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CONTRAINDICATIONS TO BREASTFEEDING

 

When women should not breastfeed

There are times when a woman should not breastfeed. If a woman

  • Has HIV, the virus that causes AIDS, because there is a risk of passing the virus through human milk. Women should know their HIV status before deciding to breastfeed.

  • Has active, untreated tuberculosis. If the mother has been treated, it is safe to breastfeed. If it is safe for the mother to be in contact with her infant, she may breastfeed.

  • Has HTLV-1, The Human T-cell leukemia virus type 1. Current recommendations are that women in the United States with HTLV-1 disease not breastfeed.
  • Has maternal lead levels greater than 40 micrograms/deciliter. Milk levels are one-tenth to one-fifth of maternal levels.

  • Uses illegal drugs: amphetamines, cocaine, heroin, marijuana, or phencyclidine

  • Takes radioactive compounds therapeutically. It may take weeks or months to clear the radioactivity from the milk and the primary disease may be a serious enough reason to avoid breastfeeding.


When mothers should temporarily stop breastfeeding

There are times when breastfeeding should stop temporarily. The mother should express or pump her milk as often as baby would be nursing to maintain her milk supply. This milk should be discarded.

Women should not breastfeed until these situations have passed:

  • Infected lesions on their breasts, such as superficial boils, impetigo, and herpes simplex. Breastfeeding is not recommended until the lesions are completely cleared.

  • Single dose radioactive compounds taken for diagnostic purposes. Temporary cessation of breastfeeding is recommended until the time it takes to clear the radioactive compound from the mother’s plasma.


Source: Lawrence RA. 1997. A Review of the Medical Benefits and Contraindications to Breastfeeding in the United States (Maternal and Child Health Technical Information Bulletin). Arlington, VA: National Center for Education in Maternal and Child Health.

MAINTAINING YOUR MILK SUPPLY

Tips for mothers who temporarily stop breastfeeding

Mothers who must temporarily stop breastfeeding can maintain their milk supply until it is safe to resume breastfeeding. Women who take certain medications or radioactive agents will need to pump and discard their milk until the unwanted substance is clear from the milk. When breastfeeding is temporarily withheld while awaiting a galactosemia or PKU diagnosis, the mother may want to save the milk for her baby or donate it to a milk bank.

Milk supply is determined by how often and how well milk is removed from the breast and by how much time is spent expressing or pumping the milk. The most efficient way to remove milk is to use a large electric pump with a double set up. Pumping both breasts at the same time makes pumping sessions shorter and increases prolactin, an important lactation hormone. Other options include single pumping (one breast at a time) with an electric, battery or manual pump, and hand expression. A mother can make any pump more effective by briefly massaging her breasts and hand expressing several times during a pumping session. It is helpful if the mother follows a pumping routine.

If the temporary weaning occurs after breastfeeding has been well established, the mother should express or pump as often as the baby was breastfeeding. For example, if the baby was breastfeeding ten times a day, mom should try to pump ten times a day. The mother should begin expressing or pumping as soon as possible whenever breastfeeding is interrupted. Some women have been able to maintain their milk supply by pumping 5 - 8 times per 24 hours for a total of 90-125 minutes.

If breastfeeding must be withheld when the baby is less than two weeks old, the mother should start with at least eight pumping sessions in 24 hours, including one between midnight and 4 AM. Colostrum, the first milk, is concentrated and comes in small quantities, so the mother should not become discouraged. About a teaspoon to a tablespoon per pumping is excellent. Milk production gradually increases during the first week. Mothers should pump for time, not quantity, pumping each breast for ten to fifteen minutes at each session. The purpose of pumping at this time is to minimize engorgement and to stimulate milk production.

Any woman who must withhold breastfeeding or wean temporarily should be referred to a lactation consultant or breastfeeding support group. After temporary weaning, the baby may need some coaxing to resume feeding at the breast. Lactation consultants have techniques to help babies make the transition back to the breast.

PUMPING AND STORING HUMAN MILK

To Store Human milk for Later Use:
  • Breastmilk from different pumping sessions can be combined as long as the sessions were on the same day and all the milk is cold. Refrigerate breastmilk immediately after pumping.
  • If the milk will be frozen, leave space for it to expand. Freeze the milk on the same day it was pumped.
  • If your refrigerator has a separate door for the freezer, breastmilk can stay in the freezer up to 3 months. Place breastmilk in the back of the freezer but not near the fan.
  • Breastmilk can stay in a chest-type deep freezer (0° F.) for up to six months.

General Guidelines:
  • Read and follow the instructions that came with your collection kit.
  • Before pumping, wash your hands thoroughly using water and soap (an antibacterial is good), and clean your nails with a nailbrush. Rinse well.
  • Immediately after pumping, use cold water to rinse all pump parts that touched your milk. Then clean them in hot soapy water and rinse well, or wash in the dishwasher. Make sure your hands are clean before assembling the parts.
  • Use clean containers; they do not have to be sterilized unless you have been instructed to do so. It is best to collect the milk, store, and feed from the same container so that the milk is not handled much.
  • The best containers for breastmilk are glass or hard plastic. Plastic bags specially made for breastmilk storage are also available.
  • For newborn babies, put only 1½-2 ounces of milk in each container. For older babies, the bottles can contain 3-4 ounces. This will reduce waste if baby does not take the whole amount. Small quantities thaw faster.
  • Put the date the milk was pumped and your baby’s name on a label on each bottle of breastmilk.
  • Breastmilk is not homogenized, so the cream will rise to the top as it sits. Shake the bottle gently to mix the cream with the rest of the milk.
  • Once breastmilk has been warmed or baby has started drinking from the container, whatever milk is not used within one hour should be discarded.
Thawing Breastmilk:
  • To thaw it fast, hold it under cool running water.
  • To thaw it slowly, put it in the refrigerator. Once thawed, use within 24 hours or throw it out.
  • Do not thaw breastmilk at room temperature. Do not refreeze thawed breastmilk.
To Warm Breastmilk:
  • Hold the container under lukewarm running water or set it in a container of warm water.
  • Never warm breastmilk on the stove or in the microwave.
  • Do not make breastmilk hot. Babies can drink cool breastmilk.

Getting Ready to Pump:

  • Get something to drink and maybe a healthy snack.
  • Get comfortable. Try to pump in a warm, quiet, private place.
  • Put a sweater or blanket around your shoulders for warmth and privacy.
  • Massage your breasts before pumping to help the milk to flow.
  • Place a pillow on your lap; imagine nursing.
  • Look at a picture of your baby; think about your baby (soft, warm and cuddly).

Tips to Help You Pump:
  • Cup the breast shield in your hand and support your arm with pillows.
  • To make the breast shield form a better seal on your breast, moisten the edge of the shield with water or breastmilk.
  • Start pumping at minimum suction, then increase suction to as high as is comfortable. Reduce suction if there is any discomfort. Call your breastfeeding counselor if pumping continues to hurt. Do not use a pump that hurts.
  • While pumping, don't watch the bottle fill; just check occasionally to be sure it is not too full.
  • Talk on the phone, watch TV, listen to music or a relaxation tape, read, or just relax.

Pumping One Breast at a Time (Single Pumping):
Pump each breast for about five minutes. Then pump each breast for about three minutes, then each breast for about two minutes. Each breast is pumped a total of ten minutes but you will get more milk if you go back and forth than if you pump each breast for ten minutes straight. Follow this schedule even if you are not getting much milk. This will help you build your milk supply. Keep on pumping even if the milk stops flowing before 20 minutes is up.


Pumping for a Preterm or Hospitalized Baby:
  • Follow the instructions the hospital has given you. Use the containers the hospital recommends or provides. The hospital will tell you whether to freeze or refrigerate the breastmilk and how to transport it.
  • Pump at least eight times a day, including at least once at night. To make more milk, pump 10?12 times every 24 hours.
  • During the day, never go more than three hours without pumping. If you are pumping enough milk, you may sleep as long as five hours between nighttime pumping sessions.
  • If you will be pumping for more than a week, you might want to pump both breasts at the same time. Double-pumping sessions are ten to fifteen minutes long.

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Last Modified: Thursday, 12-Jul-12 15:18:04