• If you need to undergo radioactive isotope testing, you will need to wean your baby temporarily. (See article on "Drugs and Breastfeeding" for more specific information.) If you need to undergo radiation therapy, you can continue nursing unless both breasts are being radiated. The treatment will not affect the function of the un-radiated breast. If you must have chemotherapy and treatment with radioactive compounds, temporary or permanent weaning will be necessary. (See articles on "Weaning" and "Lactation Suppression").
The other really scary illness is AIDS, or HIV infection. There is evidence that the HIV virus can be transmitted through breastfeeding. The average risk for HIV transmission is 1 in 7 in children born to, and breastfed by an infected woman. This means that although the majority of cases of viral transmission occur during late pregnancy and delivery, more than one-third of infants acquire the virus through breastfeeding. The risk is real, so at least in the US, where we have access to nutritionally adequate infant formulas, and clean water and sanitation, HIV positive mothers probably should not breastfeed their babies. In developing countries, where the risk of artificially feeding the baby may outweigh the risk of transmitting the virus, the issue is not as clear.
Other illnesses in the mother include:
• Herpes Simplex I (cold sores) and Herpes Simplex II (Genital Herpes): The Herpes virus can be fatal to newborns up to three weeks of age. Genital sores can be transferred to the breast. If you are pregnant, you should talk to a doctor who is knowledgeable about the virus to decide which precautions to take. Generally, the baby can continue to nurse if he doesn't touch the sores. Until all the sores are dried, be sure to: wash your hands often, especially after touching the sores and before touching the baby; keep clean coverings over the sores; and avoid kissing your baby if you have sores on or near your mouth. If the sore is on the nipple or areola, you need to express milk from that breast until the sore heals. You can continue nursing on the unaffected breast.
• If you have cardiac problems, you can and should continue nursing. The release of prolactin has a relaxing effect, and can benefit women with cardiac problems.
• If you have high blood pressure, the relaxing effects of prolactin are also beneficial. Low-dose diuretics (often used to treat hypertension) are compatible with breastfeeding, but high doses may decrease your milk supply. Many beta-blockers used for cardiovascular treatment are also compatible with breastfeeding.
• If you have carpal tunnel syndrome, it usually clears up within a couple of months of giving birth. Treatments such as wearing splints, elevating the hand, and the use of low-dose diuretic drugs, are preferable to more aggressive treatments. If steroid treatments are necessary, consult your health care provider to discuss the lowest possible doses (see article on "Drugs and Breastfeeding").
• If you get chickenpox, (and this is rare because most women of child-bearing age were exposed during childhood) it can be a serious concern, because it can be fatal in a baby who catches it in utero, or a very premature baby. If you are pregnant and have been exposed, your doctor can do a blood test to determine if you have immunity to the disease. If you are diagnosed with chickenpox within five days before giving birth, you may need to be separated from your newborn for a few days to minimize the chance of infection. If this happens, express your milk and give it to your baby. If you have the virus, your baby will be given a ZIG shot. Most babies who catch it after birth will have a very mild case. Chickenpox is no longer considered contagious when you have had no new eruptions for 72 hours, and all the lesions have become crusted. If you have older children when the baby is born, keep them away from the baby. If you have had it yourself and have immunities, the risk of the baby catching it is greatly reduced.