Breastfeeding Module 5: Session 13
- 1. CONTRAINDICATIONS TO BREASTFEEDING & ISSUES RELATING TO MATERNAL MEDICATION
- 2. MATERNAL CONTRAINDICATIONS ARE RARE HIV: Women known to be HIV infected should be counseled not to breastfeed. Breastfeeding increases the risk of transmission of HIV from mother to infant. Women at high risk for HIV infection should be counseled individually regarding the appropriateness of breastfeeding. Women who are not aware of their HIV status should be informed of the potential benefits for herself and her infant of knowing her HIV status. Women taking antiretroviral medications should not breastfeed.
- 3. MATERNAL CONTRAINDICATIONS: INFECTIOUS DISEASE II 2. HTLV-1 (Human T-cell Leukemia Virus Type 1) At the current time it is recommended that women who are HTLV-1 infected should not breastfeed. Studies from Japan indicate that the primary route of vertical transmission of HTLV-1 is through breastfeeding.
- 4. INFECTIOUS DISEASES COMPATIBLE WITH BREASTFEEDING Breastfeeding may occur in all these cases, although its initiation may need to be delayed until mother has undergone treatment. Tuberculosis: Breastfeeding may be initiated after 2 weeks of maternal therapy. Group B Beta-streptococcus and Group A streptococcus Mothers infected with these organisms may initiate breastfeeding after treatment has begun.
- 5. INFECTIOUS DISEASES COMPATIBLE WITH BREASTFEEDING II Hepatitis: Hepatitis A: Mother may breastfeed after she receives gamma globulin Hepatitis B: Breastfeeding may begin immediately after Hepatitis B immunoglobulin is administered to infant at birth. Hepatitis C: Breastfeeding should not be discouraged unless there is co-infection with HIV.
- 6. INFANT CONTRAINDICATIONS TO BREASTFEEDING Galactosemia is the only infant condition in which breastfeeding is contraindicated. Galactosemia is an extremely rare enzyme deficiency (1:50,000 births) Use of special formula is required
- 7. INFANT CONTRAINDICATIONS TO BREASTFEEDING II Amino acidurias: combination feeding is possible, breastfeeding with supplements of special formula . Phenylketonuria (PKU) is the most common of the amino acid metabolic disorders.
- 8. OTHER INFANT CONDITIONS Breastfeeding is not contraindicated for any other infant condition. Breastfeeding may mask or decrease symptoms of metabolic disorders. Breastfeeding may be medically indicated in many infant conditions, although it may need to be supplemented.
- 9. RESOURCES FOR INFECTIOUS DISEASE INFORMATION Knowledge about infectious diseases is constantly evolving. For updates, contact: The Centers for Disease Control The American Academy of Pediatrics’ Red Book Committee
- 10. GUIDANCE FOR COMMON POSTPARTUM EXPERIENCES Proactive interventions providing support at critical times increase breastfeeding duration and exclusivity
- 11. MANAGING BREASTFEEDING DURING CRISES OF CONFIDENCE When milk supply concerns arise, always consider possibility of inadequate milk. Ask questions and assess for this problem. Assess the milk supply Encourage frequent nursing Dealing with distractibility: nurse in quiet, dark locations nurse at sleepy transition times offer feeding before hunger cues are seen Assure medical supervision of mother and baby
- 12. FOOD & NUTRITION FOR BREASTFEEDING MOTHERS The Recommended Daily Allowance for lactating women is 500 additional calories over pre-pregnant requirement. Women consuming less than 1800 kcal/day may be at risk of low nutrient intake. This will not change milk composition, but may deplete mother’s nutrient stores over time. Encourage women to follow dietary guidelines and consume a wide variety of foods.
- 13. FOOD & NUTRITION, CONT. Seek help of a dietitian or nutritionist to provide dietary guidance to women with special dietary concerns Contrary to myth, there are no foods that should routinely be forbidden in the diet of nursing mothers.
- 14. FOOD & NUTRITION, CONT. Rarely, breastfed infants may be sensitive to foreign proteins (such as cow milk, peanut, etc.) in mother’s milk. It is not necessary to avoid these foods unless reaction is suspected.
- 15. CONTRACEPTION DURING LACTATION The Lactational Amenorrhea Method (LAM) Is a natural, physiological mechanism Studies suggest >98% efficacy for LAM as a contraceptive method when practiced according to protocol LAM is reliable as long as the following criteria are met: Mother is amenorrheic Breastfeeding is exclusive or nearly exclusive (allows for vitamins and token foods) The infant is less than 6 months old
- 16. CONTRACEPTION, CONT. Barrier Methods may be used at any time during lactation. Hormonal Methods Use of progestin oral contraceptives, implants and injectibles is compatible with breastfeeding when started after 6 weeks postpartum Use of combined estrogen-progestin pills is controversial. Progestin only are the preferred method.
- 17. MATERNAL ILLNESS AND MEDICATIONS If mother has a common illness like a cold, flu or mastitis she should continue to breastfeed. These illnesses are not passed through her milk and breastfeeding continues to provide protective immunities to infant. Very few maternal medications are contraindicated during breastfeeding.
- 18. MINIMIZING THE IMPACT OF MATERNAL MEDICATION ON THE INFANT Is drug therapy necessary? Consultation between mother’s prescriber and pediatrician is advised Use the safest drug when a choice is available
- 19. GUIDELINES FOR PRESCRIBING (HALE) Drugs not absorbed through GI tract are probably safe. Choose drugs with lower Milk:Plasma ratios. High M/P ratios are >1. Choose drugs with shorter half-life Be cautious of drugs with long pediatric half-lives Avoid extended-release formulations Choose drugs with higher protein binding
- 20. HALE GUIDELINES FOR PRESCRIBING, CONT. Drugs that affect the brain frequently penetrate the milk in higher levels With radioactive compounds, wait 4-5 half-lives before resuming breastfeeding Substances applied to nipple are likely to be ingested and absorbed by the infant. Do not assume that topicals are safe. Herbal preparations have pharmacological properties. Do not assume they are safe until researched fully.
- 21. DRUG INFORMATION RESOURCES Hale: Medications and Mother’s Milk AAP Drug List Briggs, Freeman & Yaffee: Drugs in Pregnancy & Lactation. Williams & Wilkins Drug Information Services: The Ruth A Lawrence Poison and Drug Information Center, Rochester NY Rocky Mountain Poison Control Dr. Thomas Hale, Texas Tech