Breastfeeding and Medication – A Q&A with Dr Wendy Jones
We’ve been desperate to chat to Dr Wendy Jones, the breastfeeding pharmacist, since the beginning of Parenting Science Gang, and so it was with delight and excitement that we welcomed her to a Q&A last week.
Image: USDA
PSG G: Wow, Wendy’s here! I thought she was mythical like a unicorn ?
Wendy: I’ve been called a lot of things in my time, but never that before – usually it’s the Wendy Lady as in Peter Pan.
Jump straight to:
Wendy’s Work
Q: How should people contact you in normal life? I often see people recommending you but I’ve never worked out how to contact you!
Wendy: You can email me or Facebook me – I have a page of my own (Breastfeeding and Medication) where you can send a PM which only I can see.
Q: How many questions do you take on an average day?
Wendy: It’s around 40 + so 10,000 a year we think – I don’t have time to keep records!! This was snapshot data over 2 weeks.
Q: Wendy, how do you manage all the queries?
Wendy: My house is a tip! I answer a lot of questions on my phone so out and about or I do catch ups when I can. I always think that it might be my daughters asking the questions
I try to add more fact sheets either on BfN (Breastfeeding Network) or my own website to answer the FAQs.
We have another pharmacist who takes over on Tuesday evenings and later at night when this poor old lady gets tired!
PSG A: Glad to hear you have some help!
Q: Where do you get all your specialist info from on the effects of drugs in breast milk and is there are a way that we can prompt other health professionals to access it so people get the correct advice first time?
Wendy: Well you could always suggest they buy my book! 🙂
PSG B: Pharmacist here ?♀️, was about to ask a similar question!
Wendy: I use the freely available database LACTMed a lot and also pay for online access to Hale Medications and Mothers Milk. I also use a £600 text book called Martindale which most pharmacies can access. Sometimes I just know because I’ve been asked the question so often.
I think the message we need to keep spreading is that BF (breastfeeding) isn’t just about food it’s about health promotion and disease prevention.
Because no health care professionals get taught about BF at undergrad level they get scared and go by what the manufacturers say. Which is usually “don’t”; to protect their own butts.
PSG C: That’s the impression I got (about going by manufacturer to protect their butts!). We need to spread the message that there’s somewhere they can go for more info!! Thank you so much for answering.
PSG A: How much was that book???! ?
Wendy: Exactly!
Q: Why has no one in any of the hospitals I’ve worked in, ever heard of LactMed??
Wendy: Lots of people don’t like it cos its American. Does that make a difference? Course it doesn’t!
PSG D: P.S you literally saved me when I required multiple IVABx for meningitis and I wouldn’t have them until they checked they were BFing safe, but no one but you would confirm it!
Q: Have the questions you are asked changed over the years or are they broadly the same?
Wendy: There are a lot, lot more of them, but mostly about antibiotics, painkillers and anaesthetics plus the seasonal ones. We have just had an evaluation done by Amy Brown which was good to compare with one we did 6 years ago.
PSG A: Your fact sheets were so helpful when I had surgery. I printed and took them in!
Breastfeeding and Medicines
Q: Would you say that in general the advice on drug use is the same regardless of the age of the baby/child and the number of feeds they have per day (for example would things be different for me feeding my 3 year old who only feeds for 5 minutes every 24 hours compared to an exclusively BF newborn)?
Wendy: It varies dramatically, but the only really different period is in the first 6 weeks when baby’s liver and kidneys aren’t fully functioning so they don’t metabolise the drugs so well and they can accumulate eg fluconazole.
Things like codeine can affect an older baby just as much as a tiny if you have the metabolism that concentrates the drug.
My family hate taking codeine – when my eldest grandson was 2 his mum broke her arm and took codeine – he immediately slept far more and we had to change the drug. She took it post c-section with her second who was just too good to be true till we stopped the drug.
PSG E: Thankfully codeine hasn’t shown an adverse effect in my toddler (I did ask you for advice first after being prescribed it a couple of months ago and you did advise to exercise caution so thank you!!!)
Q: Are you aware of any long term links between antibiotics use by the mum and later impacts on infant teeth development i.e decay/discolouring?
Wendy: The only drug which I know that causes teeth discolouration is doxycycline and then only after 3-4 weeks. Not aware of anything else unless it is just your general health.
PSG F: Thanks – it was something my dentist mentioned but as I’ve only had antibiotics and not my daughter got me wondering – though I’m completely unaware how those kind of medicines would even be able to transfer.
PSG G: Yes I’ve read a couple of articles linking pregnancy & antibiotics with tooth decay.
Wendy: That can be different – pregnancy isn’t the same as BF – in BF the dose through milk is usually a fraction of the dose we give kids. But if you are ill it can affect the enamel being laid down at that time.
PSG G: Makes perfect sense.
Q: I have a seven week old, who I am expressing for and I’m taking 40mg of citalopram daily. Are there possible long-term effects for his future health? Also I have an oversupply that I’m hoping to donate – is this a terrible idea given the medication I’m on?
Wendy: There is one case at 40mg of a baby having an uneasy sleep pattern but it’s a single case report.
In the past you wouldn’t have been able to donate but I’m working with the Hearts Milk Bank and Human Milk Foundation so your milk could be shared with a baby whose mum maybe had cancer and couldn’t BF. It’s been so great to be able to do that when before we would have had to say sorry no.
PSG H: I’ve been in touch with Hearts Milk Bank and whilst they said it was ok, I was still a little uneasy. Thank you – I shall go ahead with the donation!
Q: One question I’m often asked about is IVF and breastfeeding. Frequently women want to try a ‘natural cycle’ with a frozen embryo but get told that even the cyclogest and HCG are incompatible with breastfeeding. Is that correct?
Wendy: Cyclogest doesnt get into milk – fact sheet on my website (not BfN) and HCG can’t be absorbed from the stomach – so baby can’t get any. Have you joined the IVF Facebook group (there is a link in IVF fact sheet on BfN website)?
PSG I: No, but maybe I should at least keep the link handy! (luckily my family is now complete).
Q: My consultant said I’m ok to BF taking leviteracetam. I occasionally need to take an emergency dose of clobazam, usually 10mg but has been 20mg on occasion. Baby is now 11mo. I’m told that this is ok but it’s a sedative so it does worry me. Do you know any more info?
Wendy: With occasional clobazam I wouldn’t worry just watch for drowsiness but if you want to PM me I can send the full research
PSG G: Fantastic thanks very much Wendy ?
Q: I have a friend who suffers from really bad migraines, is there anything suitable while feeding (her little girl is almost 1) as gp keeps fobbing her off?
PSG I: Are triptans really so bad? My GP refused to prescribe them while I was BF. And my migraines are so bad I can be hospitalised with them.
PSG J: I’ve taken triptans in the past based on my reading of Wendy’s factsheet.
Wendy: I would always say use sumatriptan, the amount in milk is small and actually it is widely used. There is a product called Paramax that is brilliant but quite old fashioned now. I often use a home remedy which mimics it – 2 Stugeron travel sickness tablets then 20 minutes later 2 paracetamol and 400mg ibuprofen and if possible, an hour’s sleep.
There is a BfN factsheet on migraine and I can send more data for a GP if you want – or tell GP to buy my book:)
PSG I: Paramax was my friend. ? Luckily my local pharmacist also became my friend and persuaded my GP that I could take them if I promised not to BF for 6hrs. (Which he then kindly told me to ignore!)
PSG K: Thank you Wendy, ? she was told they were unsuitable for pregnancy and BF so has struggled on.
Q: What do you know about drinking alcohol and breastfeeding?
PSG L: There’s a factsheet about alcohol on the breastfeeding network page.
PSG M: Thanks, I was just curious to hear what Wendy said about it ?.
Wendy: Well I wrote the factsheet! My basic rule is if you know where your baby is and you feel capable of caring for it carry on BF. If you have been binge drinking and are in the gutter chucking up please don’t – I’d like to say pump and dump but probably most people wouldn’t face that! As the alcohol level in your body falls alcohol comes back out of milk – it isn’t stuck in there – so you can enjoy your G and T and wine over Christmas.
PSG M: I love everything about what you just wrote ? thank you ?
Wendy: That’s made me laugh!!!!
Q: Which drugs are women most likely to be incorrectly / unnecessarily told they need to stop BFing to take?
Wendy: Anaesthetics for operations and painkillers would be the top 2. But also sedatives for things like colonoscopy, contrast media for MRI and CT.
I am doing my best to infiltrate the national bodies and get accurate guidance based on evidence. Also I’m currently working with anaesthetists nationally so keep your fingers crossed.
Q: Is it safe to assume that a drug suitable for use during pregnancy will also be ok while breastfeeding?
Wendy: No you can’t assume that – in pregnancy the drug is taken back into the mother’s blood stream and her body detoxifies it. When the baby is born it has to do the metabolism by itself and for the first 6 weeks the liver and kidneys are not fully working so can affect baby. You can also get withdrawal from placental transfer eg fluoxetine and venlafaxine.
PSG N: Thanks. Now I think about it, of course it’s a completely different process!
Q: Are there actually ANY drugs that can’t be taken when breastfeeding? Doctors just seem to blanket say NONE. So are there any which simply definitely should not be?
Wendy: Chemotherapy, lithium, furosemide would be absolute no. Care with some that cause drowsiness eg I hate BF mums taking sleeping tablets just too many risks. I have to admit I am very reluctant with cannabis smoking too.
PSG N: How about monoclonal antibodies? My friend who has MS was told that any drugs ending in ‘mab’ are not compatible with breastfeeding.
Wendy: Most monoclonal antibodies are bioavailable so can’t be absorbed by the baby, so things like Rebif and copaxone are okay.
PSG D: At work I have to ask if the Inflixamab/Vedolizumab etc patients aren’t planning to get pregnant or breastfeed.
Wendy: I run a Facebook group for BF mums with IBD and these drugs are fine for BF!
PSG O: Interesting that you say that about cannabis. Is that because of the effect on the mother, or because of the effect on the child? What research is there on cannabis and breastfeeding? I imagine it’s hard to do because while people may do it, they probably don’t tell their doctors.
Wendy: Cannabis has a very long half-life so it passes into the brain for potentially 5 x 57 hours after use. Do we know what that does to the developing brain? No, we don’t.
PSG P: What happens with furosemide? I remember my son had this himself at age 6 months post surgery. Is it because of much goes into the milk?
Wendy: Furosemide can reduce milk supply by dehydrating mum
PSG P: Thank you, that makes sense.
The Future
Q: If we could teach GP’s one thing about meditation and breastfeeding what should it be?
Wendy: That breastfeeding matters and very few drugs are absolutely contra indicated. Stopping BF isn’t like turning off a tap, and formula is an intervention. BF is the norm
PSG D: Oh Wendy, can I carry you round in my pocket?
Q: I’ve found that the anaesthetists I’ve come across have been the best informed out the HCPs, and dentists the worst – are there any plans to include dentists in some BF education?
Wendy: I’m desperately trying as they are some of the worst.
Last week one told a mum she couldn’t feed for 48 hours after a local. “So did your arm go numb?” I asked her. “No” she laughed. Well then, how can you tell it goes anywhere?
I’m hoping in the New Year to do a webinar on my page and there is a book in the pipeline for all HCPs about BF and will include most topics written by a group of people we have coerced into writing with us
PSG Q: Thanks. I agree. It was after the dentist told me I’d need 24 hours off of feeding for a filling under conscious sedation that I discovered you existed. Thankfully you knew exactly what nonsense was being spouted and once I arrived, the anaesthetist basically said that my dentist was an uninformed idiot who should find out his facts before scaring a new mum.
I used to work on the ambulances and once you’ve sorted out the pesky dentists maybe a little information booklet for all the paras and techs out there would be a good idea too. (I fell and hurt my ankle – knew I just needed to get a quick X ray but couldn’t put any weight on it – medic was reluctant to let me have entonox as I was pregnant and breastfeeding (facepalm).
Q: Have you considered making a database so that you can search for a medication by name rather than having to know what it is used for
Wendy: I’ve thought about it and my son in law has said he will help, but the time commitment is huge and of course all this is voluntary. I’m hoping to do something on the BfN page for the factsheets – you can’t search pdfs.
PSG I: It’s often said that volunteers are not paid not because they are worthless, but because they are priceless. And you Wendy are certainly beyond your weight in gold!
PSG R: I can appreciate how much of a time commitment that your work is, and I feel so conflicted when on one hand I say “You are amazing and I can’t believe the time you put into this”, and on the other hand “I’m saying do more please” ? sorry!
PSG P: I wonder if you could find a student who could do that for their degree work for you. Like how we’ve had academics pick up some of our research ideas and take it on. Not really research I guess, but optimising the database might be an appropriate sort of task.
Q: If you could commission a research study in an area of breastfeeding what would it be?
Wendy: More research studies into the drugs we have no information on – so a centre we could send samples of milk to. And I’d like to make it law that manufacturers had to publish data we have about the amount of older drugs that we know are safe.
PSG R: That is a good answer.
The amount of people I see commenting on parenting forums who want to take safe medications, but because the leaflet says not to take they think they need to stop breastfeeding and it’s heartbreaking that there isn’t support there for those women.
Q: I really hope you’re training someone up to fill your shoes when you retire P. S please don’t ever retire!! ?
PSG C: Can we clone her???
Wendy: That’s a scary thought!
Wendy: That is the hard bit – I want people with a background in pharmacy who have BF and done a BF peer support training., As I said we have Amanda but she has a young family and she works. Not everyone is as lucky as me that my husband let me retire from pharmacy to do this full time.
But the evaluation hopefully will help us get some national funding for the future. Not going anywhere a while yet.
PSG Q: You are amazing but it’s such a travesty that you don’t get paid for your wonderful work. I love the NHS but this is something that’s very wrong with it.
PSG S: Yes, the work you do needs properly funding. That would be a real breakthrough??good luck with that. And also, phew.
Wendy: I did get my lovely Point of Light award from the Prime Minister which meant a lot.
Q: Why won’t the BNF fund you?
Wendy: BNF are sewn up with the drug companies. Did you see the article today about over diagnosis of cow’s milk protein allergy driven by Nutricia et al?
PSG I: I did. And sadly it didn’t surprise me.
PSG A: I did but didn’t clock Nutricia funding
Q: I have a waking toddler situation so will have to duck out. Thank you very much for your time Wendy Jones. You are amazing!
Wendy: ?♀️?♀️?♀️?♀️?♀️sprinkling of fairy dust – see I am from Peter Pan
PSG I: Not a question but a statement, I’ve loved all the Q&A sessions I have been a part of but at the risk of coming over all ‘fan-girl’ –, it is BRILLIANT to have you here. Every week I volunteer I refer to your work. You make a real difference to so many breastfeeding journeys. Thank you from the bottom of my heart!
PSG M: This! I have suggested Wendy so many times to people! Wendy, you are amazing and thank you for everything you do! Fanfare!!
PSG R: I feel the same Wendy. You are truly inspirational!
Wendy: Thank you I cant tell you how much that means – maybe you will have me back some time xx
PSG C: I agree with the others! Every time I see someone in a group asking about medication or needing to wean I drop a link to your page on there. I’m sure you have no idea how many lives you change every day.
PSG I: And as I’ve been a volunteer peer supporter for over 10 years that’s over 520 cases you’ve directly or indirectly helped with me alone!
PSG O: Can we all fangirl?! You are a legend Wendy.
PSG A: I love you Wendy you’ve helped me so much over 3 yrs of breastfeeding
PSG S: I can only echo what the others just said ?
PSG T: Fortunately I’ve never needed your services personally Wendy, but I’m very aware of the amazing work that you do. Thank you very much for everything you do to support breastfeeding mothers.
I’m a medical student and am hoping to make as many of my peers as possible aware of the information on BfN and your website so that they can be a bit more informed. And I too thought you were a unicorn ??
PSG U: Just wanted to add my thanks – both for when you’ve answered questions re: medication in my own BF journey (six years with eldest, 20 months and still going strong with youngest!) and for the fact sheets that I’ve referred so many other women to, you truly are amazing.
Wendy: Now I’m blushing!
Thank you so much Wendy for joining us. As you have heard, you really are an inspiration and a god-send to us. Thanks for all your work and for answering so many of our questions tonight.
Wendy: Loved spending the hour with you – remember never believe anyone who says you have to stop BF to take a medication – unless it’s me xxxx
And Happy G and T filled Christmas with lots of boobing xx
If I haven’t answered your question please PM me on the BF and Medication Facebook page.
Night all – I need a cup of tea xx
Wendy’s website: http://www.breastfeeding-and-medication.co.uk/
Wendy’s FB group (PM her from here): https://www.facebook.com/breastfeedingandmedication/
Breastfeeding Network: https://www.breastfeedingnetwork.org.uk/
Factsheets here: https://www.breastfeedingnetwork.org.uk/drugs-factsheets/
If you enjoyed this Q&A, why not check out some of our other sessions:
- Bigger Births and Breastfeeding with Prof Debra Bick
- The Art of Motherhood with Lisa Creagh
- Breastfeeding Experiences with Dr Sally Dowling
You can read all the other Q&As on lots of subject relating to parenting at: www.parentingsciencegang.org.uk/live-chats-with-the-experts/
