Help me write a letter to ER nurses!

[hopefulfaith]

I'm an ER nurse (and a bf mom) and I receive the Journal of Emergency Nursing, a professional journal for RNs/APNs who work in the ER. This month's issue had a fantastic article about utilizing pain medication in breastfeeding mothers - the point of the article was to clearly indicate that pain meds don't have to interfere with successful bf and there was tons of good information for providers about how to medicate bf moms. It was a great article and I wish all prescribing providers could read it!

I want to write a supportive letter to the Journal thanking them for this article but pointing out that it's the attitudes expressed by health care providers when bf moms seek health care that hurt ... that it is the misleading information that providers (often ER nurses!!) give that discourages bf and can lead women to stop nursing.

I'm looking for reputable published articles to cite, if anyone knows of any; I can't just use only anecdotal statements ("When I went to the ER, the nurse told me..."), although I plan to mention that there is a lot of that floating around.

Thanks so much!


P.S. - Is Jack Newman the only physician who's an IBCLC?

[PatioGardener]

Good luck for your letter. I have no resources, but I can answer your last question:

Originally Posted by hopefulfaith

P.S. - Is Jack Newman the only physician who's an IBCLC?

I'm pretty sure that Jack Newman is not an IBCLC. He doesn't state IBCLC behind his name in any of his handouts. He works with IBCLCs, but I'm pretty sure he isn't one.

On the other hand, there are physicians who are also IBCLCs. And pharmacists, and chiropractors and osteopaths too.

Hope that helps

[lirpasirhc]

jay gordon is an ibclc.

[MaryJaneLouise]

Here's one article that addresses this issue, kind of peripherally:

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

Clin Pediatr (Phila). 2003 May;42(4):325-40.
Adverse drug reactions in breastfed infants: less than imagined.

Anderson PO, Pochop SL, Manoguerra AS.

Medication use during breastfeeding shortens the duration of breastfeeding often because of overly cautious information given by healthcare providers. No comprehensive review of the literature on infant adverse reactions from drugs in breastmilk has been published. All published studies and case reports on adverse events in infants caused by medications (excluding drugs of abuse) in breastmilk were identified and analyzed. Of 100 case reports evaluated, none were considered to be "definite" using a standard ranking scale; 47% were "probable" and 53% were "possible." Drugs with central nervous system activity accounted for half of all reports. All 3 reported fatalities involved central nervous system depressants, but each had extenuating circumstances. At least 63% of reported cases were in neonates and 78% were in infants 2 months or younger; only 4% of adverse reactions occurred in infants older than 6 months of age. Published studies expand on and generally reinforce the analysis of case reports. By taking a few simple precautions in drug selection and considering the infant's age, breastfeeding rarely needs to be discouraged or discontinued when a mother needs drug therapy.

PM me your email if you need the full text.

[MaryJaneLouise]

Here's another quote from a big journal that quoted the above one:

http://www.ncbi.nlm.nih.gov/pubmed/1...ubmed_RVDocSum

BMJ. 2008 Apr 19;336(7649):881-7.Breast feeding.

Hoddinott P, Tappin D, Wright C.

How should doctors prescribe for breastfeeding
mothers?

Doctors tend to be overcautious when prescribing for
breastfeeding mothers, and specific advice or subtle
cues can undermine breast feeding.27 Careful use of
expert resources (box), however, can usually enable
breast feeding to continue. Each prescribing decision
needs to take account of the risks and benefits to the
individual mother and baby, including the indication
for treatment, the pharmacokinetic properties of the
drug, the age of the baby, the volume of feeds, and the
frequency of feeds. Unfortunately, standard adult
reference texts like the British National Formulary may
be unhelpful. Drug manufacturers are not required to
license drugs for use by breastfeeding mothers, and
they tend to be cautious and recommend against use.
Most published data on safety rely on case studies or
small samples of fewer than 20 mothers. However, if a
drug is licensed for infants, then the small amounts
present in breast milk are likely to be safe, so the British
National Formulary for Children is a better guide to
maternal prescribing.

[MaryJaneLouise]

This article documents more the "bad bfing advice by health professionals" vein:

http://www.ncbi.nlm.nih.gov/pubmed/17623757

Ann Pharmacother. 2007 Sep;41(9):1352-60. Lactation safety recommendations and reliability compared in 10 medication resources.

Akus M, Bartick M.

BACKGROUND: Discontinuation of breast-feeding is linked with an increased risk of acute and chronic diseases in children, as well as increased risk of maternal disease. Mothers and physicians often depend on pharmacists for accurate drug information. Their information is only as good as the sources available to them. OBJECTIVE: To determine the reliability of safety recommendations for drugs used during lactation, based on current research and information, and determine whether resources may be inappropriately advising the interruption of breast-feeding. METHODS: A comparison of 10 frequently used sources for information on medication used during breast-feeding was done for 14 commonly used drugs. Our sources included the databases used by 2 retail pharmacy chains, available text references, and electronic references. We assessed the number of drugs thought to be safe in breast-feeding for each source. The drugs reviewed included those widely accepted as safe, widely regarded as not safe, and drugs that fit into neither category. RESULTS: We found that many sources did consider the most recent research. For drugs thought to be unequivocally safe, the 2 retail pharmacy databases gave an alternative recommendation at least 75% of the time. CONCLUSIONS: If healthcare practitioners are using outdated sources for making safety recommendations to their patients, such a practice may result in many women being inappropriately advised to stop breast-feeding, thus increasing the potential health risks to them and their infants. As the most accessible medication expert, the pharmacist needs to be well educated and continually updated using the most reliable resources for lactation recommendations.

[hopefulfaith]

MaryJaneLouise, I PM'ed you. Thanks so much for the references.

Lirpasirhc & PatioGardener - thanks. I mixed up Jay Gordon and Jack Newman.

[G8P4]

Jack Newman is an IBCLC.

And I do know of a few other doctors who are IBCLC's.

[PatioGardener]

Originally Posted by G8P4

Jack Newman is an IBCLC.

Do you know why he doesn't list IBCLC as part of his qualifications? His website doesn't list it either: http://www.drjacknewman.com/about-senior.asp

I always thought that he wasn't an IBCLC because he didn't list it as a credential.

ETA: Just re-read this - I hope it doesn't come across as rude because I didn't mean to be. I'm just curious as to why he would become an IBCLC and not list it as a credential. It would be something I would list and be proud of!

[HomeBirthMommy]

Good for the Journal. My ped is also an IBCLC.

[NorthernPixie]

Haven't seen her myself, but have heard great things about this IBCLC doc: http://www.twofloridadocs.com/

[hopefulfaith]

This is great, and gives me a lot to work with. Thanks, everyone!!!

MaryJaneLouise, I : you - thank you for the articles.

~Em

[melmel2849]

My ped is an IBCLC too!