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Breastfeeding Home > Resources > Breastfeeding Resource Handbook Table of Contents > Common Questions Asked by Healthcare Professionals Common Questions Asked by Healthcare Professionals

Birth Control and Breastfeeding

Natural family planning and barrier methods have no effect on lactation. If a woman wants a hormonal birth control while breastfeeding, the combination pills with estrogen and progestin should be avoided because they cut back on the milk supply. If using the progestin only methods (mini-pills, injectables, or implants), it is best to wait six weeks to ensure an adequate milk supply. In assition, the baby needs to be carefully monitored for adequate weight gain after beginning the use of hormonal birth control.

When a baby is under six months, is totally breastfeeding (i.e. not getting anything else to eat), has all of his sucking needs met at the breast (i.e. no pacifier or thumb/finger sucking), is waking to breastfeed during the night, and the mother has not had a period, breastfeeding affords 98% protection from pregnancy. Breastfeeding could be used in conjunction with another form of birth control to make both more effective.

Contra-indications for Breastfeeding

Breastfeeding is contraindicated when a mother is HIV positive, uses street drugs, or is an alcoholic. A baby with galactosemia cannot be breastfed due to the inability to metabolize lactose.

Immunizations and Breastfeeding

“A patient who has been identified as susceptible to rubella virus infection should receive the rubella vaccine in the postpartum period. Rubella vaccine can be administered before discharge, even if the patient is breastfeeding.” 1

Hepatitis B vaccine and Flu vaccine may be given to a breastfeeding woman. The smallpox vaccine should not be given to any woman with a child under one year of age.

Jaundice and Breastfeeding

“A review of available follow-up data for apparently healthy term infants whose serum bilirubin concentrations were as high as 25 mg/dl showed no apparent ill effects for these concentrations.”1

“Some evidence indicates that frequent breastfeeding (8-10 times per 24 hours) may reduce the incidence of hyperbilirubinemia.” 1

“Supplementing nursing with water or dextrose-water will not lower serum bilirubin levels in jaundiced, healthy, breastfeeding infants.”1

“When an indirect serum bilirubin concentration is elevated by some pathologic cause, there is no reason to discontinue breastfeeding.”1

“In the absence of dehydration, routine supplementation (with dextrose-water) of infants receiving phototherapy is not indicated.” 1

Postpone Putting Baby to Breast

  • Group A streptococcus -mother may breastfeed when over acute stage and after 24 hr. treatment
  • active tuberculosis - must wait until mother’s treatment is established, at least two weeks
  • active hepatitis B - give baby HBIG and hepatitis B vaccine. Baby may go to breast immediately after birth before given the immunity shots, but they should be given soon.
  • chronic carrier of hepatitis-ask for infectious disease opinion
  • active herpes simplex lesions in the nipple area-may breastfeed after lesions are healed
  • chickenpox “When maternal chickenpox occurs within 6 days of delivery or immediately postpartum and no lesions are present in the neonate, mother and infant should be isolated separately. Only half the infants born to mothers who developed the disease 7 to 15 days before delivery will develop the disease. They should receive zoster immune globulin (ZIG) ... If no lesions develop by the time the mother is noninfectious, the infant and the mother may be sent home together. When the mother and infant can be together, the child can be breastfed.”2

Red Flag when Breastfeeding

Women in the following situations sometimes do not produce a full milk supply; therefore, their babies need to be carefully followed with frequent weight checks:

  • a woman who has had infertility problems
  • a woman who does not experience breast changes during pregnancy and during the first postpartum week
  • a woman who has had breast surgery
  • a woman who has asymmetrical breasts
  • a woman who is using hormonal birth control.

Surgery and Breastfeeding

Babies and children may breastfeed until two hours before surgery.

After a woman has had surgery, she may breastfeed when she is alert enough to hold the baby. At that point enough of the sedative is out of her body that it is safe to breastfeed.

Yes, it is all right to breastfeed when:

  • a woman has a breast infection
  • a woman is pregnant
  • a woman has twins, triplets, or quadruplets
  • a woman is a teenager
  • a woman needs to have a mammogram
  • a woman needs to have breast surgery
  • a woman has had extensive breast surgery*
  • a woman is adopting a baby*

(*In the preceding two cases the baby may need to be supplemented at breast.)

  • a baby is jaundiced
  • a baby has diarrhea
  • a baby is over two years
  • a baby has PKU. Under supervision the baby can breastfeed along with being fed a Phenylalanine-free formula.

Thrush

Thrush, which is an overgrowth of yeast, can affect baby’s mouth and mom’s breasts and nipples. Thrush often occurs after antibiotic therapy in the mother or baby or following a case of cracked nipples. It may be passed between them, from baby to mother or from mother to baby. It is not harmful in and of itself but it is associated with premature weaning. Babies with thrush may have white spots in their mouths and pain with feedings, making feedings more difficult. Mothers may also develop this on their nipples, causing extreme pain and/or within the milk ducts, causing an aching or burning feeling deep in the breasts which begins after the beginning of the feeding and lingers after the feeding is over. This pain is often worse at night. It is possible to have symptoms without being able to see or culture any obvious source. When yeast overgrowth is suspected to be a problem for either mom or baby, both must be treated. There are several effective antifungals currently recommended. These include Nystatin, Gentian Violet and Fluconazole. All these are compatible with continued breastfeeding and should be used until all symptoms are resolved.

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1 American Academy of Pediatrics and American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care (4th Edition). Elk Grove Village, IL: AAP, 151, 183-188, 1997. The Academy of Breastfeeding Medicine Protocols on Supplementary Feedings & Mastitis

2 RA Lawrence, RM Lawrence: Breastfeeding: A Guide for the Medical Profession (5th Edition). Philadelphia: Mosby, 1999, pp. 584-588
RA Lawrence: A Review of the Medical Benefits and Contraindications to Breastfeeding in the United States, 1997,
pp. 17-19

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