Commonly used medicines after birth

1. Analgesics (pain killers)

a) Paracetamol (500mg tablets)

What is it used for? Paracetamol works by relieving pain and lowering high temperature. It can provide effective reliefnfrom mild to moderate pain, including headache, toothache, sore throat, symptomatic relief of rheumatic aches and pains, influenza symptoms and fever. How do I take it? Paracetamol can be taken regularly or when required for pain. Dosage: Adults and young persons aged 12 and over: take 2 tablets up to 4 times per day, as required. The tablets should be taken with water. Take only as much as you need to relieve symptom and leave at least 4 hours between each dose. Do not take more than 8 tablets in 23 hours. What are the side effects? Paracetamol is generally well-tolerated in most people. Is it safe to use while breastfeeding? Paracetamol is commonly used during breastfeeding.

b) Co-dydramol

What is it used for? Co-dydramol (10/500 10mg dihydrocodeine and 500mg paracetamol) is a combination of paracetamol and dihydrocodeine. Dihydrocodeine is stronger than paracetamol and is used for the relief of mild to moderate pain. If you have had a caesarean section or moderate pain post-delivery, then you may be give a box of 30 tablets of co-dydramol on discharge from hospital. How do I take it? Dosage: Co-dydramol 1 to 2 tablets every 6 hours when required up to a maximum of 4 times per day. Do not take more than 8 tablets in 24 hours. We recommend that you step down pain relief and substitute these tablets for paracetamol as soon as possible which is usually after 3-4 days. Since these tablets contain paracetamol you should not take any other paracetamol tablets at the same time. Do not drink alcohol whilst taking co-dydramol. What are the side effects? The most common side effects of dihydrocodeine are drowsiness, constipation, feeling sick or dry mouth. You may be advised to take a gentle laxative if you experience constipation whilst taking co-dydramol. Is it safe to use during while breastfeeding? Dihydrocodeine can be used during breastfeeding as a pain killer where paracetamol has not been effective. Use the minimum effective does for the least amount of time. IMPORTANT: Although there is a small dose of dihydrocodeine in these co-dydramol tablets, if you are breastfeeding whilst taking it, inform your midwife immediately if your baby is showing signs of increased drowsiness, difficulty feeding, breathing problems or anything else unusual. Research has shown that some babies may be more susceptible than others to these side effects. If you would like any further information regarding the use of dihydrocodeine while breastfeeding, please discuss it with your midwife/doctor.

c) Ibuprofen

What is it used for? Ibuprofen is anti-inflammatory drug used to treat inflammation in a variety of conditions. It is commonly used after birth to help ease pain and inflammation. How do I take it? Swallow tablets whole, with a glass of water. Take the tablets with, or after, food. Dosage: Adults: 400mg three times a day, 8 hours apart, is often prescribed after a procedure. If you have been given a diclofenac suppository after birth or a procedure, you cannot start ibuprofen until 18 hours later. The dose can be reduced to 200mg three times a day when the pain improves. Who should not use ibuprofen? Women with any of the following conditions should consult a doctor, midwife, or pharmacist before taking ibuprofen if there is history of:

• asthma or breathing problems
• previous stomach ulcer
• previous reaction to aspirin, diclofenac and other non-steroidal anti-inflammatory drugs (NSAIDs)
• other medical conditions, e.g. kidney disease, heart disease, blood clotting disorders, liver disease.

What are the side effects? Common side effects include headache, dizziness, feeling sick and diarrhoea. IMPORTANT: Stop taking the medicine and seek immediate help if you:

• pass blood in your faeces (stools/motions)
• pass black tarry stools
• vomit blood or dark particles that look like coffee grounds
• suffer any allergic reaction such as itching, drowsiness, swelling of the face, lips, tongue, mouth or throat, which may in turn cause shortness of breath or difficult swallowing.

Ibuprofen is considered as a suitable treatment option whilst breastfeeding.

2. Ferrous Sulphate (Iron supplements)

What is it used for? Iron supplements are used to treat iron deficiency anaemia. When the body does not get enough iron, it cannot produce the number of normal red blood cells needed to keep you in good health. It is common for women who are pregnant or who have just given birth to have this condition. These medicines work by replacing body iron. Iron is a mineral that the body needs to produce red blood cells. How should I take it? Swallow the tablets who with water. Although iron preparations are best absorbed on an empty stomach, they may be taken after food to reduce the effects on the stomach. Iron supplements should not be taken within one hour before or two hours after eating or drinking the following products: tea, coffee, milk, eggs and wholegrains. These products can reduce the absorption of iron. Dosage: Ferrous sulphate 200 mg tablets Treatment of iron deficiency anaemia: 1 tablet 2-3 times a day Prevention of iron deficiency anaemia: 1 tablet per day What are the side effects? Like all medicines, ferrous sulphate tablets may cause side effects, the most common of which are constipation, diarrhoea, stomach pain, feeling sick and blackened stools (faeces). Is it safe to use during breastfeeding? Ferrous sulphate tablets are commonly used safely while breastfeeding. Ensure that you do not take more than the recommended dose. If you cannot tolerate ferrous sulphate tablets, an alternative is available called ferrous fumarate. This is available as a liquid or tablets. The same side effect and safety information applies as above for ferrous sulphate.

3. Laxatives

What are they used for? Laxatives are used to treat constipation. What else can I do to prevent becoming constipated? The following hints are helpful in maintaining regular bowel habits:

• Eat fibre-containing foods, e.g. wholegrain bread, fruit and vegetables.
• Drink sufficient liquid, preferably water.
• Take regular exercise.

Laxatives may be prescribed after birth. If you think that you need a laxative discuss with your midwife or doctor. What are the side effects? Common side effects of laxative include feeling bloated, increased wind (gas) and mild abdominal pain. Commonly used laxatives in pregnancy/after birth:

a) Lactulose

Lactulose is a liquid laxative used to treat and prevent constipation. Lactulose can take 2-3 days to have an effect; it is generally considered to be a gentle laxative. Dosage: Usually 10 mls twice daily. It must be taken regularly to have an effect.

b) Fybogel (Ispaghula husk)

Fybogel is a high fibre drink that works to increase the fibre in your diet. Increased fibre in the diet helps to gently relieve constipation. Fybogel is considered to be a gentle laxative. It is important to maintain an adequate intake of fluid whilst using Fybogel. Dosage: The usual dose is one sachet mixed with a glass of water, up to twice daily. Is it safe to use Lactulose or Fybogel after birth? Lactulose and Fybogel are not absorbed into the blood and only have a local effect on the gut. Both drugs are generally considered safe to use while breastfeeding, under the advice of a midwife or doctor.

4. Blood clot prevention

Enoxaparin (also known as Clexane) is used to prevent blood clots. Blood clots usually present as deep vein thrombosis (DVT) usually in a leg vein, or pulmonary embolism (PE), a blood clot in the lung. Blood clots are more common during pregnancy and some women will be more at risk of blood clots than others. As well as prevention, enoxaparin is also used at higher doses for treatment of DVT and PE. Is it safe to use during breastfeeding? Enoxaparin is given as an injection just beneath the skin (subcutaneous). It is usually injected into a skin fold in your abdomen (stomach) or the upper part of your thigh. If this is not suitable, you may be advised to inject into an alternative site. It should not be injected into your muscles. It may be given either once or twice daily. You should adminster the dose at the time recommended by your doctor. How is exonaparin used after birth/caesarean section? If you have, or develop risk factors at the time of the birth, you may be started on enoxaparin. Examples of possible risk factors would be having a caesarean section or infection. If you were on enoxaparin during pregnancy, your doctor will want you to stay on the same treatment after the birth. They will inform you how long to continue this treatment. How to inject Enoxaparin (Clexane) You will be able to inject enoxaparin once you have been shown how to do so by your doctor or midwife, or by following the instruction leaflet that will be given to you upon discharge. It is a simple process and one that you can do at home. Follow these steps:

• Wash and dry your hands.
• Clean the injection site. If someone else is doing it for you it is advisable that they wear gloves.
• Choose the injection site either on the outer aspect of your left or right thigh or your stomach if advised to do so. It is important that you change the site each time. If there is any oozing of blood at the injection site, apply gentle pressure. Do not rub as this may cause bruising.
• Dispose of the syringe in the yellow sharps box provided. This box should be kept out of the reach of other people.

Produced by pharmacists at Chelsea and Westminster Hospital NHS Foundation Trust and used with permission.

Heart health after giving birth

Chest pain in pregnancy and/or after your baby’s birth should never be ignored. Some chest pain can be serious and can head to a heart attack, heart failure, cardiac arrest or even death. Most women do not suffer from these conditions during or after pregnancy but it is important to recognise the symptoms and, if you have any of them, to seek treatment quickly.

Pre-exisiting heart conditions

If you have a known heart condition, were born with a congenial heart defect or have been diagnosed with heart disease, your midwife/GP/cardilogist will monitor your heart health before, during and after pregnancy.

Symptoms of a heart attack can include:

• central chest pain
• arm pain or numbness
• pain in the jaw, back or shoulders
• nausea
• sweating/clamminess
• breathing difficulties

Some people experience indigestion-like chest or throat pain that does not respond to indigestion remedies.

When should I contact the midwife or doctor?

If you feel unwell, contact your midwife or GP for guidance. If you experience some/all of the above symptoms, dial 999 and ask for an ambulance as yoru heart health needs to be investigated quickly. An ECG monitor and a troponin blood test should be carried out to find out if you have had a heart attack.

When am I more likely to have a heart attack?

You are more likely to have a heart attack if you:

• have a family history of heart problems
• have high blood pressure
• have high cholesterol
• smoke
• drink excessively
• are obese

Rarely, women with no risk factors or history of heart disease in their family will experience heart attack symptoms. Heart attack symptoms are pregnancy should never been ignored. Contact your midwife or GP for further advice.