When a mother is ill, it affects the whole family. For a breastfeeding mother, there are additional concerns about how her illness may affect her baby, whether directly because of any medication she needs to take, or indirectly if the illness makes it more difficult for her to feed and care for her baby.
Whilst there may be a risk if you continue to breastfeed while taking a medication, it’s important to be well informed about the medication and to balance these with the risks of stopping breastfeeding—even temporarily. Substituting infant formula can be risky for a baby as it will deprive him of the antibodies and immune factors that help protect him from illness. Where there is a family history of allergy a baby may have an increased risk of developing asthma or eczema when exposed to infant formula. For a breastfed baby nursing is more than just food—it’s love and comfort too. So caring for your baby and keeping him happy without being able to breastfeed is likely to be difficult for everyone concerned. And if abrupt weaning causes overfull breasts, blocked ducts or mastitis, this will compound your problems.
Generally, a medication that is safe for babies is the best choice for a breastfeeding mother. In any case, watching for any side effects in a baby is always a sensible precaution. Usually, when a mother takes a medication, her baby receives a much smaller amount through breastfeeding than he would during pregnancy. However, medications that are considered safe during pregnancy may not necessarily be compatible with breastfeeding. A pregnant mother’s liver and kidneys may detoxify and excrete a medication before it reaches her baby through the placenta. After birth a breastfed baby must process the medication on his own once it has reached his bloodstream. Many medications can safely be taken by breastfeeding mothers. Some medications don’t pass into a mother’s milk, some are not absorbed from a baby’s digestive tract, and for some there is a long history of safe use by nursing mothers. However, it’s wise to check with your doctor or pharmacist as certain medications can cause problems. Consider the following points when making decisions:
- Premature and newborn babies are the most likely to be affected by medications. After one month of age most babies are better able to handle certain medications.
- A heavier baby will be less affected by a medication he receives through his mother’s milk than a lighter baby of the same age.
- A baby who is receiving solid foods or formula as well as breastmilk will probably receive less of the medication than one who is exclusively breastfeeding. A breastfeeding toddler who nurses infrequently will receive less of the medication than a toddler who nurses more often.
- A medication taken for weeks or months may have a greater potential impact on a breastfed baby than one that is taken for only a few days.
- The level of a medication in a mother’s milk can vary according to the time between taking the medication and the next breastfeed.
It is always wise to check over-the counter medications. Although paracetamol and ibuprofen are considered compatible with breastfeeding some medications, like aspirin, are not safe for babies. Others, such as cold and flu remedies, can cause sleepiness and reduce your milk production. Medications with only one active ingredient may be a better choice than compound medications.
An LLL Leader can help you find more information on breastfeeding with particular illnesses and health conditions, and support you as you consider options.
Common colds, flu and stomach bugs can be hard to cope with while breastfeeding— particularly if you don’t feel like eating. Even if you can’t eat, try to keep up your fluid intake to prevent dehydration. You will continue to make milk for your baby, though if you feel very ill it may seem as though you are producing less milk. Continuing to breastfeed whenever your baby is interested will help maintain milk production while you are ill and increase it afterwards if needed. There is no need to stay apart from your baby—he will already have been exposed to the illness before you realised you were ill. Continuing to breastfeed gives him valuable protection against the effects of your illness. Sensible hygiene precautions such as using tissues and binning them immediately, and washing hands with soap and water or using hand cleansers can help reduce transmission of illness.
If you have contracted a less common illness, such as chickenpox, impetigo or Herpes simplex you will want to know how it will affect you and your baby. Your midwife, health visitor, GP or hospital consultant can give you detailed medical information about your illness and how to minimize risks of transmission.
Mental health concerns
Since mothers often experience depression, a lot of information is available on medications and breastfeeding. It is usually possible to find appropriate treatment that can be taken while breastfeeding. With prompt treatment mothers recover quite quickly and are then able to fully enjoy parenting their new baby. And breastfeeding helps maintain the important bond between mother and baby even if a mother is depressed.
Chronic health concerns
Many mothers have breastfed with long term medical conditions including asthma, diabetes, cystic fibrosis, lupus, multiple sclerosis, epilepsy and thyroid disease. Breastfeeding requires very little physical effort and helps protect a baby from future illness.
If you need to spend time in hospital you will naturally have concerns about separation from your baby. First consider whether the treatment could be delayed until your baby is older, or take place with you as an outpatient. Explain to your health care professionals that not being able to breastfeed or express milk will put you at risk of painfully overfull breasts, blocked ducts, mastitis and a reduction in your milk production and ask for access to your baby or to a pump to be written into your careplan.
Make clear to your partner and health care team on the day that if you are not alert enough to breastfeed after the operation they will need to help you express your milk. If you can’t keep your baby with you whilst in hospital, ask that your partner or whoever is looking after your baby be able to bring your baby in before and after the procedure so you can breastfeed. This is likely to be much easier and more restful for you than expressing.
Hope for the best—plan for the worst
Even if you can breastfeed in hospital, planning for the possibility that you might not will help you cope. If you are going to be apart from your baby, you’ll need to make arrangements to express your milk. It may not be easy to gain regular access to hospital pumps so it’s a good idea to learn to hand express and/or take in your own or a rented pump. If the pump requires electricity, the hospital electricians may be required to test it for safety before you can plug it in. For a planned hospital stay ask to have it tested in advance. You might also practice expressing beforehand.
Your baby’s needs
Your baby will miss you so if you know you will be apart, try to find a carer whom your baby already knows and loves eg his daddy or a grandparent. If possible, express and freeze milk in the weeks beforehand so you have an emergency supply for your baby.
Medications used for local and general anaesthesia do not remain in a mother’s system or affect her milk. It is safe to breastfeed as soon as you are alert enough to handle your baby. For planned treatment ask in advance for detailed information on which drugs you will need to take and on pre-op procedures such as fasting. Request post-op pain relief medication that is compatible with breastfeeding. To help you cope with fasting prior to a medical procedure avoid tea, coffee and salty foods and eat well and drink plenty of water the day before. Don’t be surprised if you find it difficult to express much milk during the hours leading up to your operation. Afterwards, milk production will pick up very quickly with frequent breastfeeding. After any operation, try to organise as much help as possible with meals, household tasks etc. Depending on how you are feeling, you may even appreciate someone helping you care for your baby. Plan complete rest for the first 24 hours and then take things easy for at least a week.
The important thing for any mother after any illness is taking time to recuperate. Be wary of trying to do too much too soon. Eating and drinking, rest and relaxation will help both your recovery and, combined with frequent nursing, your milk production. If your baby is fussy at the breast you may be concerned about whether you are making enough milk. Encourage your baby to breastfeed frequently and offer both sides to give your breasts the message to boost milk production—you’ll probably notice a difference within just a day or two. You may find breastfeeding while lying down lets you rest and nurse your baby. If you are groggy from medications, ask whoever is looking after you to help keep your baby safe. If you still don’t feel like eating much, try frequent small meals or snacks and sips of juice. Try a night-time snack and drink until your normal appetite returns.
Enforced weaning is not easy on either mother or child so if you are told to stop breastfeeding your baby because of a medical condition or medication, it’s normal to feel overwhelmed and upset. Do contact an LLL Leader to discuss the options—she can access information on individual medications if needed. Whilst each medication needs to be checked individually, many are compatible with breastfeeding. For a short course of treatment, temporary weaning may be an option. To minimize discomfort and maintain milk production you will need to express or pump your milk frequently instead of nursing, discarding it until your treatment is completed. You can then re-establish breastfeeding.
Nursing is more than just a method of feeding. It’s also a familiar source of closeness and comfort. So if weaning really is necessary try to end breastfeeding as gradually as time allows, giving your baby lots of love and extra attention. You can hand express or use a pump to reduce your milk production gradually. This will help keep your breasts comfortable and slow down hormonal changes. Our leaflets A Sudden End to Breastfeeding and Thinking of Weaning? How Breastfeeding Ends can give you ideas about how to proceed and how to help your child adjust to life without nursing.
Written by Karen Butler, Sue Upstone & mothers of LLLGB.
Adjusting to Motherhood
A Sudden End to Breastfeeding
Engorged Breasts – avoiding and treating
Expressing Your Milk
Hand Expression of Breastmilk
If You Leave Your Baby
Is My Baby Getting Enough Milk?
Safe Sleep and the Breastfed Baby
Storing Your Milk
Thinking of Weaning
When Mum Can’t Be There
Breastfeeding Today stories
Breastfeeding Through Critical Illness
Additional Sources of Support
The Breastfeeding Network Drugs in Breastmilk Information Service (Facebook page)
The Breastfeeding Network – Drugs Factsheets
The Hospital Infant Feeding Network
This information is available to buy in printed form from the LLLGB Shop
Copyright LLLGB 2016