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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 always: Almost never. Breastfeeding with a little
drug in the milk is almost always safer. In other words, being careful means
continuing breastfeeding, not stopping.
Remember
that stopping breastfeeding for even a short period of time 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. Most infections are caused by
viruses, 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 diarrhea, 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 Drugs and
Breastfeeding with regard to continuing breastfeeding while taking
medication.
The only
definite exception to the above is HIV infection I the mother. Until we have
further information, it is generally felt that the mother who is HIV positive
not breastfeeding, 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 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, secretory IgA is not absorbed by the baby.
There is no issue. Continue breastfeeding.
Breast
Problems
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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 Blocked Ducts
and Mastitis)
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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 around the areola
(the line between the dark part of the breast and the lighter part).
Such an incision may decrease the milk supply considerably.
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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?
If so, 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.
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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.
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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.
-
Diarrhea 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 breastfeeding.
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Jaundice. Exclusively breastfed
babies are commonly jaundiced, even to three months of age, though
usually, the yellow color 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 Breastfeeding
and Jaundice.)
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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 inane to discuss.
About The Author: Dr. Jack Newman is a Toronto
pediatrician who has practiced medicine since 1970. In 1984 he established the
first hospital based breastfeeding clinic in Canada, at the Hospital for Sick
Children in Toronto. He now holds breastfeeding clinics in several Toronto area
hospitals. Jack has been a consultant with UNICEF's Baby Friendly Hospital
Initiative and has spoken at conferences around the world. He is the father of
three children, all breastfed.
Dr. Newman is the author of
"The Ultimate Breastfeeding Book of Answers"
NOTE: The article above titled "Illness
in the Mother or Baby: You Should Continue Breastfeeding (2)" was written by Dr. Jack Newman and is the opinion of its author. "The New Parents Guide" does not guarantee the information to
be factual. Always use the guidance of your personal
doctor or your child's doctor over information you read on this site or elsewhere; your doctors know what is
best for you and your baby.
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