Navigating Healthcare Whilst Breastfeeding

Whilst we hope that every breastfeeding journey goes smoothly, sometimes it’s necessary to seek help for a health issue. It might be a breastfeeding-related problem, or you or your child might have an illness unrelated to breastfeeding. This article gives details of the roles of different professionals that a breastfeeding mother might encounter in the healthcare system, where to find information about medication and breastfeeding, what to expect as a breastfeeding mother when you or your child are admitted to hospital, and how to give feedback to healthcare services about your experience.

Healthcare professionals (HCPs) & how they can help with breastfeeding.

Midwives help new mothers get breastfeeding established in the hours and days after birth. Then, as part of their postnatal home visits (or appointments at hospital), they will check how breastfeeding is going. Your midwife can also be contacted about problems with breastfeeding up to 28 days after birth, even if she has discharged you before then. Infant Feeding Co-ordinators are specialist midwives working in hospitals. They protect and promote breastfeeding within the hospital, and provide training to other staff on infant feeding. Women having problems with breastfeeding can be referred to an IFC for help and support.

Health Visitors and their supporting colleagues (for example, Nursery Nurses and Assistant Practitioners) work with families in the community to promote health and wellbeing. Health Visitors are qualified nurses or midwives who have undertaken further training in public health, specialising in child development and emotional health and wellbeing, and maternal health. In Norfolk, all Health Visitors and 0-5 Assistant Practitioners are “UNICEF Baby Friendly” trained; this means they can offer specialist support around breastfeeding, and infant feeding in general. Infant feeding is discussed and supported at the antenatal, new birth (10-14 days) and 6-8 week review appointments that are offered to all families as part of Norfolk’s “Healthy Child Programme”. There are also Infant Feeding Champions who can support women in the home or in the community. Infant Feeding Clinics are held daily across the county, offering help with any infant feeding issue – including support with positioning and attachment, and assessment for tongue tie. Appointments for these clinics, as well as telephone advice for queries about breastfeeding (or any other child health or development issue), can be accessed via Just One Number, 0300 300 0123. This service is available 8am-6pm on weekdays, and 9am-1pm on Saturdays. Alternatively, you can text Parentline on 07520 631590 (same hours) with your question or concern, and a member of the team will text you back with an answer. Online support is available at justonenorfolk.nhs.uk, which has information on all aspects of care for children aged 0 to 19: emotional support, safety, sleep, immunisations, and healthy lifestyles (which includes infant feeding). The website also contains links to other UNICEF-approved sources of information, such as NHS Start4Life. GPs can assess and treat medical conditions related to breastfeeding, such as mastitis.

GPs can assess and treat medical conditions related to breastfeeding, such as mastitis and thrush. If you have an urgent medical issue and your GP surgery is closed (or you’re not sure what to do), you can call 111 (available 24/7), or visit your local Urgent Care Centre/Walk-in Centre.

Emergency care: 999 or A&E for immediate medical attention when someone is seriously ill

Drugs and breastfeeding: sources of helpful information

There are some fantastic resources available for information on which medications can be taken whilst breastfeeding, and it can be useful to direct your HCP to these websites when they are thinking about what medication to prescribe for you. • Breastfeeding Network Drugs Factsheets breastfeedingnetwork.org.uk/drugs-factsheets (and if your or your HCP’s query isn’t answered by one of the factsheets, fabulous expert Pharmacist Dr Wendy Jones can be contacted via the Breastfeeding Network Facebook page at facebook.com/TheBreastfeedingNetworkUK • LactMed toxnet.nlm.nih.gov/newtoxnet/lactmed.htm – searchable database of drugs and other substances • GP Infant Feeding Network gpifn.org.uk – help for GPs with prescribing in breastfeeding (together with lots of other useful information about breastfeeding)

Going into hospital

When you or your child is unwell, it can be a difficult and worrying time. Breastfeeding can provide comfort and reassurance to child and mother, as well as having a vital nutritional role. The following are some ways in which your hospital can help to support your breastfeeding relationship whilst you are an inpatient.

• Emergency admissions for breastfeeding mothers: ◦ Tell the medical team when you are admitted that you are breastfeeding ◦ Medications: it might be helpful to tell the doctors about the Breastfeeding Network website (or one of the other resources above) if they are unsure about prescribing for you as a breastfeeding mother ◦ If your baby is exclusively breastfed, you should be offered a side room if possible, so that baby can stay with you during the admission* ◦ Breastfed babies or children who are not staying with you in hospital should be allowed to visit the ward at any time for feeds* ◦ If you need to express milk, the hospital should provide you with a pump – ask your nurses for this. Depending on the hospital, a pump might be loaned for you from the medical equipment library for the duration of your admission, or alternatively one might need to be borrowed from Maternity as and when you need to express. ◦ If you need to store expressed milk, you may be able to use the fridge on the ward or in the Maternity Unit, or the freezer in NICU. All expressed milk being stored should be fully labelled. Alternatively, the expressed milk may have to be taken straight home by a relative or friend. Again, this depends on the hospital – ask the nurses looking after you.
• Planned (“elective”) admissions for breastfeeding mothers, for example for planned surgery ◦ When you have your clinic appointment and it is decided that you need an operation, tell the doctor that you are breastfeeding. He or she can then discuss with you any implications for breastfeeding of the surgery itself, and the recovery afterwards. ◦ Once you have a date for your operation or admission, contact the hospital as soon as possible to let them know you are a breastfeeding mother, so arrangements can be made for you. Contact the ward or Unit that your letter says you are going to be admitted to. For an operation, for example, this might be the Day Surgery Unit, or the Surgical Admissions Unit. Also contact the hospital’s Infant Feeding Co-ordinator (via the main hospital switchboard), so that they know you are coming in, and can help with arrangements if necessary.

◦ At your pre-operative assessment, tell the nurses and the Anaesthetist that you are breastfeeding. The Anaesthetist may find the BfN factsheets on “Anaesthesia and Breastfeeding” and “Analgesia (painkillers) and Breastfeeding” helpful – breastfeedingnetwork.org.uk/wpcontent/dibm/anaesthetic%20and%20breastfeeding.pdf and breastfeedingnetwork.org.uk/wpcontent/dibm/analgesics%20and %20breastfeeding.pdf ◦ If you think you will need to express milk at any point during an elective admission, take your own pump with you when you go into hospital ◦ After an operation, generally your baby can be with you as soon as you are out of Recovery, as long as you are well enough*. This also depends on the procedure and the drugs that you have been given – check with your medical team. *It’s important to note that whenever a breastfeeding baby is brought into hospital to be with its mother, another adult must always stay with you to look after the baby – the nursing staff cannot look after the baby.

• Admissions for children: ◦ Paediatric (children’s) wards normally allow one parent to stay overnight with the child ◦ If you are breastfeeding your baby or child, some hospitals will try to place your child in a side room if possible, to allow for privacy whilst feeding ◦ If you need to express milk for your child, ask the nursing staff about borrowing a pump and/or facilities for storing expressed breastmilk (see above). If you know in advance of your child’s admission that you will need to express milk, take your own pump into hospital. ◦ At some hospitals, such as QEH King’s Lynn, mothers of breastfed babies under six months are eligible to receive free meals whilst their baby is in hospital ◦ Babies and children having surgery are usually allowed to continue to have breastmilk until four hours before their operation. This also applies to other procedures requiring general anaesthetic or sedation, such as scans. However, always check with your child’s medical team.

Feedback

If you feel that an individual HCP or a team has done particularly well in supporting you with breastfeeding, consider sending them a note or an e-mail to tell them so. It’s always lovely to receive compliments, and it will hopefully encourage that team to keep up the good work! If, unfortunately, your experience with healthcare and breastfeeding wasn’t so good, you could think about making a complaint. This might prompt the organisation involved to review how it does things, or perhaps provide more breastfeeding training for its staff. Sometimes it can be helpful to mention the resources given above, as an educational opportunity. For GP surgeries, send your feedback to the Practice Manager. For hospitals, contact the Patient Advice and Liaison Service (PALS). Of course, only give feedback if and when you feel up to it. If you do want to, take your time and make sure you or your child are fully recovered first – there’s no rush!

♥ Get well soon! ♥

With thanks to Jayne Cozens & Flo Crawley (Infant Feeding Co-ordinators, QEHKL), Gayle Macartney (Infant Feeding Co-ordinator, NNUH), Kay Horn (Infant Feeding Co-ordinator, JPUH), and Sarah Clark (Infant Feeding Lead for Norfolk Children & Young People’s Services).