Illness and 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 handout Blocked Ducts and Mastitis)

• 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 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. 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. These days breast abscess does not always require surgery. Repeated needle aspiration, or placement of a catheter to drain the abscess plus antibiotics often allows avoidance of surgery.

• 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? Could a needle biopsy be enough? If you do need the surgery now, 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. 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 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.

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 so slowly, though; because pregnancy is associated with a decreased milk supply and 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.

• 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.

• 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 breastmilk.

• 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. (There are causes of jaundice that are not normal, but these do not, except in very rare cases, require stopping breastfeeding.)