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)

You are an HCP of some sort, Lovesthechaos. So you will have learnt something of the scientific method? You will have understood that one case (the one you witnessed) where the baby had some unexplained symptoms at the same time as his mother was using warfarin is not evidence, and no evidence at all compared to properly-constituted investigations, I am sure.

You will also have learnt that an HCP has a repsonsibility not to scare-monger, and this would include avoiding coming onto forums and saying "If she is on warfarin then breast feeding would be extremely dangerous."

Dogmatic statements like this help no one. In fact they have the potential to do harm.

IV warfarin is sometimes used, BTW.

It wouldn't need to just be retrospective trials though would it? I mentioned to my Haemotologist that I would be happy to provide samples of breastmilk to be tested. Surely if they can prove that the drug does NOT pass into the breastmilk then they CAN conclusively declare that it is safe. He didn't seem to think that anyone was doing a study .

I know this is not as straightforward for warfarin because very small amounts can pass into the breastmilk, but from what I was told it is only given as the drug of choice because it is significantly cheaper than LMW.

I don't think there would be any studies on-going with warfarin - it's been well-accepted for years that it only appears in breastmilk in insignificant quantities. Pharmacology studies reveal how drugs behave; they know the size of the molecule; they know if it is capable of passing into breastmilk; they know how long the active ingredients stay active; they can work out the likely effect of a drug with this info and they can observe infants of mothers who take it.

All of this stuff has already been done with the mainstream DVT drugs.

Well thanks everyone for your comments.

Texted friend this morning saying I hoped she was getting out today & that there is lots of info out there supporting bf & if i could do anything to say so.

She replied: no chance of getting out today and have spoken to more docs who are all saying no to bf. i can't take the risk, if anything happened to T i would never forgive myself.

I'm so sad for her and angry at the docs.

but there we go.

What a shame. We don't even treat DVTs as outpatients - I wonder why they won't let her out? There must be more to this I think.

Actually - although LMW heparin is more expensive to buy, as long as the individual self administers it works out cheaper because they dont have to come to clinic every few weeks and have a blood test. A clinic episode is pretty expensive.

No-one is going to do any trials on warfarin now, because it will have gone in 5 years. The new oral heparins will take over, they are safer all round.

I am so sorry your friend is going through this, OP. It sounds horrendous.

Sorry - we don't treat DVTs as IN-PATIENTS. We treat them as OUT-PATIENTS. Should have checked my typing.

TikTok the baby had a raised INR and bled out. It's not the first time it happened to a baby either. The scary thing was that they don't know why it happened considering that research has shown that warfarin does not usually make it into breast milk. It's the unknown variable that makes it dangerous. I personally wouldn't screw around with warfarin and continue to breastfeed.

I highly doubt that anyone on here is going to listen to anything that is said on a forum rather than listen to their doctors (who have specialised knowledge of the individuals specific situation).

We do not know every last detail of the OP's friends medical situation. It is foolish to immediately determine that her doctors are wrong simply because you want to promote breastfeeding. There could be something else going on with this patient that we on this forum are not aware of. The fact that there is research out there that has shown that warfarin won't always harm a breastfed infant is not enough to assume that it is safe at all times in every situation.

LovestheChaos - no one sensible wants anyone to make medical decisions based on what they read on an internet forum. You will see my posts have bee consistent on this - any info the OPs friend decides to explore should be discussed with her doctors before she decides to do anything. As you say, we cannot know every detail and even if we did, she would have to discuss with her docs anyway. There is, however, enough evidence from respected sources to show that warfarin is safe, generally speaking.

However, I am not assuming warfarin is safe for every mother in every situation - but you are making an equally grave error in declaring, as you did yesterday, that warfarin would be 'extremely dangerous' to take when bf. You are being dogmatic and seeing in 'black and white' which is not helpful, it's scaremongering, and you should admit it...especially since declaring you are an HCP which gives weight to anything you post in a medical field.

I rather sense though that you are a little bit closed-minded on this one, and will not admit how wrong you were

Wuglet should be applauded for being prepared to admit that doctors do not know a lot about breastfeeding and medication. I'm sure she would be prepared to be questioned about her knowledge in these circumstances and there is no reason to think that other doctors would be any different.

No-one is suggesting that the OP's friend ignores her medical advice, but she is being provided with additional information so that she can have an informed discussion. After all, it was me who suggested to Heparin to the consultant who was treating me and he had to admit that he hadn't thought of it and didn't realise that it didn't pass into the breastmilk.

However it sounds like the OP's friend has decided to go with the advice she has been given which is fair enough. I think the OP has done the right thing in trying to help her friend and she will no doubt support her decision.

Well done for trying JustBe. Hopefully the advice and some of the links on this thread might be useful to other people searching for the same information.

What a shame that the Dr's don't realise that by telling this mother to stop bf they are putting the baby and the mother at many more health risks than by bf when on anticoagulants.

Going off topic now....

Nigglewiggle (and everyone else).

My teaching in breastfeeding to date during:
5 years of medical school
4 years in hospital medicine (including 6 months in obstetrics and 6 months in paediatrics)
and 5 years as a GP

has been precisely 0.

All my knowledge of BF has come from doing it myself and this forum (and the Unicef BF management course but that was me doing it off my own bat not part of my professional education).

The vast majority of doctors out there will be in exactly the same situation.

We really don't always know best.

I agree WUG, I am also a doctor and have had no education about bf in training. I have learnt lots about bf from my own experiences, good and bad, and the internet and bf groups.

some of the things i have heard my colleagues say about bf are ridiculous. very much 'if in doubt, tell her to stop, formula is just as good, why bother' kind of thing.

Least favourite is a comment on a medical forum by a GP 'i've never seen a baby who has been harmed by formula milk'.

That backs up what a lot of us on here had suspected. Doctors can't be expected to be experts on everything, but considering the fact that healthcare professionals are supposed to promote breastfeeding it is rather shocking that you get no training at all.

I applaud your honesty. How can we change this?

For those PCTs that are going for baby-friendly status there is a requirement that medical staff have some training on BF awareness.

As trying to teach GPs is often quite a lot like herding cats it has been agreed that they get a handout to read and that is it. [hmmm]

bum. I meant of course

As well as there being no training re breast feeding, there is virtually no training in DVT, anticoagulation, thromboprophylaxis unless and until tne juniors are doing a rotation in haematology, and even then it is very hit and miss. Even the specialist registrars in haematology are very hazy when they first start.

Many of the junior doctors in obstetrics will be GP trainees, their training is less specialised than the career obstetricians'. They won't have done any haematology.

Junior doctors nowadays have had far less experience than the generation that are now in their 50s, because of the EU working time directive. It is really very scary. consultants of the future will have had less than half the training/experience hours of the current ones.