Doctors and breastfeeding 2: Resource list

Doctors and breastfeeding 2: Resource list

World Breastfeeding Trends Initiative UK (WBTi)

Uses the WBTi Assessment Tool to score a country’s support for breastfeeding according to 10 key indicators based on evidence-based strategies in the 2003 WHO Global Strategy for Infant and Young Child Feeding: 

So far, 97 countries have produced a WBTi report: https://www.worldbreastfeedingtrends.org/

2016 WBTi Report on the UK : see Indicator 5 for health professional training, with the main summary table in Part 1 and details for individual professions in Part 2.

e-book by Patricia Wise of WBTi UK: free downloadable PDF, Supporting mothers who breastfeed: A guide for trainee and qualified doctors

Baby Feeding Law Group (BFLG)

Working to protect all babies by strengthening UK laws on infant feeding in line with UN recommendations

Publications include: Comfort milks, lactose-free infant milks and anti-reflux milks: Why these products should be removed from shop, supermarket and pharmacy shelves

Breastfeeding Network

* Breastfeeding Network Drugs in Breastmilk Information

* Drug fact sheets: https://www.breastfeedingnetwork.org.uk/drugs-factsheets/

 New e-learning module Supporting breastfeeding mothers with thrush £30: www.breastfeedingnetwork.org.uk/product-category/training/

e-learning for Healthcare

e-LfH programmes: https://www.e-lfh.org.uk/programmes/

Programmes include: Breastmilk Provision for Preterm and Sick Neonates,

Infant Feeding: supporting education around the implementation of Baby Friendly standards in infant feeding

First Steps Nutrition

Public health nutrition charity providing independent information and resources to support eating well from preconception to five years old: 

Information on infant milks for health workers

booklets available as free PDFs include: Infant milks in the UK: A practical guide for health professionals: 

*GP Infant Feeding Network (GPIFN)

The website is a clinical resource for GPs.

GP Education

Maternal mental health

 GPIFN Resources

iMAP (International Milk Allergy in Primary Care Guideline 2019)

Hospital Infant Feeding Network (HIFN)

The website provides information on supporting breastfeeding in a hospital setting, and there is also a network with a Facebook page.

HIFN posters on various aspects of caring for breastfeeding women in hospital

* Don’t stay stop look it up campaign on prescribing for breastfeeding women

Human Milk Foundation

Working to help more families feed their babies with human milk

Hearts Milk Bank: Redefining the boundaries of human milk donation

Lactation consultants of Great Britain (LCGB)

Professional association for International Board Certified Lactation Consultants (IBCLCs)

The crucial role of breastfeeding: supporting mothers with anxiety and depression Handout

Breastfeeding: a vital part of the first 1001 Critical Days. Briefing on the impact of breastfeeding on brain development and infant mental health.

Parenting Science Gang

A user-led citizen Science project

Breastfeeding and Health Care Experiences project

Personal Breastfeeding Experience of Health Professionals and Professional Practice

Royal Colleges

Royal College of GPs (RCGP):  Breastfeeding Position Statement and link to online resource on breastfeeding

Royal College of Paediatrics and Child Health (RCPCH):  Breastfeeding position statement

* UKDILAS: UK Drugs in Lactation Advisory Service

Enquiry-answering service, fact sheets and database on drug prescribing during breastfeeding

Unicef UK Baby Friendly Initiative

Working with public services to support families better with infant feeding and developing close loving relationships through training and accreditation

e-learning packages for GPs and paediatricians

Resources list

Recommended learning outcomes for different specialisms of healthcare practitioners

Include learning outcomes for medical students

Other resources

Facebook group: Breastfeeding for Doctors Peer Support

* ed. Amy Brown and Wendy Jones (2020) A guide to supporting breastfeeding for the medical profession Routledge

* Wendy Jones (2018) Breastfeeding and Medication Routledge 2nd edition

Key: * relevant to prescribing

WBTi UK Doctors and breastfeeding project 2020

Vision: That all doctors have sufficient training in infant feeding to protect the decisions of mothers who want to breastfeed.

Breastfeeding and medication: training for pharmacists and counter staff

Breastfeeding and medication: training for pharmacists and counter staff

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.

For details of gaps in health professional training, see “Indicator 5” in Part 1 of the WBTi Report for the summary table above and in Part 2 for the detailed findings on each health profession.

In this blog, Wendy Jones MBE discusses gaps in the training of pharmacists (See Indicator 5 in Part 2 of the WBTi report for our detailed findings on pharmacist training) and introduces her new free online educational resources for pharmacists.

On a daily basis I hear that pharmacy staff have advised mothers not to breastfeed whilst taking medication or have refused to sell products such as antihistamines to lactating mothers. This is frustrating for families (and me!) and unnecessary.

We know that there are barriers around breastfeeding and medication:

  1. The patient information leaflet – invariably it says that the product should not be used during lactation. This doesn’t imply risk usually rather that the manufacturer didn’t include breastfeeding when applying for marketing authorisation. For more information see this leaflet on the Breastfeeding Network website.
  2. Understanding of the importance of breastfeeding for the future health of mother and child. Sadly breastfeeding, let alone understanding the pharmacokinetics of transfer of drugs into breastmilk, is not covered currently in most undergraduate training. Most knowledge relies on personal experience (Jones W 2000 Doctoral thesis University of Portsmouth. The role of community pharmacy is supporting mothers requiring medication).
  3. Fear of litigation – to sell a medicine outside of its licence application entails taking responsibility. Pharmacists are concerned, rightly so if they do not access evidence-based information (Hale TW Medications and Mother’s Milk, Jones W Breastfeeding and Medication, LactMed , UKDILAS, Breastfeeding Network factsheets)
  4. Time – frequently counter assistants rather than busy pharmacists are involved in sales of simple medications and do not discuss safety in breastfeeding unless asked by the mother.
  5. Time limitations to consult expert sources.

Conflicts of interest

It has come to my attention recently that continued professional development (CPD) materials on infant feeding are being provided free of charge to make pharmacists and staff “Infant Feeding Champion”. Sadly, these are provided by the formula companies and the support of breastfeeding is considerably less than what I would describe as evidence based and full of advertisements for products ranging from nipple shields to nipple creams and specialist formulas.

New free training materials

I decided that I wanted to provide training materials for pharmacists and counter staff free of charge using the knowledge that I have gained over the past 31 years as a qualified, registered breastfeeding supporter as well as pharmacist with a specialist interest in the safety of drugs in breastmilk. The first module can be found here. More modules are underway looking at the pharmacokinetics of drug transfer and the treatment of common conditions.

In the meantime, my message is #DontSayStopLookItUp

I’m happy to be contacted:

and I will send detailed information to mothers and professionals.

 Dr Wendy Jones  MBE

Wendy was one of the founder members of a UK charity the Breastfeeding Network. In her employed life she was a community pharmacist and also worked in doctor surgeries supporting cost effective, evidence-based prescribing. She qualified as a pharmacist prescriber using her knowledge to reduce the risk of heart attacks and strokes in clinics to help patients stop smoking, weight optimisation and control of blood pressure and cholesterol. She feels she was best described as the conscience of the village. Her aim was to run clinics for breastfeeding mums needing medication but never managed it. 

Wendy left paid work to concentrate on writing her book Breastfeeding and Medication (Routledge 2013,  2nd edition 2018), developing information and training material on drugs in breastmilk as well as setting up her own website http://www.breastfeeding-and-medication. She has also published Breastfeeding for Dads and Grandmas (Praeclarus Press) and Why Mothers Medication Matters (Pinter and Martin).

Wendy is known to many from her work on providing a service on the compatibility of  drugs in breastmilk and has been a breastfeeding supporter for 30 years. She is passionate that breastfeeding should be valued by all and that medication should not be a barrier. She has 3 daughters and 5 grandchildren ranging in age from 6 years to 6 weeks. All her family seem as passionate about breastfeeding as she is and currently all 3 of her daughters are breastfeeding. 

She was awarded a Points of Light award by the Prime Minister in May 2018 and was delighted to be nominated for an MBE in the New Year’s Honours List 2018 for services to mothers and babies. She received her award at Windsor Castle in May 2019 from Her Majesty the Queen. 

Don’t Say Stop Look it Up – A New Breastfeeding Campaign for HCPs (HIFN): 2

Don’t Say Stop Look it Up – A New Breastfeeding Campaign for HCPs (HIFN): 2

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.

For details of gaps in health professional training, see “Indicator 5” in Part 1 of the WBTi Report for the summary table above and in Part 2 for the detailed findings on each health profession.

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”.

DontStopLookItUp

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.

Using UKDILAS

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.