Promoting breastfeeding friendly prescribing in a baby friendly health initiative accredited hospital.

Abstract

Objective To promote breastfeeding friendly prescribing in a regional general hospital following a case where a mother was advised not to breastfeed as a result of pharmacological interventions required postpartum. Clinical features, case progress and outcomes JH, a 27-year-old Caucasian female (gravida 3, para 3) delivered a healthy term infant post-elective caesarean section (CS) for polyhydramnios and macrosomia. Past medical history includes rosacea, endometriosis and obesity. She was noted to be tachycardic perioperatively, which persisted post CS. Electrocardiogram showed rapid atrial fibrillation requiring 2 doses of intravenous amiodarone 150mg, following which she was advised not to breastfeed by medical staff, despite her strong desire to do so. However after clinical pharmacy review, JH elected to commence breastfeeding. She remained tachycardic despite repeat doses of intravenous metoprolol and required cardioversion at 24 hours postpartum, and commencement of bisoprolol. Transthoracic echocardiogram showed low-normal left ventricular ejection fraction for which she was to continue regular bisoprolol and perindopril. However consultation between medical staff and clinical pharmacy resulted in a change to metoprolol and enalapril to support continued breastfeeding. Interventions As a result of this case, a ‘breastfeeding mother’ alert sticker and supporting clinical practice guideline (CPG) was developed to promote breastfeeding friendly prescribing within the organisation. The sticker is to be attached to all medication charts of breastfeeding patients to act as a prompt for prescribers to consider the use of medications compatible with breastfeeding where possible. The CPG assists clinical staff with navigating references to determine suitable medications for breastfeeding mothers. Conclusion The innovation of a ‘breastfeeding mother’ alert sticker makes identification of breastfeeding status easily recognisable. Where possible a mothers desire to breastfeed should not be compromised by her need to take medications; rather choice of medication should be adjusted to enable breastfeeding to continue safely for both mother and infant.