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Breastfeeding - Prenatal Care

The American Academy of Pediatrics encourages prenatal women to breastfeed exclusively for six months, and continue after solids are introduced, with continuation of breastfeeding for one year or longer.

What you say to expectant mothers and their families can have a positive influence on the decision to breastfeed. If you recommend exclusive and continued breastfeeding, more new mothers will breastfeed for longer periods of time.

Prenatal breastfeeding education starting in the 1st trimester, includes discussing importance of the following:

  • Exclusive breastfeeding for the first 6 months.
  • Continued breastfeeding as complimentary foods are introduced, with continuation of breastfeeding for one year or longer.
  • Early skin-to-skin contact.
  • Early initiation of breastfeeding.
  • Rooming-in on a 24-hour basis.
  • Feeding on demand or baby-led feeding.
  • Frequent feeding to help assure optimal milk production.
  • Effective positioning and attachment.
  • Breastfeeding continues to be important after 6 months when other foods are given.
  • Signs of effective breastfeeding or breastfeeding problems.
  • Benefits of breastfeeding to mother, baby, and society.
  • Resources for help with problems.

Mothers CAN breastfeed even if theyā€¦

  • Have cesarean deliveries:

    Recommend initiating breastfeeding immediately after delivery by placing baby on mother's chest. Later, mothers can breastfeed by using a semi-recumbent position or side-lying position.

  • Take medications:

    According to the American Academy of Pediatrics (AAP), only a small proportion of medications are contraindicated in breastfeeding mothers or associated with adverse effects on their infants.  The AAP recommends LactMed as the most comprehensive, up-to-date source of information regarding the safety of maternal medications.  https://www.toxnet.nlm.nih.gov/newtoxnet/lactmed.htm. See also: Clinical Therapy in Breastfeeding Patients.

  • Have had breast surgery such as augmentation, reduction or biopsy:

    Monitor infant growth as milk supply may be compromised. Refer to an International Board Certified Lactation Consultant (IBCLC) if there are supply issues.

  • Have Hepatitis B:

    Initiate breastfeeding immediately and follow up with HBIG and the first dose of hepatitis B vaccine within 12 hours of birth.

  • Have Hepatitis C:

    Initiate breastfeeding immediately after delivery if the mother has hepatitis B or C, breastfeeding technique should be followed closely during the first couple of weeks to avoid nipple damage. If nipples become cracked or bleeding, temporarily stop breastfeeding, pump to keep up milk supply and discard milk until wounds heal.  Refer to an IBCLC for preventive measures.

  • Have pierced nipples:

    To avoid risk of choking, mother should remove nipple accessories before feeding.

  • Have an occasional alcoholic drink:

    Avoid breastfeeding for two hours after a single serving of alcohol.

  • Smoke cigarettes:

    Mothers who smoke should quit, but it is better to breastfeed than not. If a mother continues to smoke while breastfeeding, the mother should smoke as little as possible, wash hands and change clothes before breastfeeding, smoke after breastfeeding rather than before, and smoke out of the home and away from baby.  For more information and free help to quit smoking, call 1-800-NO-BUTTS.

  • Have Tuberculosis (TB):

    Breastfeeding is not contraindicated in women treated with first-line antituberculosis medications since the concentration in breast milk is too small to be toxic to newborns. Breastfeeding is not advisable for women with untreated, active TB.

  • Use hormonal contraception:

    Hormones can reduce milk supply but they will not harm baby. It is best to avoid hormonal contraception until mother is six weeks postpartum in order to establish the milk supply.

  • Develop an infection:

    Viruses are not transmitted through breastmilk during acute maternal infections such as gastroenteritis, upper respiratory infection and influenza. However, protective maternal antibodies pass through breastmilk to the baby.

Mothers SHOULD NOT breastfeed if theyā€¦

  • Are infected with HIV

  • Are infected with HTLV (Human T-cell Lymphotropic Virus)

  • Use illegal drugs

  • Are receiving cancer chemotherapy agents that interfere with DNA replication and cell division

  • Are receiving radiation therapies; however nuclear medicine therapies require only a temporary interruption

  • Have active herpes lesions on the breast, including varicella (can breastfeed on other breast if lesion-free)

  • Have an infant with galactosemia

  • Have untreated, active TB (pumping and feeding in a bottle is acceptable)


Resources:

1. Breastfeeding and the Use of Human Milk. American Academy of Pediatrics Policy Statement. Pediatrics 2005; 115(2): 496ā€“506. (PDF)

(https://pediatrics.aappublications.org/content/pediatrics/115/2/496.full.pdf)


2. Breastfeeding and the Use of Human Milk. American Academy of Pediatrics Policy Statement. Pediatrics 2012; 129 (3): e827ā€“e841. (PDF)

(https://pediatrics.aappublications.org/content/pediatrics/early/2012/02/22/peds.2011-3552.full.pdf)


3. How Doctors Can Help. Surgeon General's Call to Action to Support Breastfeeding 2000. (PDF)

(https://www.cdc.gov/breastfeeding/pdf/actionguides/doctors_in_action.pdf)


4. The Guidelines & Evaluation Criteria. Baby-Friendly USA. 2016.

(https://www.babyfriendlyusa.org/for-facilities/practice-guidelines/)


5. Centers for Disease Control and Prevention. Strategies to Prevent Obesity and Other Chronic Diseases: The CDC Guide to Strategies to Support Breastfeeding Mothers and Babies. Atlanta: U.S. Department of Health and Human Services; 2013: 34. (PDF)

(https://www.cdc.gov/breastfeeding/pdf/BF-Guide-508.PDF)

6. The Transfer of Drugs and Therapeutics into Human Breast Milk: An Update on Selected Topics. American Academy of Pediatrics 2013.

(https://pediatrics.aappublications.org/content/132/3/e796)

7. LactMed. Drugs and Lactation Database. National Institutes of Health. U.S. National Library of Medicine Toxnet Toxicology Data Network. Updated Monthly. (LactMed has a free phone App)

(https://www.ncbi.nlm.nih.gov/books/NBK501922/)

8. Hale T, Berens P. Clinical Therapy in Breastfeeding Patients. 3rd ed. Amarillo, TX: Hale Publishing; 2010.


9. Lawrence R, Lawrence R. Breastfeeding A Guide for the Medical Profession. 8th ed. Philadelphia, PA: Elsevier; 2016.


10. Centers for Disease Control and Prevention. Hepatitis B and C Infections. 2009, Updated 2015. 

(https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/maternal-or-infant-illnesses/hepatitis.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fbreastfeeding%2Fdisease%2Fhepatitis.htm)

11. Reece-Stremtan S, Marinelli,KA. ABM clinical protocol #21 Revised 2015: Guidelines for breastfeeding and substance use or substance use disorder. Breastfeeding Med. 2015; 10(3): 135ā€“141. (PDF)

(https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/21-drug-dependency-protocol-english.pdf)

12. U.S. Department of Health and Human Services. National Institutes of Health. National Cancer Institute. Smokefree Woman.gov website. 

(https://smokefree.gov/help-others-quit/health-professionals)

13. Centers for Disease Control and Prevention. Tuberculosis and Pregnancy. Updated 2012.

(https://www.cdc.gov/tb/topic/populations/pregnancy/default.htm)

14. ABM Clinical Protocol #13: Contraception During Breastfeeding, Revised 2015. Breastfeeding Med. 2015; 10(1): 1ā€“10. (PDF)

(https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/13-contraception-and-breastfeeding-protocol-english.pdf)

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