Why can’t I donate my milk, but I can carry on breastfeeding my own baby?

Babies who will receive donor breastmilk are normally very premature and may well be poorly, so it is essential that the milk is as pure as it can be and free of any drug which may impact on the baby receiving it. The babies are also very vulnerable because their livers and kidneys, which have to deal with any drug to which they are exposed, are still very immature and not fully functioning. All babies born at term are more susceptible to drugs in the first 6 weeks of their life, a period in which we are careful about what drugs we use. Premature babies are vulnerable for much longer. It is also important that they don’t receive anything which may interact with medicines which they may be given directly.

We need to avoid any drugs:

• which reach babies in significant quantities
• which may cause drowsiness in a premature baby
• which might produce diarrhoea resulting in fluid loss e.g., antibiotics
• which might make it harder for the baby to breathe (when they may already be having respiratory difficulty)
• which might make them irritable or otherwise alter their behaviour
• which might change the balance of micronutrients and chemicals within the blood
• drugs which may increase the risk of infection

Prescribed medicines which you may be able to take and still become a breastmilk donor:

Even if your GP has confirmed that you can continue to breastfeed your own baby, you should inform the milk bank of any medication you have been prescribed before continuing to donate, even if the medication is on the following list:

• Asthma inhalers to prevent symptoms e.g. steroids (brown inhalers) –beclometasone ( Clenil®, Qvar®, Asmabec®),Budesonide (Bricanyl®), Fluticasone (Flixotide®, Seretide®), Formoterol (No data is available on Formoterol’s transfer into human milk, but the extremely low plasma levels would suggest that milk levels would be incredibly low, if even measurable. Studies of oral absorption in adults suggests that while absorption is good, plasma levels are still below detectable levels and may require large oral doses prior to attaining measurable plasma levels. It is not likely the amount present in human milk would be clinically relevant to a breastfed infant)
• Asthma inhalers to relieve symptoms (blue inhalers ) – salbutamol ( salamol®, ventolin®), terbutaline, (Bricanyl ®)
• Levothyroxine to relieve symptoms of under active thyroid
• Progesterone only contraceptive pill
• Progesterone only contraceptive injection
• Progesterone only contraceptive IUD/coil (Mirena ®)
• Omeprazole
• Steroid creams to relieve symptoms of eczema in normal, sparing amounts (avoid applying to the nipples)
• Insulin

Over the counter medicines which you can take and continue to donate:

Please check with the milk bank before donating after taking any medicine which you buy from a supermarket or pharmacy even if they appear on the list below. And always write on the label of your breastmilk container any medications taken in the 24 hours prior to expressing even if on the accepted list:

• Painkillers: paracetamol but not ibuprofen, aspirin, codeine, tramadol or dihydrocodeine (these may be in products to treat migraines or period pains.
• Drugs to treat asthma: blue or brown inhalers. If you need to take prednisolone stop donating until 24 hours after the course has finished
• Contraceptive: the progesterone only pill, Mirena® or simple coil (IUD), Progesterone only contraceptive injection
• Drugs to treat hayfever: loratadine or cetirizine, nasal sprays and eye drops to relieve symptoms of hayfever e.g., Beconase®, Opticrom®
• Indigestion remedies: simple antacids or alginates (Gaviscon®), Omeprazole
• Folic acid and vitamins in products aimed at pregnant and breastfeeding women
• Cold Remedies: Nasal sprays to relieve symptoms of cold e.g., xylometazoline (Otrivine®), Oxymetazoline (Vick Sinex®), Simple cough mixtures i.e., ones which don’t cause drowsiness and don’t contain decongestants e.g., glycerine honey and lemon, simple linctus, Sore throat lozenge e.g., Strepsils®, Lockets®, Tunes ®
• Laxatives: bulk forming laxative (e.g., lactulose) osmotic laxatives e.g., Movicol® and stool softeners but not stimulant laxatives (bisacodyl, senna)
• Head lice treatment
• Loperamide (Imodium®) for diarrhoea (please be very careful with hand hygiene)
• Moisturisers and steroid creams to relieve symptoms of eczema (not applied to nipples) e.g., E45®, Diprobase®, Hydrocortisone cream
• Fucithalmic® or Sofradex® eye drops for conjunctivitis. With chloramphenicol eye drops do not donate during treatment and for 24 hours afterwards

Over the counter medicines which you should NOT take when you are donating but can be taken when feeding your own baby:

• Treatments for threadworm- avoid donating for 48 hours (Ovex®, Vermox®)
• Chlorpheniramine to relieve symptoms of allergy or hayfever (Piriton®)
• Nicotine patches or other nicotine replacements.

Prescribed medicines which you should NOT take when you are donating but can be taken when feeding your own baby:

• Sleeping tablets (includes herbal products)
• Sedatives (includes herbal products and over-the-counter products)
• Domperidone
• Antibiotics (please temporarily stop collecting your milk and discuss how long with milk bank)
• Anti-hypertensives
• Anti-depressants
• Propylthiouracil and Carbimazole to treat over-active thyroid gland
• Mesalazine and other drugs for Inflammatory bowel disease
• Metformin
• Tranexamic acid
• Blood thinning injections

Herbal Remedies

Many people assume that an herbal remedy is not a medicine because it is “natural”. In fact, many products can and do produce significant actions and thus side effects. Please check with your milk bank before taking any herbal remedies whilst donating.

Herbs and miscellaneous products which you should not take whilst donating:

• Fenugreek
• St John’s Wort
• Ginkgo biloba
• Any herbal products to reduce anxiety or help sleep
• Herbal fruit teas can be drunk in normal quantities.
• CBD Oil

Other sources of information:

• Herbs to avoid whilst breastfeeding. https://kellymom.com/bf/gotmilk/herbs_to_avoid/
• Too much milk: Sage and other herbs for decreasing milk supply. https://kellymom.com/bf/can-i-breastfeed/herbs/herbs-oversupply/
• Herbs and Breastfeeding: References. https://kellymom.com/bf/can-ibreastfeed/herbs/herbal-ref/
• Herbal safety for nursing moms. https://kellymom.com/bf/can-ibreastfeed/herbs/herbal_safety/
• The Nursing Mother’s Herbal 2003 by Shelia Humphrey. Available from Amazon £9.99

Beaty Treatments

The following beauty treatments can be enjoyed whilst donating breastmilk:

• Hair dyes
• Hair perm or hair chemically straightened
• False nails fitted
• Massages with simple oils (please consult if any aromatherapy oils are used)

Where to get more information

Please check with the milk bank to whom you are donating about any medication which you take before donating the milk and until then label your container with the drug you have taken and dose. They will check with a specialist pharmacist if there are concerns.

The Breastfeeding Network Drugs in Breastmilk Helpline 0844 412 4665
https://www.breastfeedingnetwork.org.uk/drugs-factsheets/
www.Breastfeeding-and-medication.co.uk
Medicines Information at Local Hospital
Regional Medicines Information Services (UKMI)

Frequently asked questions

Which painkillers can I take whilst I am donating breastmilk?
Whilst donating you should only take paracetamol (up to 8 x 500mg tablets in 24 hours). If you need to take any other medication e.g., ibuprofen, codeine, dihydrocodeine, tramadol you should stop donating until 24 hours after you have stopped the tablets. You can continue to breastfeed your own child whilst taking all of these drugs, but we cannot expose premature babies to a drug which may increase the risk of drowsiness or respiratory problems.

I would really like to donate breastmilk, but at the moment I am taking an antidepressant. If I stop taking my drug how long must I wait before I can donate?
It is really not a good time to try to stop taking antidepressants immediately after giving birth. This is a very stressful time with little opportunity to sleep. If you stop your medication now, you may find your mood drops quickly. Although donating your breastmilk may sound, and is, a really wonderful thing to do, you need to take care of yourself and your baby first. Maybe you can fundraise for the special care baby unit or find a different way to support mothers and babies.
Some, but not all, milk banks can take donations of breastmilk from mothers taking antidepressants to provide milk for older/term babies whose mothers cannot breastfeed because of conditions and medication. Please discuss with the milk bank.

I have been taking domperidone to increase my milk supply and now I have more milk than my baby needs, can I donate the excess to the milk bank?
It is really good to hear that you now have a good milk supply but unfortunately you cannot donate your milk. Although very little domperidone passes into breastmilk, it is a drug which cannot be given to babies who have any heart problems. It is not possible to label all milk with any drugs which may be present so we cannot accept milk which may have even a trace of domperidone. Similarly fenugreek, a herb used to increase breastmilk supply, has several interactions and cannot be given to premature or sick babies other than via their own mother’s milk where we are aware of what she is taking.

I need to have minor (day) surgery. When can I start to donate again?
General anaesthetics have a very short half-life in the body, and it is usually safe to breastfeed your own baby as soon as you are awake and alert after surgery. However, because of the small amounts of anaesthetic that will take a little longer to leave the body, which would be fine for a healthy, term baby it is important to wait for 72 hours after surgery before donating milk to a milk bank, as trace amounts of the drugs may affect tiny, premature babies more seriously, or interfere with the drugs they’re already being given.

My baby was stillborn, and I would like to donate my milk rather than taking a drug to dry up my supply.
We are so sorry for your loss and will do all we can to support you. Donating your precious colostrum and milk to another baby is a wonderful tribute to your baby who was born sleeping. Thank you for the generosity of that gift at this painful time. Please call the milk bank and talk to them.

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