Breastfeeding and medicines
In accordance with NICE CG37, UNICEF’s baby friendly initiative and WHO guidelines mothers should be supported to breastfeed their child. Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age and beyond. Breastmilk is acknowledged as being the optimal way to feed all babies including in developed countries.
Ensure health professionals and pharmacists who prescribe or dispense drugs to a breastfeeding mother consult supplementary sources (for example, the Drugs and Lactation Database [LactMed] or seek guidance from the UK Drugs in Lactation Advisory Service.)
Health professionals should discuss the benefits and risks associated with the prescribed medication and encourage the mother to continue breastfeeding, if reasonable to do so. In most cases, it should be possible to identify a suitable medication which is safe to take during breastfeeding by analysing pharmokinetic and study data. Appendix 5 of 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.’
In addition, NICE [NG194] Postnatal Care reinforces the message that women have the right to breastfeed in any public space under the protection of the Equality Act 2010, and section 1.5.6 highlights that:
Healthcare professionals caring for women and babies in the postnatal period should know about:
- breast milk production
- signs of good attachment at the breast
- effective milk transfer
- how to encourage and support women with common breastfeeding problems
- appropriate resources for safe medicine use and prescribing for breastfeeding women.
Information sources for safe prescribing
CKS Breastfeeding Problems outlines guidance on scenarios and how to manage them and links to local and national support; includes engorgement, blocked ducts, galactocele, ductal infection, mastitis or breast abscess, nipple damage, skin conditions, nipple vasospasm or Raynaud’s disease of the nipple, low milk supply and milk oversupply.
Breastfeeding Network Drug Factsheets
CKS Breastfeeding Problems refers to Breastfeeding Network Drug Factsheets which are useful; created by the prescribing pharmacist Dr Wendy Jones MBE. A popular resource endorsed by many breastfeeding support groups. Parents may attend a consultation with a print out or link to this. The National Breastfeeding Helpline offers breastfeeding support on the phone, every day of the year, 9.30am to 9.30pm: 0300 100 0212.
Thrush and breastfeeding
Menopause and breastfeeding
See our menopause webpage for further resources around menopause and hormone replacement therapy.
Breastfeeding and HRT – Oestrogen:
Breastfeeding and HRT – Progesterone:
Mirena® 20 micrograms/24 hours intrauterine delivery system can be used as protection from endometrial hyperplasia during oestrogen replacement therapy. See SPC for detail on length of treatment. Mirena is effective for 5 years in the indication of contraception, but 4 years for the progesterone component of HRT.
Breastfeeding and Medication – The Menopause and Breastfeeding
- Breastfeeding and Medication learning resources – written by Dr Wendy Jones MBE, this resource includes the Pharmacokinetics and transport of drugs into breastmilk presentation as well as some other very valuable presentations that may be relevant to your practice.
- GPIFN is a resource put together by GPs. This has many very useful links and CPD opportunities suitable for all health care professionals.
- eLearning for Healthcare- Infant feeding resource.
- ABM link to breastfeeding training for professionals.
- How to advise women on the safe use of medicines while breastfeeding
- Guidance sheets for providing remote care during the Covid-19 outbreak
Vitamin D should be taken for the duration of breastfeeding. Advise breastfeeding people to take Vitamin D 10 micrograms per day. PH56 Vitamin D: supplement use in specific population groups. Also suitable for self-care.
The Department of Health recommends that:
- Babies from birth to 1 year of age who are being breastfed should be given a daily supplement containing 8.5 to 10 micrograms (µg) of vitamin D to make sure they get enough. This is whether or not you’re taking a supplement containing vitamin D yourself.
- Children aged 1 to 4 years old should be given a daily supplement containing 10µg of vitamin D.
- Babies being combination fed breastmilk and formula receiving over 500ml of formula per day do not require additional vitamin D supplementation.
Healthy Start vitamins are available for families who qualify for free, see how to apply. Healthy Start women’s vitamin tablets contain folic acid and vitamins C and D (Children’s drops also available). FAQs. The application form must be signed by a midwife, health visitor, doctor or nurse.
The information and links provided are for guidance, clinical decisions remain the responsibility of the practitioner; the intention is to help prescribers find evidence based information and does not replace input from appropriate professionals or constitute medical advice for individual patients.