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 so
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 3
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