Can I breastfeed IF
**This post is on whether or not a mother can breast feed if she has a certain condition that is of concern. There is another post "Can I breast feed if my child ___" for conditions on whether or not the mother should breast feed a child with a certain condition such as pre-term, cleft lip, or allergies**
It is common for mothers not to breastfeed due to a perception of the lack of ability to do so. Some of the reasons are related to physical conditions (such as inverted nipples, tattoos, and implants), medical conditions (such as Diabetes or depression) and certain lifestyle factors (such as smoking or drinking). It is important to have the knowledge about each situation in order correctly asses if you should continue breastfeeding or not. Even in cases where a mother has a disease and there are risks of the disease or medication being transmitted through breast milk, the benefits usually outweigh the risks and therefor breastfeeding would still be recommended (except for HIV). Below I will try to run you through the most common concerns with breast feeding mothers so you wouldn’t deprive your baby of the protective, nutritional, and emotional benefits of breast feeding without a legit reason. Please note that I will be giving you a general answer on most cases, however please consult your physician and pediatrician throughout your breastfeeding journey if you have a medical condition or are taking medications. Embrace yourselves for the long list of "Can I breastfeed if I"?
Lifestyle factors and poor diet
Can I breastfeed if I smoke (cigarettes/argili)?
Yes, BUT. According to AAP policy on Breastfeeding “Maternal smoking is not an absolute contraindication to breastfeeding but should be strongly discouraged, because it is associated with an increased incidence in infant respiratory allergy and SIDS. Smoking should not occur in the presence of the infant so as to minimize the negative effect of secondary passive smoke inhalation.104 Smoking is also a risk factor for low milk supply and poor weight gain”
Eidelman, A. I., Schanler, R. J., Johnston, M., Landers, S., Noble, L., Szucs, K., & Viehmann, L. (2012). Breastfeeding and the use of human milk.Pediatrics, 129(3), e827-e841.
Can I breastfeed if I am an alcoholic?
Can I drink alcohol while breastfeeding and how long after do I have to wait?
No. According to the AAP policy on Breastfeeding. “Ingestion of alcoholic beverages should be minimized and limited to an occasional intake but no more than 0.5 g alcohol per kg body weight, which for a 60 kg mother is approximately 2 oz liquor (60 ml), 8 oz wine (240 ml), or 2 beers. Nursing should take place 2 hours or longer after the alcohol intake to minimize its concentration in the ingested milk”
Does that mean moms have to abolish all drinking from their lives? Obviously Not. With proper education and planning, you can still plan a date night and have a drink to take the edge off of the long days of parenting. How? As mentioned it is important to leave 2 hours between 1 drink and breastfeeding. It is vital, that you do not breastfeed in this timeframe. So, plan accordingly. If your baby is due to be sleeping for 4-5 hours, then you can safely consume a drink without worrying about the risks associated. By that token, if you plan on having 2 drinks you must wait 4-6 hours before breastfeeding. Pumping and dumping milk will not hasten the process of alcohol elimination from your body and is therefore unnecessary (Anderson, 1995).
Note that alcohol it may blunt prolactin response to suckling and negatively affects infant motor development(Eidelman,2012). It does NOT stimulate milk production, it is simply an old wives tale.
For a very practical handout for drinking, check out the Australian breastfeeding association webpage on Can I drink alcohol while breastfeeding? They have a wonderful guide for mothers that you can download and use.
Eidelman, A. I., Schanler, R. J., Johnston, M., Landers, S., Noble, L., Szucs, K., & Viehmann, L. (2012). Breastfeeding and the use of human milk.Pediatrics, 129(3), e827-e841.
Anderson PO. Alcohol and breastfeeding. J Hum Lact.1995;11 :321– 323
According to NHS, breastfeeding 2-3 hours after having a glass of wine is unlikely to harm your baby. If your baby Is sleeping 6-9 hours, you can have 2 glasses of wine and be alcohol free by the time your baby is ready to feed. You do NOT have to pump and dump to get the alcohol out. However, if you are giving your baby a formula instead of breastfeeding then it is a good idea to pump and dump to continue to stimulate your breastmilk during this time.
Can I breastfeed if I am using street drugs?
No. According to the AAP policy on Breastfeeding, breastfeeding is contraindicated for “Street drugs such as PCP (phencyclidine), cocaine, and cannabis can be detected in human milk, and their use by breastfeeding mothers is of concern, particularly with regard to the infant’s long-term neurobehavioral development and thus are contraindicated”
“Maternal substance abuse is not a categorical contraindication to breastfeeding. Adequately nourished narcotic-dependent mothers can be encouraged to breastfeed if they are enrolled in a supervised methadone maintenance program and have negative screening for HIV and illicit drugs” Review ref 96
Eidelman, A. I., Schanler, R. J., Johnston, M., Landers, S., Noble, L., Szucs, K., & Viehmann, L. (2012). Breastfeeding and the use of human milk.Pediatrics, 129(3), e827-e841.
Can I breastfeed if I my diet is not sufficient or I am malnourished (due to poverty, famine, wars, etc.)?
Yes. You can definitely breast feed even if your diet is not perfect. Even a malnourished mother still produces sufficient breast milk and breast milk is the perfect food for a baby living in difficult conditions who desperately needs the immune protection that breast milk provides. According to UNICEF’s guiding principles on feeding infants and young children during emergencies“[o]nly in cases of extreme deprivation will a mother’s health or nutritional status seriously alter her ability to produce adequate amounts of high-quality milk. However, a woman’s perception of reduced milk volume may prompt her to supplement prematurely her child’s diet with other fluids or solids. Decreased milk production due to reduced suckling can transform an otherwise unjustified fear of insufficient milk into a practical reality.” Babies have been breastfed during famines and even very thin mothers are able to breastfeed their babies with milk rich in nutrients. In fact it is “especially” recommended to breastfeed in areas where malnourishment is prevalent as to the lack of safe hygiene and alternatives for breast milk.
Please look at this short presentation by UNICEF on breast feeding during emergencies which addresses common concerns such as stress and milk supply as well as lactation and malnourishment.
To sum up, there are only very few and serious medical reasons for a mother to discontinue breastfeeding such as HIV, or true inability to produce milk such as hypoplasia. Do not stop breastfeeding because of lack of knowledge on your case. Remember, you are providing your baby with life-long benefits that outweigh most concerns that you might have.
For Can I breastfeed if my child---? Look for the next post.
Can I do laser hair removal while breastfeeding?
There is no evidence or studied that have been done. However, it seems to be safe while breastfeeding.
Can I do hair dye while breastfeeding?
According to NHS
While information about hair treatments while breastfeeding is limited, it's thought to be fine to dye your hair while you are breastfeeding.
Very little of the chemicals used in hair dye enter your bloodstream, so it's very unlikely that a significant amount will be passed on through your breast milk.
In the past, many women have used hair treatments while breastfeeding with no known negative results.
Can I breastfeed if I and do botox?
This is a tricky question because research has not been done on the topic.
According to the FDA, It is not known if BOTOX or BOTOX Cosmetic passes into breast milk.
The best summary I have found on the topic is from healthline.
Doctors aren’t sure if Botox, a prescription medication made from the bacterium Clostridium botulinum, can be transferred through breast milk to your baby. The toxins produced by the bacterium cause paralysis. Botulinum toxins are very dangerous, even deadly, when not administered by a trained healthcare provider. As a result, many have a legitimate concern about the safety of Botox while breastfeeding.
Some doctors comfortably say it's safe and others do not. I would personally recommend not taking the risk.
The American Academy of Pediatrics, New Jersey Chapter, believes it’s unlikely that the amount of Botox used cosmetically affects breast milk. It’s best to speak with your doctor if you are breastfeeding or planning to breastfeed and considering Botox, according to the
Mode of delivery, pregnancy, and twins
Can I breast feed if I have had a C-section?
Yes. Mothers who have had a C-section can successfully breastfeed. Having a cesarean delivery does put you off on a more rougher start as your are in pain due to the surgery and thus you are finding it difficult to position your baby comfortably on your breast. You did not get to do skin to skin directly post birth, and obviously there is a delay till after you reach the recovery room to do the first feeding. The anesthesia during labor and the IVs and medications to numb pain may be causing you to feel drowsy and may be putting you or your baby at a decreased odds of successfully initiating breastfeeding (Smith, 2010). Plus, you may be sad or disappointed that you had a C-section instead of a normal vaginal birth which might be causing you stress. In addition, it may take on average longer for the milk to come in if a mother has had a C-section (Scott, 2007)(Kuguoglu,2010). However, this is not a hurdle. I did a C-section on Dec. 8, 2013, I continued to breastfeed frequently and by day 10 my son had already regained his birth weight and even added a few hundred grams over it. With some support and determination, you can definitely do it. Some tips on successful breast feeding after a C-section:
- If you and your baby are both stable, ask the nurses to bring your baby as soon as possible and not to supplement with formula at ALL (unless medically necessary). Sit comfortably on the inclined bed, try putting a pillow on your tummy and ask the nurse to bring your baby to you. I recommend you do skin to skin at this point, if it’s cold turn up the heat, whatever is necessary, do it. With the help of the nurse or lactation consultant try to latch your baby correctly. Chest to chest, chin to breast and nose away from the breast (as described in the post breastfeeding: 0-6 months). You can try the football hold or side laying position to avoid the discomfort of the incision. Check out LLL for detailed information on positioning.
- By the way, after the baby's birth while you are in recovery you can ask the dad to do skin to skin with the baby as this has been shown to have a positive influence.
- It is important to start breastfeeding as soon as you are able to and to breastfeed frequently to ensure a good milk supply. After all, C-section or not this is what breastfeeding is all about. Supply and demand.
- Even if your milk takes a bit longer to come in, you should stick through it. In my case, it took until day 6 for transitional milk to come in, which is slightly above the average. However, I stuck it through and in a week’s time I had more than enough milk and Karim was doing better than most babies at the time.
- Finally, get lots of support in your post-partum period, ask for help from family members as your movement will be limited. Relax and enjoy it. Breastfeeding your baby will provide bonding for you and your baby which is well needed especially if you felt having a C-section caused you to have a negative connotation to your birth experience and decreased bonding between you and your baby. I know I did.
-Smith, L.J. (2010). Impact of Birth Practices on Breastfeeding, (Second edition), Jones and Barlett
-Sema Kuguoglu, Hatice Yildiz, Meltem Kurtuncu Tanir and Birsel Canan Demirbag (2012). Breastfeeding Aftera Cesarean Delivery, Cesarean Delivery, Dr. Raed Salim (Ed.), ISBN: 978-953-51-0638-8, InTech, Available from: http://www.intechopen.com/books/cesarean-delivery/breastfeeding-after-a-cesarean-delivery
-Scott, J. A., Binns, C. W., & Oddy, W. H. (2007). Predictors of delayed onset of lactation. Maternal & child nutrition, 3(3), 186-193
Can I breast feed if I am pregnant?
Yes. You can still breastfeed while pregnant given you have an uncomplicated pregnancy and eating well in order to gain weight within the recommended range which is usually 25-35 lbs (11-16 kg’s) for the entire pregnancy. Many mothers not only continue nursing during pregnancy but also "tandem nurse" – that is, breastfeed both their newborn and their older child. This is amazing because it allows your older child to get another dose of the super colostrum. A privilege only granted to a few.
If you plan on nursing while pregnant, look at this FAQ handout based on the information from the book Adventures in Tandem Nursing: Breast feeding during pregnancy and beyond by Hilary flower.
A trusted source for nursing while pregnant would be La leche league, you can check out this article by LLL on Breast feeding while pregnant for some more clarification and motivation.
Can I breast feed if I have twins or multiples?
Yes!!! You can. I know several mothers who have done it, and they are to be applauded. It is hard work but can definitely be done. If your babies are preterm infants, please read the post on Can I breastfeed my pre-term infant?
The three commonly used positions for bar simultaneous breastfeeding are as follows (Filidel Rimon & Shinwell, 2005)
- ”Double football”. An infant’s head is supported in each of the mothers hand or on a pillow, with an infant’s body lying under each of the mother’s arms. Many mothers use these positions initially until they gather more experience.
- ”Double cradle”. In this position each infant is held, in the cradle position. The two infants cross on the mother’s abdomen. This position is often used when the mother is more experienced and the infants have better head control.
- “Combination of cradle with double football”, one infant is held in the cradle position and the second in the football position.
Filidel Rimon, O.; Shinwell, ES. (2005). Postpartum Concerns; In: Multiple Pregnancy,Epidemiology, Gestation & Perinatal Outcome, Blickstein, I.; Keith LG,(Ed.). pp. 1128-1149, Taylor Francis, ISBN-10 1-84214-239-9, ISBN e-book 0-203-01775, Oxon,UK
Breast shapes and sizes
Can I breastfeed if I have flat/inverted nipples?
Yes. Although inverted nipples may make it difficult for the baby to latch correctly, breastfeeding can still succeed. It depends on the level of inversion of the nipple. Some nipples may respond to a pinch test and therefor cause no problems in breastfeeding. Other nipples are extremely inverted and make latching very difficult. Seek a lactation consultant while pregnant or directly post birth to help you with techniques to protrude the nipple and make sucking much easier. For example, hand nipple stimulation or pumping to help evert the nipple before the baby latches on. There are many other techniques suggested by LLL about inverted/flat nipples that you can try. Some moms with extremely inverted nipples may not be able to breastfeed at all. In that case, it is recommended that they pump if possible and give their baby expressed milk
Can I breast feed if I have small breasts?
Yes. Women with small breasts make as much milk as a women with large breasts over 24 hours. The only difference is that women with small breasts store less milk than women with larger breast. Imagine two women, both have the capacity to produce 10 bottles of milk a day, however one woman can give her child one bottle at a time, and another one can give her child 2 bottles at a time. Even though both of their children will consume the same amount at the end of the day, the child of the mother with the small breasts will be coming back more frequently. This may mean that women with smaller breasts can breastfeed more frequently to produce the same amount of milk.
Ramsay, D. T., Kent, J. C., Hartmann, R. A., & Hartmann, P. E. (2005). Anatomy of the lactating human breast redefined with ultrasound imaging.Journal of Anatomy, 206(6), 525-534.
Can I breastfeed if I have had breast surgery?
Yes, you can. According to a recent review of the literature on breast surgery and breastfeeding, “compared to the general population, women post reduction mammoplasties are able to lactate and have similar breastfeeding rates for at least the first month postpartum” (Thibaudeau et. al, 2010). Evidence to date shows that some women are able to meet the goal of exclusive breastfeeding for 6 months with support and encouragement. However, in some cases the shape of the breast before augmentation plays a very important factor. Women may have been hypoplasic,with little or no glandular tissue, before augmentation and may face issues with breastfeeding irrelevant of implants.
Some studies show complications post-surgery such as mastitis which can interfere with successful breastfeeding (Tran, 2014). Other sources such as BFAR, breastfeeding after augmentation surgery, claim that lactation depends on the type of breast surgery, the location of the incision, and the location of the implants. For example, breast reduction may cause the most reduction of milk supply. If you feel that the surgery has impacted your ability to breast feed (as it shouldn’t) contact a lactation consultant or LLL leader and get immediate help to assess whether or not you are actually having milk supply difficulties, and to get help to improve milk supply in that case. You can also seek help through BFAR: The BFAR website provides information and support to mothers who wish to breastfeed after breast reduction surgery and is a resource for health care providers for information about the feasibility and protocols of breastfeeding after breast reduction surgery.
A helpful read you can also use, Defining Your Own Success: Breastfeeding after Breast Reduction Surgery by Diana West, BA, IBCLC. A comprehensive book on the subject of breastfeeding after breast reduction surgery. It was written by Diana West, IBCLC, a board-certified lactation consultant, co-founding member of the BFAR forums, and the owner/ administrator of this website. She is a BFAR mother herself and has successfully breastfed three sons.
-BFAR: The BFAR website provides information and support to mothers who wish to breastfeed after breast reduction surgery, and is a resource for health care providers for information about the feasibility and protocols of breastfeeding after breast reduction surgery. <a href="http://www.bfar.org">The BFAR Website</a>
-Tran, P. L., Houdjati, H., Barau, G., & Boukerrou, M. (2014). [Breastfeeding after breast surgery: Patient information.]. Gynecologie, obstetrique & fertilite.
-Thibaudeau, S., Sinno, H., & Williams, B. (2010). The effects of breast reduction on successful breastfeeding: A systematic review. Journal of plastic, reconstructive & aesthetic surgery, 63(10), 1688-1693.
Can I breastfeed if I have breast abnormalities such as Poland syndrome or hypoplasia?
It depends on your specific case. In some cases you may be able to breastfeed fully, in other cases you may be able to breastfeed but with supplementary aid and in some cases you may not produce any milk. Having hypoplasia in itself cannot guarantee an inability to breastfeed.
In a study of 34 mothers by Kathleen Huggins, et al. (2000), the researchers found a correlation between the following physical characteristics and lower milk output:
- widely spaced breasts (breasts are more than 1.5 inches apart)
- breast asymmetry (one breast is significantly larger than the other)
- presence of stretch marks on the breasts, in absence of breast growth, either during puberty or in pregnancy
- tubular breast shape ("empty sac" appearance)
Additional characteristics that may indicate hypoplasia are:
- disproportionately large or bulbous areolae
- absence of breast changes in pregnancy, postpartum or both
Do not be discouraged even with the more severe types of hypoplasia, some women progress to full milk production and thus can be encouraged to keep stimulating and draining the breasts (Huggins, 2000). Try and see how it goes. Contact a lactation consultant or LLL leader ahead of time preferably while pregnant to assess your case and help you find modality treatments (such as hormone treatments) while pregnant that may help, and then support you once your baby is born. Or hopefully assist you with your next pregnancy.
Breastfeed frequently and as much as possible and watch your baby under close supervision of a registered dietician or physician. You may be able to breastfeed fully or to mix feed. Don't be disappointed. According to LLL, Supporting Mothers with Mammary Hypoplasia “Hypoplasia can be a heartbreaking discovery for a mother and those who are supporting her efforts to breastfeed, but it does not necessarily mean the end of the breastfeeding relationship.”
You can look at alternative feeding methods that may feel more comfortable for you and your baby than bottle feeding, such as a supplemental feeding device. This is all up to you and a lactation consultant can help you with your decision. Take a look at MOBI, which stands for Mothers Overcoming Breastfeeding Issues which is a wonderful non-profit organization committed to supporting mothers with extraordinary circumstances that hinder or prevent the breastfeeding relationship. You will find tips on increasing milk supply, alternative feeding, and support through the difficulty of chronic low milk supply.
-Huggins, K., Petok, E., Mireles, O. Markers of lactation insufficiency: a study of 34 mothers. Current Issues in Clinical Lactation 2000; 25-35 (The URL for this study, which contains the most significant research on hypoplasia, is here: http://www.sonic.net/~mollyf/igt/)
-MOBI international at www.Mobimotherhood.com
Can I breastfeed if I have a tattoo on my breast?
Yes. There should be no harm in breastfeeding if you have a tattoo.
Can I breastfeed if I have nipple piercings?
Yes. According to article by LLL Nipple Piercing: Is It Compatible with Breastfeeding?, there has been no evidence that nipple piercings may affect the ability to breastfeed (referenced: Breastfeeding answer book). However, it is recommended by LLL that you remove nipple accessories as it may pose a risk for choking and other difficulties such as ”poor latch, babies frequently coming on and off the breast, slurping, gagging and milk leaking from the baby's mouth.” The recommendation to remove jewelry is also advisable by the APP, Association of professional piercers, position on nipple piercing and breastfeeding. Nevertheless, you should be able to breastfeed normally. Sometimes milk is ejected through the piercing holes, this should not be of concern. It is also recommended that you consult with your health care physician for any signs of infection of the piercing.
In regards to getting a nipple piercing while breast feeding, the Association of professional piercers, position on nipple piercing and breastfeeding states that “it is advisable and prudent to wait three months following the cessation of breast milk production before piercing of the nipples.”
There should be no problems putting your piercing again after weaning, the association of professional piercers have some tips or you can ask your piercer. Rock on Mama
-APP:Association of Professional Piercers
-Nipple Piercing: Is It Compatible with Breastfeeding? By LLL
-Mohrbacher, N. and Stock, J. BREASTFEEDING ANSWER BOOK, revised edition. Schaumburg, Illinois: LLLI, 1997; 382.
Stress and Maternal diseases
Can I breast feed if I am stressed or have postpartum depression?
Yes. Milk supply should not get discontinued when a mother is shocked or depressed. Breastfeeding is still recommended. If anything it may help you overcome the stress or depression as many studies show that breastfeeding decreases chances of depression due to the effect of oxytocin and that early cessation of breast feeding is associated with increased anxiety and depression (Ystrom, 2012). The way I see it, knowing that no matter what is surrounding you, you are actively and positively participating in the health of development of your child can only be a positive thing.
Stress does cause decreased supply because it stimulates cortisol which at elevated levels depresses milk production. Dopamine which acts as prolactin inhibiting factor also does the same. Depression, stress, and fatigue can also affect oxytocin which decreases milk let down. This can be overridden with frequent suckling. However, postpartum anxiety and depression is a risk factor for developmental delays and internalizing problems in the child if left untreated (Brand, 2009). It is preferred that the mother goes through treatment which is usually psychotherapy and/or the use of anti-depressant drugs depending on the mother’s case under the supervision of a physician. According to the protocol on use of antidepressants for nursing mothers Academy of Breast feeding Medicine (ABM) “women with moderate to severe symptoms may request only antidepressant drug treatment, and this must be considered as the benefits of treatment likely outweigh the risks of the medication to the mother or infant.” Do not listen to people who tell you that you cannot breastfeed when you’re stressed, you can breastfeed and succeed at it, if you want to. If breastfeeding is causing you anxiety and worsening your symptoms or you simply do not wish to continue breastfeeding then this is your choice, just don’t stop simply because of misinformation on medication and breast feeding.
There are several support groups all over the world that can help you, on an international level or local level. For information for safety of drug use during lactation you can look at TOXNET lactmed, or the ABM protocol #16 for anti-depressant use for nursing women.
-Brand, S. R., & Brennan, P. A. (2009). Impact of antenatal and postpartum maternal mental illness: how are the children?. Clinical obstetrics and gynecology, 52(3), 441-455.
-Ystrom, E. (2012). Breastfeeding cessation and symptoms of anxiety and depression: a longitudinal cohort study. BMC pregnancy and childbirth, 12(1), 36.
-Kendall-Tackett, K., & Hale, T. W. (2010). Review: The use of antidepressants in pregnant and breastfeeding women: A review of recent studies. Journal of Human Lactation, 26(2), 187-195.
-Breastfeeding and diseases: A reference guide by Buescher, E. Stephen, M.D. and Hatcher, Susan W., RN
Can I breastfeed if I have an infection such as flu, sore throat, or UTI or other infections?
Yes. If you have a cold, the flu or other infections breastfeeding is permitted as it does not transfer through breast milk and is recommended because the breast milk provides the antibodies you produce to your baby to protect against infection (Lawrence, and Lawrence 2001). You should make sure to wash their hands often and take precautions such as covering sneezes and coughs to avoid spreading the infection. If you feel too sick or hospitalized and don't want to be too close to the baby as not to spread the infection then you could pump your milk and feed your baby without direct contact. Most medications are safe, but as always, you should always check with your physician.
Even in cases of infectious diseases such as Strep A, Hepatitis B or C, lyme disease, bacterial vaginosis, or chlamydia breastfeeding with proper treatment is not contraindicated according to AAP policy on Breastfeeding. However, in cases where the mother is receiving certain antibiotic or antiviral medications, such as treatment of strep A, the mother may have to pump and dump her milk and then continue to breastfeed after the treatment is over and the infection is gone. In the case of hepatitis B, the baby needs to receive a hepatitis B injection 12 hours post birth for breastfeeding to not be contraindicated according to CDC on Hepatitis B and C (Lawrence, and Lawrence 2001).
For References and more information:
-CDC. Recommendations for prevention and control of Hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR, October 16, 1998, 47(RR-19):1–39.
Ketan, G., & Ketan, S. (2005). AMERICAN ACADEMY OF PEDIATRICS: Breastfeeding and the Use of Human Milk. Pediatrics, 115(2), 496-506.
- Eidelman, A. I., Schanler, R. J., Johnston, M., Landers, S., Noble, L., Szucs, K., & Viehmann, L. (2012). Breastfeeding and the use of human milk.Pediatrics, 129(3), e827-e841
-Buescher, E S, Hatcher S W. Breastfeeding and Diseases. Hale Publishing, Amarillo, Tx. 2008.
-Hale T., Medications and Mother’s Milk 2010. Hale Publishing; Amarillo, Tx. 79106
-Lawrence R, Lawrence R. Breastfeeding: A Guide for the Medical Profession. 7th Edition. St Louis: MosbyYear
Book, Inc., 2011.
Can I breast feed if I have diabetes or gestational diabetes mellitus (GDM)?
Yes. And you should! Breastfeeding is recommended by the American Diabetes Association. It can help diabetic women use insulin better, improving glucose tolerance directly after birth (Rivielo, 2009). Breastfeeding can even lower the need for insulin for type 2 diabetics. It also helps your baby, as breastfeeding in infancy is associated with a reduced risk of type 2 diabetes, with marginally lower insulin concentrations later in life. It is also associated with lower blood glucose and serum insulin concentrations in infancy (Walker, 2006).
With gestational diabetes, it is recommended to breastfeed even for a short duration as maternal postpartum glucose tolerance is enhanced in lactating women with recent GDM (Gunderson, 2007). In addition, The Nurses’ Health Study reported that increasing duration of lactation was associated with reduced risk of type 2 diabetes, with each additional breastfeeding year decreasing the risk by 15% among women in general. Recent research recommends that breastfeeding should be encouraged among these women because it offers a safe, feasible and low-cost intervention to reduce the risk of subsequent diabetes in this high-risk population (Ziegler, 2012).
Lactogenesis, or in common terms “milk coming in”,may take longerpedue to insulin effect. GDM women had more difficulty expressing colostrum from their breasts during the first 2 days of lactation (Gunderson, 2007). Patience is required. Keep breastfeeding as frequent as possible and pumping in between feeds to encourage milk production. Do not be discouraged if your baby needs some supplementation in the first few days. It is essential with diabetic women or women with gestational diabetes to monitor their glucose levels especially after a feed to avoid hypoglycemia (Rivielo, 2009).
Tips from American Diabetes Association:
- Plan to have a snack before or during nursing
- Drink enough fluids (plan to sip a glass of water or a caffeine-free drink while nursing)
- Keep something to treat low blood glucose nearby when you nurse, so you don't have to stop a feeding to treat low blood glucose levels –
Make sure to discuss your medications with your doctor as well as monitor your glucose levels closely.
-Riviello, C., Mello, G., & Jovanovic, L. G. (2009). Breastfeeding and the basal insulin requirement in type 1 diabetic women. Endocrine Practice, 15(3), 187-193.
-Owen, C. G., Martin, R. M., Whincup, P. H., Smith, G. D., & Cook, D. G. (2006). Does breastfeeding influence risk of type 2 diabetes in later life? A quantitative analysis of published evidence. The American journal of clinical nutrition, 84(5), 1043-1054.
-Gunderson, E. P. (2007). Breastfeeding After Gestational Diabetes Pregnancy Subsequent obesity and type 2 diabetes in women and their offspring. Diabetes Care, 30(Supplement 2), S161-S168.
-American Diabetes Association
-Ziegler, A. G., Wallner, M., Kaiser, I., Rossbauer, M., Harsunen, M. H., Lachmann, L., ... & Hummel, S. (2012). Long-term protective effect of lactation on the development of type 2 diabetes in women with recent gestational diabetes mellitus. Diabetes, 61(12), 3167-3171.
Can I breastfeed if I have heart disease?
Yes, but under supervision. Heart disease is not a contraindication in the AAP policy on Breastfeeding. The woman’s choice to breastfeed should be promoted, where not medically contraindicated according to European society of cardiology. However, careful considerations should be made for your specific case and medications. For example, the ESC Guidelines on the management of cardiovascular diseases during pregnancy states that “due to high metabolic demands of lactation and breastfeeding, preventing lactation maybe considered in PPCM(peripartum cardiomyopathy).” However, the guidelines do not mention prevention of lactation in other situations. Regardless of whether you decide to breastfeed or not, you should take it easy and not put extra exertion that may put you or your health at risk. Be extra careful in regards of medication during lactation and make sure to consult your physician. You will find a long list of medications allowed while breastfeeding that are helpful on pages 42-45 of the ESC guidelines on the management of cardiovascular diseases it has been published by the US Department of Health and Human Services. (Source: Drug Information for the Health Care Professional; USDPI Vol 1, Micromedex 23rd edn.,01.01.2003). Adapted and modified from Bonow et al.
-Regitz-Zagrosek V, Blomstrom Lundqvist C, Borghi C, Cifkova R, Ferreira R, Foidart J-M, et al. ESC Guidelines on the management of cardiovascular diseases during pregnancy: The Task Force on the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). European Heart Journal.2011;32(24):3147-97.
-Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O’Gara PT, O’Rourke RA, Otto CM,Shah PM, Shanewise JS. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American HeartAssociation Task Force on Practice Guidelines (Writing Committee to Revisethe 1998 Guidelines for the Management of Patients With Valvular HeartDisease): endorsed by the Society of Cardiovascular Anesthesiologists, Societyfor Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons.Circulation 2008;118:e523–e661.
Can I breast feed if I have epilepsy?
Yes. Epilepsy is not a contraindication for breastfeeding. According to a press release by American Academy of neurology a study published in the November 24, 2010, online issue of Neurology®, the medical journal of the American Academy of Neurology “breastfeeding your baby while taking your seizure medication may have no harmful effect on your child’s IQ later on. The women were taking the drugs carbamazepine, lamotrigine, phenytoin, or valproate.” Meador noted that more research is needed on the effects of other, newer drugs for epilepsy. The WHO guidelines on anti-peleptic drugs is that “Neither phenobarbital, phenytoin, carbamazepine nor valproate are secreted in clinically significant amounts in breast milk. Breast feeding is beneficial for babies and is recommended.” Breastfeeding is in general safe but needs appropriate observation of the nursing infant due to any risks of adverse effects and hence you should review with your physician (Sabers, 2009). Read the following tips on keeping infant safe at home by Epilepsy action for some tips on bottle feeding or breastfeeding your baby safely, such as “[w]hen breast or bottle feeding your baby, sit on the floor, preferably on a thick rug, with your back well supported. This way, if you had a seizure, the baby would not have far to fall and would not land on a hard surface.”
For more information on the safety of drugs during pregnancy and lactation check The national guidelines by US department of health and human services.
-American academy of neurology
-Meador, K. J., Baker, G. A., Browning, N., Cohen, M. J., Bromley, R. L., Clayton-Smith, J., ... & Loring, D. W. (2014). Breastfeeding in Children of Women Taking Antiepileptic Drugs: Cognitive Outcomes at Age 6 Years. JAMA pediatrics, 168(8), 729-736.
-Sabers, A., & Tomson, T. (2009). Managing antiepileptic drugs during pregnancy and lactation. Current opinion in neurology, 22(2), 157-161.
Can I breastfeed if I have a thyroid disease?
Yes, unless taking medications such as radioactive iodine for hyperthyroidism as it is contraindicated in AAP policy on Breastfeeding. In the case of hypothyroidism maintaining proper milk supply can be difficult. If that is your case, it is best to get proper medication and contact a lactation consultant or LLL leader to help you increase your milk supply. Read this article by LLL on the impact of thyroid dysfunction on breast feeding. It includes tips on how to improve lactation such as, “exogenous pitocin (i.e., pitocin nasal spray) might provide the oxytocin necessary to eject milk. Massaging the breast from the chest toward the nipple prior to feeding may make more milk available to baby. Breast compression, which mechanically increases internal pressure, may also help to propel milk from the breast during the feed” among others.
-Ketan, G., & Ketan, S. (2005). AMERICAN ACADEMY OF PEDIATRICS: Breastfeeding and the Use of Human Milk. Pediatrics, 115(2), 496-506.
- Eidelman, A. I., Schanler, R. J., Johnston, M., Landers, S., Noble, L., Szucs, K., & Viehmann, L. (2012). Breastfeeding and the use of human milk.Pediatrics, 129(3), e827-e841.
-The Impact of Thyroid Dysfunction on Lactation Lisa Marasco, MA, IBCLC from Breastfeeding Abstracts February 2006, Vol. 25, No. 2, pp. 9-12.
Can I breastfeed if I have PCOS?
Yes, it is common for women with PCOS to produce milk normally and breastfeed without difficulty (Vanky, et al 2007). Even if you are taking Glucophage (Metformin) as there are no noted side effects in babies (hale, 2002).
There has been research linking PCOS to low milk supply in some women (Marasco, 2000). If you feel this may be your case it is suggested that women with PCOS pump their milk from each breast for at least 10-15 minutes in order to maintain an adequate milk supply in the first 2 weeks of nursing (Vanky Et. al, 2007). Milk production can be maximized with frequent feedings with full drainage along with an adequate diet and drinking fluids. If needed, consult an IBCLC or LLL leader in your area.
Vanky, E.; Isaksen, H.; Moen, MH.; Carlsen, SM. (2008). Breastfeeding in Polycystic Ovary
Syndrome. Acta Obstetricia Et Gynecologica Scandinavica, Vol.87, No.5, pp.531-535,
ISSN 0001-6349, 1600-0412 (online)
Marasco L, Marmet C. et al Polycystic ovary syndrome: A connection to insufficient milk supply. Journal of Human Lactation 2000 16 (2) 143-148
Hale T. W. Kristensen J. H. et al Transfer of metformin into human milk. Diabetologia 2002 45:1509-1504
Sema Kuguoglu, Hatice Yildiz, Meltem Kurtuncu Tanir and Birsel Canan Demirbag (2012). Breastfeeding Aftera Cesarean Delivery, Cesarean Delivery, Dr. Raed Salim (Ed.), ISBN: 978-953-51-0638-8, InTech, Available from: http://www.intechopen.com/books/cesarean-delivery/breastfeeding-after-a-cesarean-delivery
Can I breastfeed if I have herpes or any other lesions on my nipples?
No. According to the AAP policy on Breastfeeding, breastfeeding is contraindicated for “Breastfeeding should not occur if the mother has active (infectious) untreated tuberculosis or has active herpes simplex lesions however, expressed milk can be used because there is no concern about these infectious organisms passing through the milk”
Eidelman, A. I., Schanler, R. J., Johnston, M., Landers, S., Noble, L., Szucs, K., & Viehmann, L. (2012). Breastfeeding and the use of human milk.Pediatrics, 129(3), e827-e841
Can I breastfeed if I have human immunodeficiency virus (HIV?)
No, unless you live in an underdeveloped countries. According to AAP policy on Breastfeeding “In the industrialized world, it is not recommended that HIV-positive mothers breastfeed. However, in the developing world, where mortality is increased in non-breastfeeding infants from a combination of malnutrition and infectious diseases, breastfeeding may outweigh the risk of the acquiring HIV infection from human milk. ”In developing areas of the world with populations at increased risk of other infectious diseases and nutritional deficiencies resulting in increased infant death rates, the mortality risks associated with artificial feeding may outweigh the possible risks of acquiring HIV infection (Lawrence, and Lawrence, 2001).
Lawrence RM & Lawrence RA. Given the Benefits of Breastfeeding, what Contraindications Exist? Pediatric Clinics of North America 2001 (February); 48(1): 235-51.
Can I breastfeed if I have active untreated tuberculosis (TB) disease?
No. Not until after treatment. According to the AAP policy on Breastfeeding
“Breastfeeding should not occur if the mother has active (infectious) untreated tuberculosis or has active herpes simplex lesions on her breast; however, expressed milk can be used because there is no concern about these infectious organisms passing through the milk. Breastfeeding can be resumed when a mother with tuberculosis is treated for a minimum of 2 weeks and is documented that she is no longer infectious.”
American Academy of Pediatrics. Tuberculosis. In: Pickering LK, editor. Red book: Report of the Committee on Infectious Diseases. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012. pp. 736–56
Can I breastfeed if I have T-cell lymphotrophic virus type I or II or untreated brucellosis?
No. According to the AAP policy on Breastfeeding “Mothers who are positive for human T-cell lymphotrophic virus type I or II or untreated brucellosis should not breastfeed nor provide expressed milk to their infants”
Can I breastfeed if I have varicella 5 days before through 2 days after delivery?
No. According to the AAP policy on Breastfeeding “Mothers who develop varicella 5 days before through 2 days after delivery should be separated from their infants, but their expressed milk can be used for feeding”
Can I breastfeed if I am acutely infected with H1N1 influenza?
No. According to the AAP policy on Breastfeeding “mothers acutely infected with H1N1 influenza should temporarily be isolated from their infants until they are afebrile, but they can provide expressed milk for feeding”
Can I breastfeed if I am getting a vaccination?
Most vaccinations are safe during breastfeeding. Look at the CDC website for vaccination recommendations on which vaccines to take and which to avoid such as chickenpox.
Centers for Disease Control and Prevention. Health Information for International Travel 2003-2004. Atlanta: US Department of Health and Human Services, Public Health Service, 2003.
What cases is breast feeding prohibited?
According to CDC
Breastfeeding is NOT advisable if one or more of the following conditions is true:
1. An infant diagnosed with galactosemia, a rare genetic metabolic disorder
2. The infant whose mother:
· Has been infected with the human immunodeficiency virus (HIV)
· Is taking antiretroviral medications
· Has untreated, active tuberculosis
· Is infected with human T-cell lymphotropic virus type I or type II
· Is using or is dependent upon an illicit drug
· Is taking prescribed cancer chemotherapy agents, such as antimetabolites that interfere with DNA replication and cell division
· Is undergoing radiation therapies; however, such nuclear medicine therapies require only a temporary interruption in breastfeeding
For information regarding substances and conditions which affect human milk, read Lawrence RA, Lawrence R. (2005) Breastfeeding: A guide for the medical professional, 6th Edition. St. Louis: Mosby.
For additional information, visit American Academy of Pediatrics' Breastfeeding and the Use of Human Milk or read: American Academy of Pediatrics Committee on Drugs. (2001) The transfer of drugs and other chemicals into human milk. Pediatrics 108:776-789. Available online athttp://pediatrics.aappublications.org/content/108/3/776.full
Please note that if you have any medical conditions or are taking any drugs while breast feeding that you need monitoring for you and your baby by a physician. I highly depended on a reference called breastfeeding and diseases by E Steven Buescher and Susan W hatcher RN, BSN, IBCLC and medication and mother’s milk 16th edition by Thomas W. Hale, PhD. and Hilary E. Rowe, PharmD
This information is advisory only and is not intended to replace sound clinical judgment or individualized patient care. The author disclaims all warranties, whether expressed or implied, including any warranty as to the quality, accuracy, safety, or suitability of this information for any particular purpose.