Written for Maternal Mental Health Week 4-10th May 2020

For this maternal mental health week, we caught up with our peer supporter Kelly in her pharmacist role to have a chat about some of the help available for breastfeeding mothers who need to take medication for a perinatal mental health condition. In her day job, Kelly is an incredibly skilled specialist pharmacist for the UK Drugs in Lactation Advisory Service. Kelly has worked for UKDILAS for 9 years and graduated as a peer supporter for the BRAS in December 2017 shortly after having her second son. She is passionate about breastfeeding and supporting mums on medication to continue breastfeeding their babies for as long as they want to.

Hi Kelly, thanks for talking to us! We know you are very busy with your work with UKDILAS. Can you tell me a little more about UKDILAS and how you work with other professionals to support parents?

Thank you for talking to me about such an important topic! UKDILAS is an NHS service which aims to support mothers to breastfeed by providing evidence-based information and advice to healthcare professionals regarding medicine use in breastfeeding mothers.

Lots of parents coping with perinatal mental health issues might feel concerned about reaching out for support from their doctor because they are worried they might be told to stop breastfeeding to take medication.

Does this happen in your experience?

Unfortunately, yes, this does still happen.

Why do you think that is? (if yes to the above)

There are lots of reasons for this. GPs don’t see a lot of breastfeeding mothers and there are not many well-known good resources available to help them prescribe for this patient group. A lot of resources will tell them to avoid use while breastfeeding and therefore they sometimes suggest stopping breastfeeding.

Often, even with day to day medication, there’s often a disclaimer on the packet which says “not suitable if breastfeeding”- is this always accurate?

Yes and no! The reason it says not to use when breastfeeding is because there have not been clinical trials of those medications in breastfeeding women, for good reason! It would not be ethical to do so. But we use the data about the drug and anything we have learned about the drug in breastmilk from case studies, or slightly larger studies, to make a risk assessment of its safety for a mother to start taking it. A lot of the time we are able to support breastfeeding and advise on the symptoms they should look for in the baby.

Is it necessary to stop breastfeeding to take medication for a perinatal mental health illness?

In the majority of cases, no it isn’t. It depends on a number of things. We consider the drug itself, the condition it is being used for, the full medication history for mum, and the health, and age of the baby including whether they were born at term or prematurely. As before, often we are able to support mums to carry on breastfeeding with only a few things to monitor for in their babies.

What are the common medications parents can use if they are struggling with perinatal mental health?

Mums mental health needs to be considered the priority when prescribing, therefore although there are some medicines that we have a bit more experience with, we would always consider the most clinically appropriate choice for mum first and recommend alternatives if that was needed. The benefit of treatment needs to outweigh the risk and choosing the right drug for mum, means that benefit will be greater.

Sometimes mums might have pre-existing illnesses and will have a medication they know works for them, is it sometimes possible to keep taking the medication which works for them?

If a person with a pre-existing mental health illness is thinking of starting a family the best thing they can do is have those conversations early. The health care professionals involved in their care can help manage the prescribing during pregnancy and breastfeeding. We can be contacted in plenty of time to advise about which choices may be preferred in a breastfeeding mother, and if it is the right thing for the patient, advise about swapping across to those.

If a breastfeeding mum has a relapse of a mental health condition which she used to take medication for, if that medication worked well before, that would certainly be one of the first drugs we would risk assess for her to start taking again.

Are there any medications for mental health conditions which aren’t suitable for breastfeeding? What sort of approach would you take in those cases?

We advise on very complex patients and in these circumstances, it is more likely to be the combination of medicines a patient is taking, rather than one specific drug which would make continuing breastfeeding an issue. Thankfully there are very few drugs which we would assess as not suitable for breastfeeding.

What would you say to folks who have been told their medication is likely safe but still feel very anxious about taking it while breastfeeding?

I understand that mums can feel nervous about taking medication while breastfeeding, and they can worry about the harm they might cause their baby. In the majority of cases, where mum is on one drug, and their baby was born at term and has no health concerns, taking the prescribed medication will not be likely to cause any harm. We provide the signs and symptoms to watch for so that if the drug is having any effect on the baby it can be picked up early. I mentioned before that treatment of maternal mental health is paramount and seeking help and getting treatment for these conditions will hopefully have a positive impact on their breastfeeding journey especially if mums are given the information to support breastfeeding to continue from the outset.

Do UKDILAS offer support to parents directly?

We are not in a position at the moment to support mums directly, but mums can ask their GP to call us directly. We answer the majority of breastfeeding questions on the same day, so there will be no delay in starting treatment.

Thanks so much for your time Kelly!

You can signpost your GP to the UKDILAS service by visiting www.sps.nhs.uk/ukdilas, and the details of the service are also printed in the front of the BNF (a directory of medications commonly used by doctors).

---