Common Medications and Products: Vegan Pregnancy & Breastfeeding Series part 3
Updated: Mar 1, 2020
Whether a medication has animal products in it is often the last thing that a doctor or midwife thinks about when they organise a prescription for you. Sometimes the person recommending the medication has never met you and has no idea about your ethical, cultural or spiritual beliefs. This is your vegan pregnancy but unfortunately our NHS maternity services are structured with minimal opportunity for you to get to know your midwife or obstetrician - *although changes are afoot. You and your baby should be the centre of any care you receive - this includes a respect for your beliefs and choices, ensuring your vegan pregnancy medications are suitable.
As a vegan midwife I make it my priority to support families through the decision making process when accepting or declining vegan medication in pregnancy or for your newborn.
It is useful for you to arm yourself with knowledge about the medications you may be offered that have animal products in them, and what the alternatives are. It is notoriously difficult for vegans to have a grasp of the pharmaceutical world, due to the complexity of labelling products, use of such a wide range of names for the same thing and the constant changing of brands. Here are a couple of good general resources to help you navigate medications during your vegan pregnancy:
Whether pregnant or breastfeeding it is your right to accept or decline a medication, and your right to be fully informed about it.
Any medications I need to be aware of during my vegan pregnancy?
The main medications you may be offered in pregnancy or after the birth of your baby that may contain animal products are listed below. You may also have nipple creams recommended, some of which contain lanolin. This blog is constantly updated, so please comment if there is something missing or you would like me to research a particular product.
Iron Medication (Ferrous Fumarate, Ferrous Sulphate and Ferrous Gluconate) are the usual tablets prescribed when your haemoglobin or ferritin levels are low, a common physiological occurrence in pregnancy and especially vegan pregnancy if your diet is not full of iron rich foods. All of the tablet forms of ferrous fumarate, gluconate and sulphate contain gelatine. The liquid suspension (syrup) does not contain gelatine or any other animal products, so it is reasonable to ask your GP to prescribe this instead. Liquid suspensions have the same concentration of medication and actually tend to have less side affects because it is more easily digestible. Read my Vegan Pregnancy Blog: Iron for more information about boosting your iron intake.
Heparin (Enoxiparin) is a blood thinning medication offered as a preventative treatment if you have a higher chance of developing a deep vein thrombosis (DVT). Certain things in your medical history or about your current situation may put you at a higher chance. These include but are not limited to autoimmune disorders, own or family history of DVT, your body mass index, whether you smoke, whether you have had an operation (such as a caesarean or repair of the perineum). The Royal College of Obstetricians and Gynaecologists (RCOG) have produced a guideline which gives you more evidence behind why each factor increases the chance of DVT, and what the suggested treatment is.
The medication used is low weight molecular heparin, known as enoxiparin sodium. The most commonly used brand in NHS maternity services is Clexane. It contains porcine, derived from pigs. The alternative that does not contain animal products is called fondaparinux sodium, and carries the brand name Arixtra.
Insulin is used for the treatment of diabetes. If you are already diabetic you may have some wisdom to share and be on medication that you have made informed decisions about. If you develop gestational diabetes in pregnancy, depending on your blood sugar readings and the interactions within your body, you may be offered insulin via injection. Because insulin is a hormone it's pharmaceutical versions can be either animal or human derived or manmade. So it is important to have this discussion with your obstetrician. Here is a great discussion forum about diabetes medication for vegans, but please remember that brands are constantly changing and active ingredients may also change:
The good news is the vegan diet is thought to be beneficial for diabetes (Diabetes UK, Veganism and Diabetes).
Lanolin is a wax that is secreted from the sebaceous glands of wool-bearing animals. In pregnancy you may find it in vitamin D3, so always check the labelling of products and read my blog about Vitamin D.
Lanolin products are often 'recommended' for moist-wound healing of sore/cracked nipples when breastfeeding. The brand commonly used is Lansinoh. If a nipple wound was left to dry, every time baby latched to the breast they would break the seal of a dry wound, exposing the healing tissues beneath and the healing process would have to begin again. The theory behind moist-wound healing is that a product keeps the wound moist, allowing the tissue to heal without being fractured several times a day. There is no evidence to suggest that using a lanolin product for this is better than using an alternative such as white or yellow soft paraffin. Furthermore, there is no actual evidence to suggest that moist-wound healing has better results than dry-wound healing (Breastfeeding Network, 2002). An alternative is to heal any wounds using breastmilk; the antibody properties in breastmilk promote healing. You simply express a small amount onto the nipple after, and in-between, feeds, rub in gently using a clean finger and allow to dry naturally. If you moisten the wound with breastmilk prior to a feed, this will reduce the chances of the healing tissues being fractured.
Lactulose is an osmotic laxative commonly given to treat or prevent constipation. It acts by increasing the amount of water in your stools and therefore making them after and easier to pass. Lactulose is specifically derived from lactose, which is a sugar derived from milk. Other osmotic laxatives are normally derived from Polyethelyne Glycol 3350, which is vegan (it is derived from petroleum), and carry the brand names Movicol or Macrogol. Therefore it may be worth considering an alternative type of laxative.
As there are several different types of laxatives, I would recommend discussing with your doctor (either obstetrician or GP) to request a suitable alternative for you. You may choose to make non-medical changes by increasing the amount of fibre and fluid in your diet. Here are some links to good sources of information:
You may find that you are automatically prescribed lactulose after a complicated vaginal birth. It is not necessary to take a laxative, but it may help with your comfort levels following trauma to the perineum. Certainly, a Cochrane Review in 2015 found that there was insufficient evidence around effectiveness and safety to support routine use of laxatives to prevent constipation in the early postnatal period. Furthermore, the review concluded that, based on current evidence, using a stool-bulking laxative for women who have had a third degree tear is not beneficial.
Vitamin K for Newborns (Konakion MM Paediatric) is not suitable for vegetarians or vegans. It contains Gylchocolic Acid, which is a bile acid derived from cattle. To date (March 2020) I am searching for an alternative but am unable to find one on the UK market. This unfortunately leaves the situation of deciding whether to accept or decline the Vitamin K that is offered to your baby at birth; a decision that may be driven by other factors too. As a vegan midwife I completely understand the dilemma that parents may face when there is no alternative vegan medication available.
For now, my best recommendation is to inform yourself about Vitamin K for newborns and make the decisions hat is right for you and your family. The Association for Improvements to Maternity Services have a succinct but evidence based and informative article: https://www.aims.org.uk/information/item/vitamin-k#post-heading-11
If you like to devour more in-depth evidence to support your choices, you could read Sara Wickham's book: https://www.sarawickham.com/topic-resources/a-decade-of-vitamin-k-articles/
In pregnancy you are offered the whooping cough and flu vaccination. I will be covering these in more detail later in the series. But for now, the Oxford Vaccine Group is a great resource as they have listed all the known ingredients in UK vaccines and clearly state if they contain animal sources: Oxford Vaccine Group - Vaccine Ingredients
It is important you make your own evidence informed choices about any medications or vaccinations you accept in pregnancy and through your journey as parents.
We each have our own interpretation of 'risk' and we should not make any judgements about the decisions of those around us. Listen to yourselves, drawing not only on scientific evidence, but on your ethical beliefs and your instincts. This is your vegan pregnancy and you will make the right choices for you and your family.
Vegan Pregnancy & Breastfeeding Series
Please comment if you have any additional information or resources about medications for the vegan pregnancy. Have you ever been prescribed an unsuitable medication?
About Lisa-Marie South, Independent Midwife
I am a private midwife offering midwifery care in Cambridgeshire and the surrounding areas. Please feel free to contact me for more information about my private midwifery services, which include private antenatal and postnatal care, homebirth, birth advocacy, individual antenatal classes and birth debrief.
Breastfeeding Network (2002) Cracked Nipples and Moist Wound Healing. Available at: https://www.breastfeedingnetwork.org.uk/wp-content/pdfs/Cracked_Nipples_and_Moist_Wound_Healing_2002.pdf
*NHS Maternity Services are working under a government document known as 'Better Births'; recommending core areas of improvement in maternity services. One of these areas is continuity of carer, which means that women should see the same midwife throughout pregnancy, birth and postnatally. The Association for Improvements to Maternity Services (AIMS) has produced a statement that clearly defines the expectations that all women should have: https://www.aims.org.uk/campaigning/item/implementingbetterbirthscontinuityofcarer