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Introduction
Over the years, far too
many women have been wrongly told they had
to stop breastfeeding. The decision about
continuing breastfeeding when the mother
takes a drug, for example, is far more involved
than whether the baby will get any in the
milk. It also involves taking into consideration
the risks of not breastfeeding, for the
mother, the baby and the family, as well
as society. And there are plenty of risks
in not breastfeeding, so the question essentially
boils down to: Does the addition of a small
amount of medication to the mother’s
milk make breastfeeding more hazardous than
formula feeding? The answer is almost never.
Breastfeeding with a little drug in the
milk is almost always safer. In other words,
being careful means continuing breastfeeding,
not stopping. The same consideration needs
to be taken into account when the mother
or the baby is sick.
Remember that stopping
breastfeeding for a week may result in permanent
weaning since the baby may then not take
the breast again. On the other hand, it
should be taken into consideration that
some babies may refuse to take the bottle
completely, so that the advice to stop is
not only wrong, but often impractical as
well. On top of that it is easy to advise
the mother to pump her milk while the baby
is not breastfeeding, but this is not always
easy in practice and the mother may end
up painfully engorged.
Illness in the Mother
Very few maternal illnesses
require the mother to stop breastfeeding.
This is particularly true for infections
the mother might have, the most common type
of illness for mothers are being told they
must stop. Viruses cause most infections,
and most infections due to viruses are most
infectious before the mother even has an
idea she is sick. By the time the mother
has fever (or runny nose, or diarrhoea,
or cough, or rash, or vomiting etc), she
has probably already passed on the infection
to the baby. However, breastfeeding protects
the baby against infection, and the mother
should continue breastfeeding, in order
to protect the baby. If the baby does get
sick, which is possible, he is likely to
get less sick than if breastfeeding had
stopped. But often mothers are pleasantly
surprised that their babies do not get sick
at all. The baby was protected by the mother’s
continuing breastfeeding. Bacterial infections
(such as “strep throat”) are also
not of concern for the very same reasons.
See previous handout on
Drugs and Breastfeeding (#9a) with regard
to continuing breastfeeding while taking
medication.
The only exception to
the above is HIV infection in the mother.
Until we have further information, it is
generally felt that the mother who is HIV
positive not breastfeed, at least in the
situation where the risks of artificial
feeding are considered acceptable. There
are, however, situations, even in Canada,
where the risks of not breastfeeding are
elevated enough that breastfeeding should
not be automatically ruled out. The final
word is not yet in. Indeed, recently information
came out that exclusive breastfeeding protected
the baby from acquiring HIV better than
formula feeding and that the highest risk
is associated with mixed feeding (breastfeeding
+ artificial feeding). This work needs to
be confirmed.
Antibodies in the milk
Some mothers have what
are called “autoimmune diseases”,
such as idiopathic thrombocytopenic purpura,
autoimmune thyroid disease, autoimmune hemolytic
anemia and many others. These illnesses
are characterized by antibodies being produced
by the mother against her own tissues. Some
mothers have been told that because antibodies
get into the milk, the mother should not
breastfeed, as she will cause illness in
her baby. This is incredible nonsense.
The antibodies that make
up the vast majority of the antibodies in
the milk are of the type called secretory
IgA. Autoimmune diseases are not caused
by secretory IgA. Even if they were, the
baby does not absorb secretory IgA. There
is no issue. Continue breastfeeding.
Breast Problems
- Mastitis (breast infection)
is not a reason to stop breastfeeding.
In fact, the breast is likely to heal
more rapidly if the mother continues breastfeeding
on the affected side. (See handout #22
Blocked
Ducts and Mastitis)
- Breast abscess is not
a reason to stop breastfeeding, even on
the affected side. Although surgery on
a lactating breast is more difficult,
the surgery and the postpartum course
do not necessarily become easier if the
mother stops breastfeeding, as milk continues
to be formed for weeks after stopping
breastfeeding. Indeed, engorgement after
surgery only makes things worse. Make
sure the surgeon does not do an incision
that follows the line of the areola (the
line between the dark part of the breast
and the lighter part). Such an incision
may decrease the milk supply considerably.
An incision that resembles the spoke on
a bicycle wheel (the nipple being the
centre of the wheel) would be less damaging
to milk-making tissue. These days breast
abscess does not always require surgery.
Repeated needle aspiration, or placement
of a catheter to drain the abscess plus
antibiotics often allows avoidance of
surgery.
- Any surgery does not
require stopping breastfeeding. Is the
surgery truly necessary now, while you
are breastfeeding? Are you sure that other
treatment approaches are not possible?
Does that lump have to be taken out now,
not a year from now? Could a needle biopsy
be enough? If you do need the surgery
now, make sure again the incision is not
made around the areola. You can continue
breastfeeding after the surgery is over,
immediately, as soon as you are awake
and up to it. If, for some reason, you
do have to stop on the affected side,
do not stop on the other. Amazingly some
surgeons do not know that you can dry
up on one side only. You do not have to
stop breastfeeding because you are having
general anaesthesia. You can breastfeed
as soon as you are awake and up to it.
- Mammograms are more
difficult to read if the mother is breastfeeding,
but can still be useful. Once again, how
long must a mother wait for her breast
no longer to be considered lactating?
Evaluation of a lump that requires more
than history and physical examination
can be done by other means besides a mammogram
(for example, ultrasound, needle biopsy).
Discuss the options with your doctor.
Let him/her know breastfeeding is important
to you.
New Pregnancy
There is no reason that
you cannot continue breastfeeding if you
become pregnant. There is no evidence that
breastfeeding while pregnant does any harm
to you, or the baby in your womb or to the
one who is nursing. If you wish to stop,
do it slowly, though, because pregnancy
is associated with a decreased milk supply,
the baby may stop on his own.
Illness in the Baby
Breastfeeding rarely needs
to be discontinued for infant illness. Through
breastfeeding, the mother is able to comfort
the sick child, and, by breastfeeding, the
child is able to comfort the mother.
- Diarrhoea and vomiting.
Intestinal infections are rare in exclusively
breastfed babies. (Though loose bowel
movements are very common and normal in
exclusively breastfed babies.) The best
treatment for this condition is to continue
breastfeeding. The baby will get better
more quickly while breastfeeding. The
baby will do well with breastfeeding alone
in the vast majority of situations and
will not require additional fluids such
as so called oral electrolyte solutions
except in extraordinary cases.
- Respiratory illness.
There is a medical myth that milk should
not be given to children with respiratory
infections. Whether or not this is true
for milk, it is definitely not true for
breastmilk.
- Jaundice. Exclusively
breastfed babies are commonly jaundiced,
even to three months of age, though usually,
the yellow colour of the skin is barely
noticeable. Rather than being a problem,
this is normal. (There are causes of jaundice
that are not normal, but these do not,
except in very rare cases, require stopping
breastfeeding.) If breastfeeding is going
well, jaundice does not require the mother
to stop breastfeeding. If the breastfeeding
is not going well, fixing the breastfeeding
will fix the problem, whereas stopping
breastfeeding even for a short time may
completely undo the breastfeeding. Stopping
breastfeeding is not an answer, not a
solution, not a good idea. (See handout
#7 Breastfeeding
and Jaundice.)
A sick baby does not
need breastfeeding less, he needs it more!!
If the question you have
is not discussed above, do not assume that
you must stop breastfeeding. Do not stop.
Get more information. Mothers have been
told they must stop breastfeeding for reasons
too silly to discuss.
Questions? (416) 813-5757
(option 3) or drjacknewman@sympatico.ca
or my book Dr. Jack Newman’s Guide
to Breastfeeding (called The Ultimate Breastfeeding
Book of Answers in the USA)
Handout
#9b. You should continue breastfeeding (2)
Revised January 2005
Written by Jack Newman, MD, FRCPC. ©
2005
This
handout may be copied and distributed without
further permission,
on the condition that it is not used in
any context in which the WHO code on the
marketing of breastmilk substitutes is violated
1. Breastfeeding:
Starting out right
a) The
importance of Skin-to-Skin contact
2. Colic in the Breastfed Baby
3. a) Sore Nipples
b) Treatments
for Sore Nipple and Sore Breasts
4. Is my baby getting enough?
5. Using a Lactation Aid
6. Using Gentian Violet
7. Breastfeeding and Jaundice
8. Finger Feeding
9. a) You should continue breastfeeding
(Medications and breastfeeding)
b) You
should continue breastfeeding (Illness in the mother or baby)
10. Breastfeeding and other foods
11. Some breastfeeding myths
12. More breastfeeding myths
13. Still more breastfeeding
myths
14. More and more breastfeeding
myths
15. Breast compression
16. Starting solid foods
17. What to feed the baby when
the mother is working outside the home
18. How to know a health professional
is not supportive of breastfeeding
19. a) Domperidone 1
b) Domperidone
2
20. Fluconazole
21. Breastfeed a toddler –
Why on earth?
22. Blocked ducts and
mastitis
23. Breastfeeding your adopted baby
24. Miscellaneous treatments for problems
25. Slow weight gain after
the first few months
26. When the Baby refuses to
latch on
27. Expressing Milk
28. Toxins and Infant Feeding
How breastmilk protects Newborns
Risks of formula feeding
Breastfeeding and guilt
Candida protocol
Protocol to increase the intake
of Breastmilk by the Baby ("Not enough milk")
When latching
Protocols for Induced Lactation
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