Can All Women Breastfeed?

Medical Contraindications to Breastfeeding

Mother holding newborn baby (0-3 months), close-up, rear view
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Breastfeeding is beneficial for both moms and babies, and experts recommend exclusive breastfeeding for the first six months of a baby’s life. But, while almost all women can breastfeed, there are a small number of mothers who cannot or should not nurse their children. It may be that a mother can’t produce a healthy breast milk supply, or perhaps she has to take a medication or undergo a medical treatment that isn’t safe during breastfeeding.

There are also a few medical conditions that aren’t compatible with breastfeeding. In some situations, it may be possible to pump and provide a child with breast milk in a bottle or to stop breastfeeding temporarily then restart. However, in other instances, a baby shouldn’t get any breast milk at all, either in a bottle or through breastfeeding. Here are the reasons some women can’t or shouldn’t breastfeed.

A True Low Breast Milk Supply

Only a small percentage of women who want to breastfeed can’t due to lactation failure or a true low breast milk supply. A true low milk supply is usually the result of an underlying condition. With treatment, some issues can be corrected, so a mother can go on to build a milk supply. However, some problems cannot be resolved. The causes of a true low milk supply include:

If you have a true low milk supply, it may not be possible to breastfeed exclusively. Your child will probably have to take infant formula or donor breast milk to fulfill the majority of his nutrition needs.

However, breastfeeding provides more than just nutrition, so you can still put the baby to the breast. Many infants and even older children breastfeed for comfort and security. And, even though you may have very little breast milk, any amount that you can give to your child is good for him.

Dependency on Illegal Drugs

The use of illegal drugs is not compatible with pregnancy, breastfeeding, or parenting. Besides being illegal, street drugs are dangerous for a mother and her child. Drugs do get into the breast milk and pass to the baby. When babies receive illicit drugs through breast milk, it can cause irritability, sleepiness, poor feeding, growth problems, neurological damage, and even death. The use of recreational drugs puts a mother at risk of contracting infectious diseases such as HIV and HTLV and impairs her ability to care for her child. Mothers who use illegal drugs during pregnancy and breastfeeding can find themselves in trouble with the law and lose custody of their children.

On the other hand, former drug users may be able to breastfeed. Those who have recovered or are in treatment for recovery, are currently drug-free and HIV negative, should discuss their desire to breastfeed with their healthcare providers.

Medication

Many medications are compatible with breastfeeding, but some are not. Certain prescription drugs can hurt the baby, and other medications can cause a decrease in the milk supply. Talk to your doctor before starting a new medication and always tell the doctor that you’re breastfeeding. If you have to take medicine, ask if it’s safe to use while you’re breastfeeding or if there’s an alternative that is safe.

Some of the medications that are not compatible with breastfeeding are chemotherapy drugs, antiretroviral medications, radioactive iodine, some sedatives, seizure medication, and medicines that may cause drowsiness and suppress breathing.

Medications that can decrease the supply of breast milk include cold and sinus medications that contain pseudoephedrine and certain types of hormonal birth control.

Infectious Disease

Many common infections are easily treated and do not interfere with breastfeeding or harm the baby. However, there are a few infectious diseases that can pass to a baby through breast milk and the risk of transmission outweighs the benefits of breastfeeding. These conditions include:

  • HIV: The human immunodeficiency virus (HIV) is the virus that causes acquired immunodeficiency syndrome (AIDS). A mother who has HIV can pass the virus to her child through breastfeeding and her breast milk. Since AIDS does not have a cure, a mother who is HIV positive should not breastfeed if she lives in an area of the world where a safe alternative is available. However, in countries where a safe replacement is not possible, exclusive breastfeeding may be recommended.
  • HTLV: The human T-cell lymphotropic virus 1 (HTLV-1) is a virus that can lead to leukemia and lymphoma. Human T-cell lymphotropic virus 2 (HTLV-2) can cause brain and lung issues. These viruses may not cause any symptoms at all, but they are lifelong conditions to which there is no cure. Since HTLV-1 and HTLV-2 can pass to a baby through breast milk, the baby should not breastfeed. Although, studies show that the HTLV-1 cells can be destroyed by the freezing and thawing of expressed breast milk if the milk is frozen at a temperature of -4 degrees F (-20 C) or below for more than 12 hours.
  • Active tuberculosis infection: Tuberculosis (TB) a bacterial infection in the lungs. It is passed through respiratory droplets, not by breastfeeding or breast milk. However, a mother can give active tuberculosis to a child through coughing, sneezing, and touching. When a mom has active TB, but her baby does not, she should not be in close contact with her child and therefore should not breastfeed. But, since tuberculosis is not transmitted through breast milk, a baby can receive pumped breast milk until breastfeeding can begin after about two weeks of treatment. When both mom and baby have TB, they can stay together during treatment, and the baby can breastfeed.
  • Herpes on the breast: Herpes is not passed through breast milk, so as long as the lesions are not on the breast, any lesions on other body parts are covered, and thorough hand washing is performed, it is safe to breastfeed. However, when there are active lesions on the breast, breastfeeding is dangerous. The herpes virus can be deadly to a baby.

When a Baby Can’t Breastfeed

Most babies can breastfeed. Even infants born with birth issues such as prematurity, cleft lip and palate, or down syndrome who may not be able to take the breast right away can still take pumped breast milk in a bottle. With patience, time, and help, these babies may go on to breastfeed successfully. It’s only when a baby is born with one of few rare genetic metabolic conditions that breastfeeding may not be possible. But, even then, sometimes a baby can still breastfeed partially. These conditions include:

Classic Galactosemia: Galactosemia is the body’s inability to break down galactose. Galactose is a part of the milk sugar lactose, and lactose is the main sugar in breast milk. So, if a baby tests positive for classic galactosemia, he cannot breastfeed or take breast milk in a bottle. The child will need a special infant formula and a galactose-free diet as he grows to prevent severe complications such as jaundice, vomiting, diarrhea, long-term developmental problems, and death.

A less severe form of galactosemia is called Duarte’s galactosemia. Children with Duarte’s galactosemia can break down some galactose. Under the direct care of a doctor specializing in metabolic disorders, it may be possible to breastfeed while supplementing with the galactose-free formula. The doctor will have to monitor the baby’s galactose levels frequently to make sure that they stay under control.

Phenylketonuria (PKU): A baby with PKU can’t break down phenylalanine, an amino acid. If phenylalanine builds up in the baby’s body, it can cause brain damage. Therefore, babies with PKU need a diet low in phenylalanine. There is a special infant formula for infants with PKU. But, since breast milk is low in phenylalanine, a baby with PKU may be able to combine breastfeeding and formula feeding with a special formula. The amount of breastfeeding needs to be controlled, and the baby has to have regular blood work and careful monitoring.

Maple syrup urine disease: A baby born with maple syrup urine disease cannot break down the amino acids leucine, isoleucine, and valine. When these amino acids accumulate in the baby’s blood, they give off a sweet maple syrup scent that is noticeable in the urine, ear wax, and sweat. The build-up of these amino acids can cause sleepiness, poor feeding, vomiting, seizures, coma, and death. To fulfill the baby’s nutritional needs, the doctor will order a special infant formula the does not contain the three amino acids leucine, isoleucine, valine. The doctor may also recommend partial breastfeeding if the amount of breast milk is carefully measured and the baby is monitored closely.

A Word From Verywell

Every mother and baby is unique, and so is every breastfeeding situation. If you want to breastfeed, but you're told that you can’t or shouldn’t, it can be devastating. It’s OK to feel angry or sad and to take the time to work through your emotions. It may also be helpful to talk about your feelings with your doctor, your spouse, or someone you trust.

As hard as it may be, try to remember that breastfeeding isn’t the only way to provide nutrition and build a close relationship with your child. Your baby can get the nutrition she needs from donor breast milk, infant formula, or a special infant formula. Bonding and connections will strengthen each time you hold your child, talk to her, comfort her, and even feed her with a bottle. Just because you can't or shouldn't breastfeed doesn’t mean you can't be a great mom and have a happy, healthy child.

Sources:

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Jansson LM. ABM clinical protocol# 21: Guidelines for breastfeeding and the drug-dependent woman. Breastfeeding Medicine. 2009 Dec 1;4(4):225-8.

Protocol AB. ABM clinical protocol# 7: model breastfeeding policy (revision 2010). Breastfeeding Medicine. 2010;5(4).

Sachs HC. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013 Sep 1;132(3):e796-809.

World Health Organization. Acceptable medical reasons for use of breast-milk substitutes. 2009.

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