During World Breastfeeding Week #WBW2019, we are hosting a series of guest blogs exploring how the wider team of health professionals and community breastfeeding support can support breastfeeding families. The WBTi Report found numerous gaps in health professional training in infant feeding, and we are delighted to see a terrific range of resources being developed to address this.
Following on from yesterday’s blog about the launch of the Hospital Infant Feeding Network website, today we are looking in more detail at the joint GPIFN, Breastfeeding Network and HIFN campaign “Don’t Say Stop Look It Up”.
This campaign, started by the GP Infant Feeding Network in 2017, aims to make sure healthcare professionals know how to check whether specific medicines can be taken by breastfeeding women. Most healthcare professionals know that with regard to breastfeeding and medication they should check what the British National Formulary (BNF) says. The BNF is a phenomenal resource, respected around the world, with comprehensive information about medication doses, side effects and cautions. However, in some cases it takes a very cautious line on breastfeeding – for example, for the antidepressant sertraline, recommended by specialist services as a preferred option in breastfeeding, the BNF says “not known to be harmful but consider discontinuing breastfeeding”. For ibuprofen, accepted by specialist services as appropriate during lactation, the BNF says “use with caution during breastfeeding. Amount too small to be harmful but some manufacturers advise avoid”. It isn’t hard to see that well-meaning healthcare professionals are nervous about recommending medicines for breastfeeding women when seeing these descriptions in a trusted source of information, and why they may advise that breastfeeding should be stopped, or that the medication cannot be taken.
The #Don’tSayStopLookItUp campaign seeks to highlight the position of the National Institute for Health and Care Excellence (NICE), which states “Ensure health professionals who prescribe drugs to a breastfeeding mother… seek guidance from the UK Drugs in Lactation Advisory Service… the ‘British National Formulary’ should only be used as a guide as it does not contain quantitative data on which to base individual decisions… Health professionals should recognise that there may be adverse health consequences for both mother and baby if the mother does not breastfeed. They should also recognise that it may not be easy for the mother to stop breastfeeding abruptly – and that it is difficult to reverse”. The campaign poster set can be downloaded, and covers common classes of drugs such as antibiotics, antidepressants, painkillers and anaesthetics. The rest of the blog will cover in more detail how health professionals can effectively use the UK Drugs in Lactation Advisory Service (UKDILAS).
UKDILAS is an NHS service specifically set up to help health professionals make informed decisions about the use of medicines during breastfeeding. It is provided by a team of highly specialised pharmacists. The website is not the easiest one to navigate so we’ll go through the three particularly useful services they provide, step by step.
Firstly, UKDILAS provides thorough lactation-specific information on individual medications. When a health professional wants to check a single medication, where they would normally look it up in the BNF, they can go to www.sps.nhs.uk (or Google UKDILAS) and use the search box at the top of the page:
Searching for codeine, for example, will bring up first the individual drug name and any lactation (and other specialist service) factsheets as well:
Clicking on the individual drug name codeine brings the reader to a long list of articles and other specialist information so the last step is to click on the “Lactation Safety Information” link under the medication name to go straight to the relevant section.
In this case, the final result is “Use when breastfeeding – No” with useful comments about how much data this is based on and what effects are seen. This will also link you through to any other relevant lactation safety information held about this medicine:
The other two UKDILAS services are the factsheets and the ability to ask specific questions. Question & Answer factsheets are available via a link from the UKDILAS part of the SPS website (www.sps.nhs.uk/ukdilas) and cover general topics like “which oral antihistamines are safe to use while breastfeeding?”. There are also general “safety in lactation” articles covering specific classes of medication – these will come up when you search for an individual medication, as shown above with codeine, which is an opioid analgesic.
To ask UKDILAS a specific question, health professionals can telephone (9am-5pm Mon to Fri) or email – full details are on the website. The team will answer any breastfeeding and medicine-related question, but particularly specialise in highly complex areas such as multiple medications and premature infants.
Other sources of information on drugs in breastmilk
As lactation professionals know, there are many other ways to access information about medications in lactation – for example the wonderful Drug Factsheets put together by Wendy Jones at the Breastfeeding Network, American national resource LactMed and textbooks such as Medications and Mothers’ Milk (Hale). This blog has focused on UKDILAS because it is an NHS source, which is reassuring to busy UK health professionals who may not have time to check the credentials of other sources.
So, in summary, health professionals naturally use the BNF to check information about lactation, but by using the Don’t Say Stop Look It Up campaign, we can help them find out about specialist sources of information to help families make informed decisions.
Ilana Levene is a paediatric doctor planning to sub-specialise in neonatal medicine and interested in research relating to neonatal nutrition. She lives in Oxford with her husband, an environmental consultant, and two children. She is a trustee of Oxfordshire Breastfeeding Support, a local grassroots network of free weekly breastfeeding drop-ins and online support. She likes cross-stitching and making patchwork quilts.