When Breastfeeding Doesn't Work Out

by Anne Smith, IBCLC

There are very few medical problems that prevent a mother from breastfeeding her baby. There are some situations where nursing must be temporarily interrupted, but if you maintain your milk supply by pumping, you can almost always resume breastfeeding when the medical problem is resolved.

Situations where breastfeeding is contraindicated include:

• Cancer
• HTLV-1
• Abuse of certain illegal drugs

Although breastfeeding does reduce the risk of breast cancer, it does not eliminate it, and a small percentage of women are diagnosed with breast cancer while they are lactating. For these women, treatment involves discontinuing breastfeeding and immediately beginning treatment for carcinoma. Breast lumps are common in the lactating breasts, and most are not cancerous. If a physician feels that a mass should be biopsied, this can be done under local anesthesia without weaning the baby. Many non-invasive diagnostic tests can be carried out without interfering with lactation, such as CAT scanning, X-rays, MRI, and ultrasound. Radiation of the breast damages the woman's breast tissue, and often adversely affects lactation capability if she tries to breastfeed subsequent babies, but if only one breast is irradiated, nursing can continue on the other breast. For mothers diagnosed with other forms of cancer during lactation, they may choose to continue nursing unless their treatment involved chemotherapy or treatment with radioactive compounds. All radioactive materials (taken orally or intravenously) and chemotherapeutic drugs cross into the milk and are potentially toxic to the infant. In some cases, mothers are able to discontinue breastfeeding until the drugs are out of their systems, and then resume nursing again. If a nursing mother is diagnosed with any type of cancer, she needs to discuss her feelings about nursing and her treatment options with her obstetrician, pediatrician, and oncologist.

The human immunodeficiency virus (HIV) that causes AIDS can be transmitted through human milk, although the rate of transmission appears to be low. Between one-quarter to one- third of infants born to HIV infected mothers will become infected with the virus. In most cases transmission occurs during late pregnancy and delivery, but some studies suggest that one third of these infants are affected through breastfeeding, which suggests an average rate for transmitting the virus through breastfeeding of one in seven. Mothers in advanced stages of the disease are more likely to transmit the virus than mothers in the early stages, as are mothers who become infected before the baby's birth. Because AIDS is an incurable, invariably fatal disease, even the small risk is unacceptable in areas where the safe use of human milk substitutes is an option. The current AAP recommendations are for HIV infected mothers not to breastfeed their infants. Feeding options include using formula, heat-treating the breastmilk before feeding (if this option is chosen, very specific guidelines must be followed), and use of donor milk. Human milk banks screen all donors for HIV and other diseases and pasteurize all donor milk in order to ensure that harmful viruses are destroyed, while preserving as many nutrients and antibodies as possible. The WHO (World Health Organization) has concluded that in communities where the infant mortality rate is high, infectious disease and malnutrition are the main cause of death, and conditions such as extreme poverty or lack of sanitary water supply don't allow for the safe use of human milk substitutes, mothers should be encouraged to breastfeed their children without regard to their HIV status, because the risk to her infant of not breastfeeding is greater than the risk of transmitting the virus via the milk. As AIDS spreads to the heterosexual population, more and more research needs to be done regarding issues regarding AIDS and breastfeeding.

The virus HTLV-1 (human T-cell leukemia virus type 1) can develop into a highly malignant disease that is nearly always fatal. This virus is not common in the US or Europe, but is on the rise in parts of Africa, South America, Japan, and the Caribbean. Since breastfeeding is a major route of transmission for this virus, it is recommended that women who are carriers of the virus not breastfeed their infants.