breastfeeding on medication would you consider it?

[Bumplovin]

Hi,

Im just posting for a general opinion as im really struggling to decide what to do. I' m taking medication for my mental health that ive been advised not to stop because of risk of postpartum depression. My baby is due in dec and Id always planned to bottle feed as the drug leaflet says to avoid breastfeeding however I have recently been diagnosed with gestational diabetes and ive read breastfeeding helps reduce risk of me and baby going on to be diabetic in future. ( plus obviously all other benefits) . Someone suggested contacting the breastfeeding network and I have emails from their pharmacist saying that although it is known to pass to breast milk she thinks my baby would only get very low levels as my tablet has to be placed under the tongue and is not effective if you swallow it as the stomach doesn't absorb it well. Her theory is that as the baby swallows the milk it's stomach wouldn't be able to absorb the medication in the milk. Nobody else can advise me as there are no studies on the drug yet as its new. I kinda think she may be right but I'm scared if she's wrong, would this kind of advice reassure you and would you breastfeed if you were on medication? Sorry for the long post but was hard to explain. Not looking for medical advice as such but just really how other people would decide? Many thanks in advance x

5madthing I might email the pharmacist and ask her that, or actually my psychiatrist would prob know that, my understanding is that it's half life might have been quite long to keep levels stable but I know the packet suggests some people take it twice a day and I only take it once. It's definitely worth just exploring that, I liked the fact that someone else suggested mixed feeding so she gets maybe breast milk in day and bottles at night (if she would take to bottles) that way she might get the benefits of breastmilk but would not get the drug with every feed. Thanks for taking the time to comment x

stiginagrump thankyou I did feel the advice I got was excellent and knowledgeable. Just had a doubt today and just want to do the right thing. Thankyou to all of you for commenting, it's been so helpful to hear views of other mums. I might email back with my other questions I just didn't want to pester again!

Honestly, I wouldn't if as you say the effects of the drug are still unknown (and I say this as someone who did BF while on other medication. The scientifically proven benefits of breastfeeding a healthy full-term baby are pretty low - they do exist but they are certainly not enormous. I think you should also consider the fact that if you are at high risk for PPD, studies show that trying and failing to breastfeed is a significant risk factor for developing PPD. It was honestly one of the hardest things I have ever done and I never made enough to exclusively breastfeed. Of course, you may well be one of those women who BF easily and with no problems (and likewise your baby may be an easy feder) but there are a lot of maybes there. I would be concerned that the combination of residual concern over the drug in breastmilk, plus the possibility of BF challenges in the early days would put your mental health, that you have done so much to protect, at risk. The hormone-infused post-partun period is very tough to navigate when you are in the depths of it and if you were developing towards PPD, it is extremely difficult to recognise that.

You mention the possiblity of BF reducing further risk of diabetes following your gestational diabetes. I am not familiar with that issue but would suggest that you talk to your diabetes doctor about that and ask how strong the evidence is for a protective effect.

So just some other factors you may wish to consider. Best wishes for the new arrival - I'm due in December too.

If you get the drug info you need you couid always speak to a bf counsellor to chat through the whole decision - they are person centred and wouldn't pressure you into feeding or not.

Hope everything goes ok. Really though I sound trust the source of your info I do t actually think k you should decide until your baby is here, so many variables and so hard to know in advance how we will feel.

Yes I think maybe once she is here it may be easier to decide, I know the pharmacist I spoke to is the most qualified person in the uk to ask and she wAs very encouraging that if I chose to do it the risk is small in her eyes. At least whatever I decide I know I have sought the best advice I could. I realise breastfeeding could be challenging and have discussed with cpn of switching to bottles if I struggled or if say I did encounter postpartum depression and had to up my dose temporarily. I really appreciate all your comments tonight I wAs just having a wobble hoping I was doing the right thing. I guess parenting is full of choices that you have to weigh up and you just have to do your best!

I would have a Google about the actual evidence in favour of breastfeeding. Although it is often stated that breastfeeding is far superior to FF, the actual evidence, if you read the studies, is far less conclusive, and it appears that the benefits have been highly overstated. The studies are usually confounded, and positive effect sizes are often very modest, and not always replicated from one study to another. Given that, I have to say that in your shoes I would avoid the risk of transferral in breastmilk and FF. It seems too big a risk for too little benefit, to me.

I get that you are worried about diabetes (it runs in my family, so I am well aware of the disease and its complications). However, breastfeeding is only one tiny part of the picture when you look at the risks your DC may have in that respect over the course of their life, and also the circumstances that may mitigate them. Breastfeeding looms large as a huge issue when you are pregnant/have a newborn, but it really does fade away very quickly as your child grows.

Tricky one... Asenapine is a relatively new drug that isn't really in wide use yet so any discussion regarding breastfeeding is going to be based on studies released by the drug company and theoretical knowledge of how medicines work.

I personally would formula feed because even if the pharmacist reassured me, it would be at the back of mind all the time. And as Estelle says the actual evidence around breastfeeding isn't all that conclusive. I guarantee you cannot tell from one e person to another who was breastfed.

1. whatever decisions you make, base then on putting your mental health first, your baby needs a happy healthy mother
2. see above

your baby needs a healthy mother more than he or she needs breastmilk. this is one of those situations where breast isn't necessarily best. i'm aware that with a better-tested drug it can different (i was encouraged to try bf on fluoxetine, although i chose to switch to formula in part because my mental health benefitted from being able to share feeding responsibilities and get a little more sleep - something to think about if you know lack of sleep can trigger an episode)

trust me, you do not want to mess about with medication immediately post-partum, you'll likely have enough on your plate! having a newborn is wonderful but it's incredibly overwhelming especially for those of us whose mental health can be a challenge

my mental health has been great since having ds 11 months ago but only because i put it front and centre - i knew i had to take my meds and watch my moods and sometimes do the 'wrong' thing parenting wise (i.e. formula feeding) because i knew it was right for me and my family.

best of luck!

I emailed back to the bfn and they said levels of a drug would be stable over a 24 HR period so expressing and discarding milk at certain times after taking it would be pointless. She reiterated that she didn't think the baby's stomach would be able to absorb any of the drug that was in the milk and said that it would just pass through the body and be excreted so the liver/kidneys wouldn't be involved at all. I don't think I can get any better advice elsewhere so think I'll just wait and see until she is born and whether I am actually able to breastfeed or not, I know some people struggle. Thankyou again for all your comments yesterday, I feel much better today