Over the course of a breastfeeding journey, most people will encounter a situation where they need to consider medications, be that antibiotics for an infection, prescribed contraception or something over the counter like vitamins or supplements.
When making a decision about medication in lactation, there is a lot to remember and consider. MOMS is a simple decision making aid, which can help mothers by preparing them for their consultation with their doctor/midwife/pharmacist/lactation consultant/other HCP and can help HCPs to remember the key steps in the use of medication in lactation.
The four steps in MOMS are:
M- Mention Breastfeeding
For mothers, if you are breastfeeding, mention it to any healthcare professional you encounter- it is relevant information and it helps to normalise breastfeeding, especially if you are feeding an older infant or child
For HCPs, if you are consulting with a patient who may be breastfeeding, mention breastfeeding. Ask the patient if they are feeding. This is a very quick information, takes no longer than asking about allergies and can elicit relevant information as well as normalising breastfeeding. The WHO recommends breastfeeding for the first 2 years of life and beyond so don’t forget the mothers of older infants and children who may still be breastfeeding.
O- Other Options
In rare cases where the medication is not compatible with breastfeeding, consider if there are any other options including non drug therapy e.g. physiotherapy depending on the individual situation and condition being treated.
As with any medication or intervention, consider risk versus benefit.
In cases where the medication is genuinely not compatible with breastfeeding- discuss options for infant feeding. Depending on duration of treatment mothers may be hoping to maintain their supply by expressing, or she may wish to attempt relactation after her treatment is complete. In some cases donor breast milk may be an option for feeding the infant when the mother is on treatment if this is what the mother would prefer.
M- More Information
Researching the medication in question and balancing the decision with the mother’s individual circumstances is a vital step to safely using medications in lactation. NICE guidance states that supplementary sources of information e.g. LactMed are consulted for in depth evidence based information on the safety of the particular medication in lactation.
Disruption of breastfeeding when not necessary can affect the health of mother and baby in many ways. It is vital to seek as much information as possible about the medication and its use in breastfeeding to allow breastfeeding to continue if possible.
As a mother, it is good to be informed about any potential treatment options you are considering. By researching your options you will be more informed in your consultation with your treating healthcare professional. Discuss what you have researched with them at your appointment and don’t be afraid to ask any questions and share your thoughts and goals.
See our Useful Resources article for some sources of evidence based information on the use of medications in lactation which can be accessed by HCPs and mothers.
S- Shared Decision Making
Of all the considerations when starting medications in lactation, one of the cornerstones is shared decision making between the mother and all healthcare professionals involved. The process must be fully informed for all parties.
And a key thought to keep in mind- it is the decision making that is shared, i.e the process of coming to a decision by researching, balancing risk and benefit and exploring all options available. The final decision belongs to the mother herself.
A final thought- the breastfeeding relationship between mother and child dyads is not only about milk transfer. Should the uncommon situation arise where a mother must stop breastfeeding in the short or the long term, she should be supported to maintain as many of the aspects of the breastfeeding relationship as she would like, e.g. skin to skin contact during feeding, responsive feeding or different feeding positions. Everyone’s breastfeeding journey is different, and if there is an unexpected turn in the road where a mother has to stop breastfeeding, she is still a successful breastfeeding mother and should be celebrated and supported as such.