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You Should Continue Breastfeeding-2
(Illness in the mother or baby)
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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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