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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 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
#9a. 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.
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