The challenges many new mothers overcome to breastfeed their babies are well documented. Despite a public health system in the UK that promotes breastfeeding, many do not have access to the support that enables them to do it. Every day, services are being cut, public attitudes are negative, and this is exacerbated by a culture that does not really understand how breastfeeding works and how best to support it.
Many women, for whom breastfeeding is going well, are told they cannot breastfeed while taking medication. In some cases, this is perfectly justified – and women who are breastfeeding should always seek professional advice before taking any medication. But research has shown that many medications are safe to take while breastfeeding. Despite this, some mothers are told that they must stop breastfeeding their baby when prescribed a new treatment, even when that treatment actually poses no risk to either them or their baby.
For our new report, commissioned by the Breastfeeding Network, we explored the experiences of 444 mothers who had been prescribed a medication. Each of these mothers had contacted the charity’s pharmacist-led Drugs in Breastmilk advice service, or accessed its online factsheets, for specific medications between August 2017 and August 2018. Set up to counter inaccurate advice about breastfeeding while on medication, the network estimates the service responds to 10,000 queries a year. It is the only independent service dedicated to offering this advice in the UK.
Over-the-counter advice
We found that the majority of queries received by the charity concerned medications that mothers had been prescribed to take while breastfeeding. The vast majority of these women had been told to stop breastfeeding, or were not given any information at all. Most women sought advice after being prescribed common medications such as antibiotics or antidepressants, or wanting to take an over-the-counter medicine such as ibuprofen or cough medicine. It wasn’t as if they had been prescribed a rare drug that medical professionals might not be expected to have up to date knowledge on.
Of particular concern was that many mothers told us that when they were advised by a medical professional that they couldn’t take a medication, their decision was not to stop breastfeeding. Instead, they explained that if they had not been correctly advised by the service they would have refused to take the prescribed treatment.
Some felt that they were being forced to make a choice between their baby’s health and their own, and decided that for them breastfeeding was more important. Others simply wanted to continue because they enjoyed breastfeeding. Many talked about preferring to experience the symptoms of their illness, or delay a procedure, rather than stop breastfeeding their baby.
But the women in our research were the lucky ones. They knew about the service and could receive the information they needed to both take the medication and carry on breastfeeding. Based on the volume of other incorrect information the women we spoke to were receiving, we believe that many mothers who do not know about the service may be stopping breastfeeding unnecessarily after receiving incorrect advice.
Some medics work on the basis that during pregnancy, certain medications are known to be harmful to the developing baby. But the placenta and breast are very different organs. Often medications can’t get into breast milk, and if they do the level in milk is so low that it would be no harm to the baby, or, in terms of health risks, the baby is still better off being breastfed than not.
Professional support
Our research also found that some health professionals underestimate the importance of breastfeeding to women. Many women recalled how they felt dismissed by health professionals, who simply recommended formula feeding, with little consideration as to whether the woman herself wanted to stop breastfeeding.
We asked women how they felt before and after they had received advice from the service and the impact was stark. Among other things, they felt less anxious, more confident and more informed. For some, this was due to relief at being able to continue breastfeeding. For others, it was because they felt that someone had finally listened to them. Even in the small number of cases when women were told that unfortunately their medication was unsuitable for breastfeeding, their anxiety was also reduced because somebody listened.
We know that breastfeeding protects the health of mothers and infants, yet some medical professionals are giving incorrect information – or simply a lack of information – to many thousands of women a year. This is yet another example of how the UK government promotes breastfeeding yet does not protect breastfeeding women and it’s time this changed. Medical professionals need in-depth evidence-based education, training and resources to accurately advise those mothers who are prescribed medication.
1/32 Britain
Sammie, Emmanuella and Yideeda – home shoot.
Photography by Unicef
2/32 Guinea-Bissau
A woman, helped by her mother, breastfeeds her newborn baby in UNICEF-supported Canchungo Hospital, in the northern Cacheu Region of Guinea-Bissau.
Unicef/Zehbrauskas
3/32 Ethiopia
Mihret Breast feeds her 6 month old son Dawit at Kihen Health Post in Kilte Awlaelo Woreda
Kihen Health Post implements Health, Nutrition, Hygiene and Sanitation programmes with UNICEF’s support targeted at building the capacity of the health system.
Unicef/Sewunet
4/32 Sierra Leone
Haja Isatu Bah who has delivered six children but lost two of them as a result of fever, poses for a photograph at her home in Waterloo Freetown, Sierra Leone. Haja Isatu Bah who has delivered six children but lost two of them as a result of fever, poses for a photograph at her home in Waterloo Freetown, Sierra Leone Tuesday, Feb. 23, 2016.
Since 2010, UNICEF have supported the Government of Sierra Leone’s Free Health Care initiative for pregnant and lactating women, and children under five, reducing the number of child deaths. Through a partnership with the Government of Sierra Leone and UNICEF, the European Union since 2013 has been supporting the country’s efforts to meet the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs) in the health sector. The aim is to reduce the country’s high levels of child and maternal mortality through multi-year investment in training, health workers, infrastructure, and the free health care initiative.
Unicef/Holt
5/32 China
As a working mother, Fiona managed to breastfeed her baby for 28 months. “I made it because I learned correct knowledge of breastfeeding online, and also having a healthy baby makes me more confident. But the biggest support is what I got from my family.” She said. Fiona pumped at 10 o’clock in the morning and at 3 o’clock in the afternoon in the office storage room. She would then immediately send the breast milk to her father waiting downstairs. A few minutes later, her baby would enjoy her still warm milk.
UnicefF/Liu
6/32 Indonesia
Nanai, a ‘cadre’ (volunteer community health worker), chats with Sujilah, who is breastfeeding her 5-day-old infant in a room of the family’s home, in Dukuh Village.
Unicef/Ferguson
7/32 Myanmar
Zar Gyi, 26, of North Htan Kone village of Oaktwin Township, who works in the paddy field, breastfeeds her child during break time. A community-based ‘Communication for Development’ project to promote exclusive breastfeeding began implementation in 574 villages in Phyu and Oaktwin townships in 2010.
Unicef/Thame
8/32 Niger
Amina Garba breastfeeding her child.
Unicef/Tremeau
9/32 Britain
Gareth, Chantelle and baby Robbie – St Thomas’ Hospital.
Unicef/Jill jennings
10/32 Ethiopia
Asha Mohammed breastfeeds her 1-year-old son, Gemechisa Dawe, while standing in the vegetable garden she and her husband have owned for the past two years, in the village of Wolargi, in Gemechis. Ms. Mohammed has three other children. “Previously, I used to buy and use the vegetables from the market, but now I’m using [vegetables] from my garden. … I’m taking my child to the health post, and his weight is being measured every month. If his weight is decreasing, then I give him more of the proper foods, and I take him back to the health post. The reason why I planted the vegetables is for my child to be healthy, to gain weight and to have a brighter mind. The future that I want for my child is for him to go to school and be a good student and become a doctor. The message that I want to pass to [my] community … is to prepare balanced meals and provide it to their children, and this will prevent malnutrition.”
Unicef/Nesbitt
11/32 Haiti
33 year old Saint Therese Petit cleans and cuts vegetables as as she breast feeds her 6 month old son Jean Philippe Darilius outside their house in Quicroit, an isolated village on the mountains south of Port au Prince.
Unicef/Dormino
12/32 Bangladesh
Sadia is breastfed by her mother Lovely at their home in Bhaluka, Mymensingh.
Unicef/Paul
13/32 Uganda
A mothers breast feeds her baby during Early Childhood Development activation in Kamuli district headquarters. Four districts in Busoga sub-region of Mid-Eastern Uganda were represented at the activation.
Unicef/Adriko
14/32 Britain
Elizabeth and Spencer Gabbe – St Thomas’ Hospital – “Spencer is a smiley, happy boy and is looking forward (I hope) to turning one next month! Breastfeeding wasn’t easy to begin with, but the assistance from the hospital and the borough (via the literature provided and the advice of midwives (home visits/milk spots)) made the process so much more manageable. I have continued support at my workplace (I resumed full time work at eight months) as there is a well maintained mother’s room for expressing mums.”
Unicef/Jill jennings
15/32 Mongolia
Mother Delgermurun Tsolomon, 32, sits in the middle and with baby Sugarmaa Batjargal surrounded by family. They live in a ger (a nomadic tent) in the Alag-Erdene area in Mongolia.
Unicef/Njiokiktjien VII Photo
16/32 South Africa
Nonhlanhla Dubazane, 29, lives in eMalahleni, Mphumaleagna, South Africa. When Nonhlanhla discovered that she was both pregnant and HIV positive, she was frightened, but through antiretroviral treatment and uninterrupted breastfeeding, her son, Answer, now 6 months old, is healthy and HIV-free. Nonhlanhla is a single mother who works, so she must express her breast milk to feed Answer while she is away. It is not easy, she says, but it is worth it.
Unicef/Schermbrucke
17/32 Mexico
Gabino helps drying his wife’s hair while she breastfeeds their newborn baby girl at the Zongolica IMSS Prospera hospital in Mexico.
Unicef/Zehbrauskas
18/32 Britain
Joanne, Samuel and baby Noah – St Thomas’ Hospital.
Unicef/Jill jennings
19/32 Nepal
Pooja, 27, breastfeeds her newborn baby at the UNICEF-supported Patan Hospital.
Unicef/Page
20/32 Mali
Mama Yeleen Fatoumata Ouattara leads a group session with women to raise awareness of the importance of prenatal health visits and other matters related to health in Baraouéli village, Ségou Region, Mali, Tuesday 6 February 2018. The Mama Yeleen initiative, which is promoted and supported by UNICEF and its partners, trains women to act as model mothers in early childhood development (ECD) and good nutritional practices, educating parents about best practices for the welfare of mothers and their children.
Unicef/Keita
21/32 Thailand
Amugpote watches his wife Kiengmachu breastfeed their baby girl named Nam (which means water), at Lerdsin Hospital, Bangkok.
Unicef/Zehbrauskas
22/32 Uzbekistan
Gulonur Bekbosinova breastfeeds her one-day-old newborn, Arman, assisted by a nurse, in the city of Khujayli’s hospital, in the Karakalpakstan Region.
Unicef/Pirozzi
23/32 Kenya
Susan Ateka, a community health worker supported by Concern, UNICEF’s implementing partner, visits Maximila and her daughter at her home in Mukuru, Nairobi. Maximila lives in a small 10 by 10 feet flat with her husband Martin, her two children as well as her younger sister and her child. Martin works as a casual construction worker. Work is hard to come by and when he does work, he earns between 300 to 500 Kenyan Shilling per day. Their accommodation costs 3000 Kenyan Shilling per month, not including utilities such as gas, water and electricity. “I will exclusively breastfeed Gloria for six months. I know I cannot give her anything but breast milk, not even water. That will make her sick. My milk has everything she needs,” says Maximila.
Unicef/Noorani
24/32 Ghana
A nursing mother breastfeeding her baby.
Unicef/Takyo
25/32 Romania
A woman cradles her newborn in the Pantelimon Maternity Hospital, in Bucharest, the capital. The hospital participates in the UNICEF-endorsed Baby-Friendly Hospital Initiative, which promotes breastfeeding, a vital source of nutrition for infants and a powerful bonding activity for women and their babies. One result of the programme has been a decline in the number of infants placed in alternative care.
Unicef/Holt
26/32 Nepal
In the remote Bijulidanda village of Amppipal VDC of Gorkha district, UNICEF’s social mobiliser Mina KC helps to educate young new mothers about proper breastfeeding.
Unicef/Shrestha
27/32 Britain
Leonie and friends in Lloyd Park, Walthamstow, August 2017 – Four East London mums enjoy support and company while being out and about with their babies. Leonie Brown, mum of 2, says, “It really helps in the early days to meet up with other mums so you can swap stories and tips with people in the same boat as you, especially about breastfeeding. Having support out and about when you’re starting to breastfeed in public is also really helpful.”
Unicef/Jill jennings
28/32 Sierra Leone
A woman breast feeds her child in the village of Old Meima, Kono district, Sierra Leone .
Unicef/Asselin
29/32 Samoa
Christina breastfeeds her newborn son Christopher Victory in the maternity ward of Western Samoa National Hospital in Apia.
Unicef/Pirozzi
30/32 Sierra Leone
Zainab Kamara, supported by her mother, breastfeeds one of her twin sons in Karineh Village in Magbema Chiefdom, Kambia District. The community health worker in the village is among the estimated 15,000 in the country helping to bringing life-saving health services to their communities.
Unicef
31/32 Sierra Leone
Fatu Kamara, supported by Community Health Worker Bai Kamara, breastfeeds one of her sons outdoors. Ms. Kamara, who gave birth in Kambia Government Hospital, initially went to Worreh Community Health Post as soon as she went into labour but was quickly transported to the Hospital when nurses at the health post determined that she needed surgery. “I am glad that I allowed Bai to persuade me to go to the health facility. Who knows what might have happened if [I] would have been stubborn and not listen? [sic] I and my sons would have been history by now,” Ms. Kamara said. “Bai visited me a couple of times when I was pregnant,” she continued. “During those visits, we talked about the importance of going for antenatal care, giving birth at the hospital, sleeping under a bednet, personal hygiene and the types [of food that] I should eat. My sons and I are alive today because I listened to him and went to the health centre as soon as I went into labour.”
Unicef/Phelps
32/32 India
Sumi Madhi a volunteer, on child feeding, nutrition and care interacts with mothers in Kudada, India.
Unicef/Vishwanathan
1/32 Britain
Sammie, Emmanuella and Yideeda – home shoot.
Photography by Unicef
2/32 Guinea-Bissau
A woman, helped by her mother, breastfeeds her newborn baby in UNICEF-supported Canchungo Hospital, in the northern Cacheu Region of Guinea-Bissau.
Unicef/Zehbrauskas
3/32 Ethiopia
Mihret Breast feeds her 6 month old son Dawit at Kihen Health Post in Kilte Awlaelo Woreda
Kihen Health Post implements Health, Nutrition, Hygiene and Sanitation programmes with UNICEF’s support targeted at building the capacity of the health system.
Unicef/Sewunet
4/32 Sierra Leone
Haja Isatu Bah who has delivered six children but lost two of them as a result of fever, poses for a photograph at her home in Waterloo Freetown, Sierra Leone. Haja Isatu Bah who has delivered six children but lost two of them as a result of fever, poses for a photograph at her home in Waterloo Freetown, Sierra Leone Tuesday, Feb. 23, 2016.
Since 2010, UNICEF have supported the Government of Sierra Leone’s Free Health Care initiative for pregnant and lactating women, and children under five, reducing the number of child deaths. Through a partnership with the Government of Sierra Leone and UNICEF, the European Union since 2013 has been supporting the country’s efforts to meet the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs) in the health sector. The aim is to reduce the country’s high levels of child and maternal mortality through multi-year investment in training, health workers, infrastructure, and the free health care initiative.
Unicef/Holt
5/32 China
As a working mother, Fiona managed to breastfeed her baby for 28 months. “I made it because I learned correct knowledge of breastfeeding online, and also having a healthy baby makes me more confident. But the biggest support is what I got from my family.” She said. Fiona pumped at 10 o’clock in the morning and at 3 o’clock in the afternoon in the office storage room. She would then immediately send the breast milk to her father waiting downstairs. A few minutes later, her baby would enjoy her still warm milk.
UnicefF/Liu
6/32 Indonesia
Nanai, a ‘cadre’ (volunteer community health worker), chats with Sujilah, who is breastfeeding her 5-day-old infant in a room of the family’s home, in Dukuh Village.
Unicef/Ferguson
7/32 Myanmar
Zar Gyi, 26, of North Htan Kone village of Oaktwin Township, who works in the paddy field, breastfeeds her child during break time. A community-based ‘Communication for Development’ project to promote exclusive breastfeeding began implementation in 574 villages in Phyu and Oaktwin townships in 2010.
Unicef/Thame
8/32 Niger
Amina Garba breastfeeding her child.
Unicef/Tremeau
9/32 Britain
Gareth, Chantelle and baby Robbie – St Thomas’ Hospital.
Unicef/Jill jennings
10/32 Ethiopia
Asha Mohammed breastfeeds her 1-year-old son, Gemechisa Dawe, while standing in the vegetable garden she and her husband have owned for the past two years, in the village of Wolargi, in Gemechis. Ms. Mohammed has three other children. “Previously, I used to buy and use the vegetables from the market, but now I’m using [vegetables] from my garden. … I’m taking my child to the health post, and his weight is being measured every month. If his weight is decreasing, then I give him more of the proper foods, and I take him back to the health post. The reason why I planted the vegetables is for my child to be healthy, to gain weight and to have a brighter mind. The future that I want for my child is for him to go to school and be a good student and become a doctor. The message that I want to pass to [my] community … is to prepare balanced meals and provide it to their children, and this will prevent malnutrition.”
Unicef/Nesbitt
11/32 Haiti
33 year old Saint Therese Petit cleans and cuts vegetables as as she breast feeds her 6 month old son Jean Philippe Darilius outside their house in Quicroit, an isolated village on the mountains south of Port au Prince.
Unicef/Dormino
12/32 Bangladesh
Sadia is breastfed by her mother Lovely at their home in Bhaluka, Mymensingh.
Unicef/Paul
13/32 Uganda
A mothers breast feeds her baby during Early Childhood Development activation in Kamuli district headquarters. Four districts in Busoga sub-region of Mid-Eastern Uganda were represented at the activation.
Unicef/Adriko
14/32 Britain
Elizabeth and Spencer Gabbe – St Thomas’ Hospital – “Spencer is a smiley, happy boy and is looking forward (I hope) to turning one next month! Breastfeeding wasn’t easy to begin with, but the assistance from the hospital and the borough (via the literature provided and the advice of midwives (home visits/milk spots)) made the process so much more manageable. I have continued support at my workplace (I resumed full time work at eight months) as there is a well maintained mother’s room for expressing mums.”
Unicef/Jill jennings
15/32 Mongolia
Mother Delgermurun Tsolomon, 32, sits in the middle and with baby Sugarmaa Batjargal surrounded by family. They live in a ger (a nomadic tent) in the Alag-Erdene area in Mongolia.
Unicef/Njiokiktjien VII Photo
16/32 South Africa
Nonhlanhla Dubazane, 29, lives in eMalahleni, Mphumaleagna, South Africa. When Nonhlanhla discovered that she was both pregnant and HIV positive, she was frightened, but through antiretroviral treatment and uninterrupted breastfeeding, her son, Answer, now 6 months old, is healthy and HIV-free. Nonhlanhla is a single mother who works, so she must express her breast milk to feed Answer while she is away. It is not easy, she says, but it is worth it.
Unicef/Schermbrucke
17/32 Mexico
Gabino helps drying his wife’s hair while she breastfeeds their newborn baby girl at the Zongolica IMSS Prospera hospital in Mexico.
Unicef/Zehbrauskas
18/32 Britain
Joanne, Samuel and baby Noah – St Thomas’ Hospital.
Unicef/Jill jennings
19/32 Nepal
Pooja, 27, breastfeeds her newborn baby at the UNICEF-supported Patan Hospital.
Unicef/Page
20/32 Mali
Mama Yeleen Fatoumata Ouattara leads a group session with women to raise awareness of the importance of prenatal health visits and other matters related to health in Baraouéli village, Ségou Region, Mali, Tuesday 6 February 2018. The Mama Yeleen initiative, which is promoted and supported by UNICEF and its partners, trains women to act as model mothers in early childhood development (ECD) and good nutritional practices, educating parents about best practices for the welfare of mothers and their children.
Unicef/Keita
21/32 Thailand
Amugpote watches his wife Kiengmachu breastfeed their baby girl named Nam (which means water), at Lerdsin Hospital, Bangkok.
Unicef/Zehbrauskas
22/32 Uzbekistan
Gulonur Bekbosinova breastfeeds her one-day-old newborn, Arman, assisted by a nurse, in the city of Khujayli’s hospital, in the Karakalpakstan Region.
Unicef/Pirozzi
23/32 Kenya
Susan Ateka, a community health worker supported by Concern, UNICEF’s implementing partner, visits Maximila and her daughter at her home in Mukuru, Nairobi. Maximila lives in a small 10 by 10 feet flat with her husband Martin, her two children as well as her younger sister and her child. Martin works as a casual construction worker. Work is hard to come by and when he does work, he earns between 300 to 500 Kenyan Shilling per day. Their accommodation costs 3000 Kenyan Shilling per month, not including utilities such as gas, water and electricity. “I will exclusively breastfeed Gloria for six months. I know I cannot give her anything but breast milk, not even water. That will make her sick. My milk has everything she needs,” says Maximila.
Unicef/Noorani
24/32 Ghana
A nursing mother breastfeeding her baby.
Unicef/Takyo
25/32 Romania
A woman cradles her newborn in the Pantelimon Maternity Hospital, in Bucharest, the capital. The hospital participates in the UNICEF-endorsed Baby-Friendly Hospital Initiative, which promotes breastfeeding, a vital source of nutrition for infants and a powerful bonding activity for women and their babies. One result of the programme has been a decline in the number of infants placed in alternative care.
Unicef/Holt
26/32 Nepal
In the remote Bijulidanda village of Amppipal VDC of Gorkha district, UNICEF’s social mobiliser Mina KC helps to educate young new mothers about proper breastfeeding.
Unicef/Shrestha
27/32 Britain
Leonie and friends in Lloyd Park, Walthamstow, August 2017 – Four East London mums enjoy support and company while being out and about with their babies. Leonie Brown, mum of 2, says, “It really helps in the early days to meet up with other mums so you can swap stories and tips with people in the same boat as you, especially about breastfeeding. Having support out and about when you’re starting to breastfeed in public is also really helpful.”
Unicef/Jill jennings
28/32 Sierra Leone
A woman breast feeds her child in the village of Old Meima, Kono district, Sierra Leone .
Unicef/Asselin
29/32 Samoa
Christina breastfeeds her newborn son Christopher Victory in the maternity ward of Western Samoa National Hospital in Apia.
Unicef/Pirozzi
30/32 Sierra Leone
Zainab Kamara, supported by her mother, breastfeeds one of her twin sons in Karineh Village in Magbema Chiefdom, Kambia District. The community health worker in the village is among the estimated 15,000 in the country helping to bringing life-saving health services to their communities.
Unicef
31/32 Sierra Leone
Fatu Kamara, supported by Community Health Worker Bai Kamara, breastfeeds one of her sons outdoors. Ms. Kamara, who gave birth in Kambia Government Hospital, initially went to Worreh Community Health Post as soon as she went into labour but was quickly transported to the Hospital when nurses at the health post determined that she needed surgery. “I am glad that I allowed Bai to persuade me to go to the health facility. Who knows what might have happened if [I] would have been stubborn and not listen? [sic] I and my sons would have been history by now,” Ms. Kamara said. “Bai visited me a couple of times when I was pregnant,” she continued. “During those visits, we talked about the importance of going for antenatal care, giving birth at the hospital, sleeping under a bednet, personal hygiene and the types [of food that] I should eat. My sons and I are alive today because I listened to him and went to the health centre as soon as I went into labour.”
Unicef/Phelps
32/32 India
Sumi Madhi a volunteer, on child feeding, nutrition and care interacts with mothers in Kudada, India.
Unicef/Vishwanathan
If you are a mother with a query about breastfeeding and medications, you can find information on the Breastfeeding Network website. Though we do recommend that you speak to your doctor about any specific health issue, the Drugs in Breastmilk service can help with any queries over prescribed medication. In any event, always seek advice from a doctor or pharmacist before taking medication while breastfeeding.
Amy Brown is a professor of child public health at Swansea University; Gretel Finch is a postdoctoral researcher in maternal and infant nutrition and behaviour at the University of Bristol; and Heather Trickey is a research fellow in public health and parenthood at Cardiff University. This article first appeared on The Conversation
