Over the years, far too many parents have been wrongly told they had to stop breastfeeding.

The decision about continuing breastfeeding when the breastfeeding 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 risks to not breastfeeding, so the question essentially boils down to: Does the addition of a small, often minuscule amount of medication, as is almost always the case, to the breastfeeding mother’s milk make breastfeeding more hazardous than formula feeding? The answer is almost never. Continued breastfeeding with a tiny amount of drug in the milk is almost always safer. In other words, being careful means continuing breastfeeding, not stopping breastfeeding. And it also does not mean bottle feeding previous expressed stored milk, because even after a week as discussed below, many babies will refuse to take the breast. See the information sheet “Breastfeeding and Medications”.

The same consideration needs to be taken into account when the mother or the baby is sick.

A reminder: stopping breastfeeding for a week or even a few days may result in permanent weaning as 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 breastfeeding parent to pump milk while the baby is not breastfeeding, but this is not always easy in practice and the breastfeeding mother may end up painfully engorged.

ILLNESS IN THE BREASTFEEDING Mother

Very few illnesses require the breastfeeding mother to stop breastfeeding. This is particularly true for infections the mother might have contracted, and infections are the most common type of illness for which breastfeeding parents are told they must stop.

Viruses cause most infections, and most infections due to viruses are most infectious before the person even begins to feel sick. By the time the breastfeeding mother has fever (or runny nose, or diarrhoea, or cough, or rash, or vomiting etc), the infection has almost already passed on 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 been stopped. But often, parents are pleasantly surprised that their babies do not get sick at all. Bacterial infections (such as “strep throat”) are also not of concern for the very same reasons as viruses.

Click here for an article in Scientific American written by Dr. Jack Newman further describing how breastfeeding protects infants from infections.

Click here for more information about breastfeeding and illness in the mother.

HIV (NEW RECOMMENDATIONS)

The World Health Organization now recommends that all breastfeeding mothers, regardless of their HIV status, practice exclusive breastfeeding – which means no other liquids or food are given – in the first six months. The World Health Organization now recommends that HIV-positive mothers be taking antiretroviral medication during the entire pregnancy and their infants take antiretroviral drugs from birth until the infant is 12 months old. This means that the child can benefit from breastfeeding with very little risk of becoming infected with HIV. With the provision of antiretroviral drugs, breastfeeding is made dramatically safer and the “balance of risks” between breastfeeding and replacement feeding is fundamentally changed. A major additional benefit of this recommendation is that the breastfeeding parent’s health is also protected for a greater proportion of HIV-infected women.

ANTIBODIES IN THE MILK

Some breastfeeding mothers have what are called “autoimmune diseases”, such as lupus erythematosus, rheumatoid arthritis, idiopathic thrombocytopenic purpura, autoimmune thyroid disease, autoimmune hemolytic anemia and many others. These illnesses are characterized by antibodies being produced by the body against the body’s own tissues. Some breastfeeding mothers have been told that because antibodies get into the milk, they should not breastfeed, as it will cause illness in the baby. This is quite simply nonsense. The breastfeeding should breastfeed.

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 information sheet “Blocked Ducts and Mastitis”).

• Breast abscess 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, not only for this baby but all subsequent babies. An incision that resembles the spoke on a bicycle wheel (the nipple being the centre of the wheel, but the incision kept as far away from the nipple and areola as is practical) would be less damaging to milk-making tissue. Nonetheless, these days breast abscess does not require surgery. Repeated needle aspiration are not recommended as it is not usually practical to have a new mother return several times, often many times, to the doctor’s office. The best treatment is placement of a catheter to drain the abscess instead of surgical drainage or repeated aspirations. See the information sheet “Blocked Ducts and Mastitis” for more information about abscess and a better way to treat abscess.  See more information about sore breasts here.

• Surgery of any kind, say, for appendicitis, or for varicose veins, does not require interrupting breastfeeding. Is the surgery truly necessary now, would be the most important question, while you are breastfeeding? For appendicitis, yes, but for vein stripping? Are other treatment approaches are not possible? Does that non-cancerous lump have to be taken out now, not a year or two from now? Could a needle biopsy of a lump be enough?

• If you do need the surgery now, 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 and not only for this baby, but also for every subsequent baby. 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. 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. 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 when the breast is lactating, but can still be useful. Once again, how long must a breastfeeding parent 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, MRI, CT scan, needle biopsy, core biopsy). On the other hand, an open biopsy should be avoided on a lactating breast unless absolutely necessary. Discuss the options with your doctor. Let him/her know breastfeeding is important to you.

A NEW PREGNANCY while you are breastfeeding

There is no reason to stop 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 still nursing. If you wish to stop, do so slowly for the sake of the breastfeeding baby/toddler. Pregnancy is associated with a decreased milk supply and the baby may stop on his own. For articles supporting lack of negative effect of breastfeeding on pregnancy, click here and here. Here are two studies that provide evidence that breastfeeding while pregnant does not increase the risk of miscarriage:

Ishii, H. Does breastfeeding induce spontaneous abortion? J Obstet Gynaecol Res 2009; 35(5): 864–868

Madarshahian F, Hassanabadi M. A Comparative Study of Breastfeeding During Pregnancy: Impact on Maternal and Newborn Outcomes. Journal of Nursing Research 2012; 20(1):74-79

“Conclusions/Implications for Practice: Results suggest that breastfeeding during normal pregnancy does not increase chance of untoward maternal and newborn outcomes. Nurses and midwives should give expectant mothers appropriate evidence-based guidance and focus attention on promoting proper nutritional intake based on lactation status during pregnancy.”

Ayrim A, Gunduz S Akcal B, Kafali H. Breastfeeding Throughout Pregnancy in Turkish Women. Breastfeeding Medicine 2014;9(3):157-160 

“Conclusions: Breastfeeding during pregnancy is not harmful, and health professionals should not advise weaning if overlapping occurs and should observe mother, infant, and fetus closely for negative effects, and if a negative effect occurs they should take precautions.”

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 and her partner.

• 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. Incidentally, oral rehydration fluids were developed as a very inexpensive treatment for dehydration. Check the price of commercial oral rehydration fluids in affluent countries. About the price of a decent bottle of wine. Not bad for selling water.

• 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 cow, goat or sheep milk, it is definitely not true for breastmilk and breastfeeding.

• 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 and bilirubin is an antioxidant. (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 breastfeeding to stop. 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 the information sheet “Breastfeeding and Jaundice” for more information.  Also our blog Breastfeeding, bilirubin 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. Breastfeeding mothers have been not infrequently told they must stop breastfeeding for reasons too silly to discuss.

The information presented here is general and not a substitute for personalized treatment from an International Board Certified Lactation Consultant (IBCLC) or other qualified medical professionals.

This information sheet may be copied and distributed without further permission on the condition that you credit International Breastfeeding Centre and it is not used in any context that violates the WHO International Code on the Marketing of Breastmilk Substitutes (1981) and subsequent World Health Assembly resolutions. If you don’t know what this means, please email us to ask!

©IBC, updated July 2009, June 2017, 2021

Questions or concerns?  Email Dr. Jack Newman (read the page carefully, and answer the listed questions).

Make an appointment at the Newman Breastfeeding Clinic.