take daily is based on your blood results. Warfarin comes in 1mg, 3mg, and 5 mg tablets. I have heard that there is an injectable form of warfarin but have never seen it so to speak.

If there really is a concern about the warfarin, she doesn't need to take it. She could just stay on the LMW heparin. She should have been offered the choice.

Lots of mums do that because they don't have to hang about in the warfarin clinic with a new baby for hours.