While under the influence of lactation, you should not operate heavy machinery (unless you count those hard-working engorged breasts that appeared seemingly overnight). You should also not enter within thirty feet of a crying infant, as this will cause your uterus to quiver and your breasts to gush a milky monsoon.
Most importantly, it’s advised that you don’t get caught up in the excitement of your newfound nurturing powers and consider (or attempt) to nurse anyone but your child, including anyone from your favorite manicurist to the especially prompt and polite mailman to your super-cute family Chihuahua.
Read on for more possible contraindications to breastfeeding!
Additional Infant Liquids/Solids
Other Drugs That Can Decrease Milk Supply
Other Possible Milk Supply Detriments
Additional Infant Liquids/Solids
Current science doesn’t support introducing solid foods (including and especially baby food and cereal) before at least six months of age. Most medical and pediatric organizations advise exclusively breastfeeding for the first half-year, which means no solid food, water or other liquids, vitamin or formula supplements.
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Feeding Schedules
It’s absolutely crucial (and normal) to feed on demand. Frequent feedings are important for a baby to thrive because caloric and fat content is higher in milk that’s replaced more often.
Anthropology professor and researcher Kathy Dettwyler explains that human children are biologically designed to nurse very frequently:
“[T]he composition of the milk of the species[,] all higher order primates keep their offspring in the mother’s arms or on her back for several years, the size of the young child’s stomach, the rapidity with which breast milk is digested, the need for an almost constant source of nutrients to grow that huge brain (in humans, especially), and so on. By very frequently, I mean 3-4 times per hour, for a few minutes each time.
“The way in which some young infants are fed in our culture — trying to get them to shift to a 3-4 hour schedule, with feedings of 15-20 minutes at a time, goes against our basic physiology. But humans are very adaptable, and some mothers will be able to make sufficient milk with this very infrequent stimulation and draining of the breasts, and some children will be able to adapt to large meals spaced far apart.
“Unfortunately, some mothers don’t make enough milk with this little nursing, and some babies can’t adjust, and so are fussy, cry a lot, seem to want to nurse “before it is time” and fail to grow and thrive. Of course, usually the mother’s body is blamed — “You can’t make enough milk” — rather than the culturally-imposed expectation that feeding every 3-4 hours should be sufficient.”
So in our modern culture, what can we do?
- Avoid premature introduction of solids.
- If you must be separated from your baby, express milk to maintain supply and don’t supplement with formula.
- No forced sleeping through the night (sleep-training).
- Don’t limit time at the breast, and always offer both sides.
- Relax (okay, try to relax!). Frequent nursing isn’t an “inconvenience” if you remind yourself that this is a huge part of your parenting role right now. If you don’t nurse, your child will require something else from you to meet his needs. Normalize the habit now and you may enjoy fewer struggles and greater rewards in the long-run.
“Mothers of the bottle-feeding set often consider feeding times a big deal. They have to sterilize the bottle and prepare the formula. Then they have to count the ounces and number of feedings, wondering if baby has gotten too little or too much. No wonder they space them out as much as possible. With breastfeeding, you can think of it as a social interaction rather than a mathematical exercise. Just as you don’t count the number of times you kiss your baby…neither do you need to count breastfeedings.” – Martha Sears, RN, and William Sears, MD in “The Breastfeeding Book”
Herbs
The following is not a complete list. As always, research any herb taken during pregnancy and lactation as they can act as drugs within an individual body:
- May decrease milk supply: Black walnut, chickweed, green tea, herb robert (geranium robertianum), lemon balm, oregano, parsley (petrolselinum crispum), peppermint (mentha piperita) or menthol extract, periwinkle (vinca minor), sage (salvia officinalis), sorrel (rumex acetosa), spearmint, thyme, yarrow
- May be dangerous: Apricot seeds, bladderwrack, buckthorn bark and berry, chaparral, coltsfoot leaf (farfarae folium), dandelion, dong quai (angelica root), elecampane, ephedra/ephedra sinica/ma huang, ginseng (panax ginseng), Indian snakeroot, kava-kava (piper methysticum), petasites root, herbal phen-fen, rhubarb, senna (extract and leaf), star anise, tiratricol (TRIAC), uva ursi, wormwood
- Other: Aloe, cascara sagrada bark, caraway oil, Germander, jin bu huan, mate tea, mistletoe, pennyroyal oil, skullcap
Infant Conditions
Infants with the following conditions should receive a special formula, no milk of any kind:
- Galactosemia
- Maple syrup urine disease
- Phenylketonuria
Infants with the following should ideally receive breast milk but may need additional supplements temporarily:
- Birth weight under 1500 g (3.3 lb)
- Born at less than 32 weeks of gestation
- Infants at risk of hypoglycemia due to impaired metabolism or low glucose, which fails to respond to breastfeeding/breast-milk feeding
Maternal Conditions
The following condition requires total avoidance of breastfeeding, only if another feeding method is AFASS (acceptable, affordable, feasible, sustainable and safe):
- Human immunodeficiency virus (HIV)
May require temporary cessation of breastfeeding:
- Severe illness that renders the mother incapable of child care (such as sepsis)
- Herpes simplex virus 1 (HSV 1); in this case, breastfeeding should stop until active lesions are healed
May raise special health concerns, but breastfeeding can continue under certain guidelines:
- Hepatitis B and C
- Tuberculosis
See also the “Chronic Diseases” section for more information.
Maternal Diet
It’s easy to feel like breastfeeding is more cumbersome or complicated than it’s worth when all you hear is, “Can you really eat that?” … “Won’t your baby have a reaction?”…”I’ve heard that’s not healthy to eat while nursing.”
It can be draining, worrisome, and shameful being on the receiving end of such comments. Don’t let it be so. Fact is, unless a breastfeeding mother is already on a special diet for health reasons, she can eat just about anything she wants to eat. There’s no need for a mother to immediately impose restrictions upon her diet just because she’s nursing. The best diet for a nursing mother and her baby is almost always the best diet for that mother in her healthy state. Many mothers in non-Western cultures regularly enjoy traditional foods that are spicy, gassy, or acidic (think curries, hot peppers, rich cheeses), and their babies don’t suffer from more digestive issues than ones with mothers who bought into this old wives’ tale.
It’s very rare for a baby to be affected by something a mother ate (it is less common than what many mothers presume–only 3-7% of babies have any food sensitivity or allergy, and usually not severe enough to make a difference in behavior). What about gassiness? Anne Smith, IBCLC explains:
“[G]as is produced when bacteria in the intestine interact with the intestinal fiber. Neither gas or fiber can pass into the bloodstream, or into your breast milk, even when your stomach is gassy.”
Of course, babies can suffer from gas and bloating, but it’s quite unlikely that the mother’s side of broccoli for dinner is to blame. Newsflash: babies, by nature, get fussy. They are experiencing overlapping spurts of physical, mental and emotional development. It’s normal! Fussiness is part of the deal, whether or not a breastfeeding mother munched on a few jalapeno poppers.
So what about cow’s milk, the number-one offender that most mothers are told to ditch first from their diets if they suspect an allergy/sensitivity? Anne Smith clears the confusion about lactose intolerance:
“The problem with cow’s milk is the protein, which is difficult for babies to digest, and not with the lactose. Human beings are not born lactose intolerant, unless they are born with a rare metabolic disorder. Lactose intolerance is caused by a deficiency of the enzyme lactase, which breaks down lactose (milk sugar) so it can be easily digested. Mammals are born with this enzyme in their intestines. As they grow older and wean, the lactase enzyme decreases. That’s why lactose intolerance rarely shows up in humans before age 3 or 4, since that’s around the natural age of weaning.”
In extenuating circumstances in which other possible culprits of fussiness have been denied (Are you giving the baby bottles? Is she using pacifiers? Do you have a foremilk/hindmilk imbalance that can be resolved by block feeding? ) then check out this list of the top maternal dietary triggers:
- Chocolate
- Cow’s milk/dairy (This is the most common. 2-7% of babies have a dairy sensitivity, and it runs in families with allergies. If baby isn’t allergic to dairy, there’s no reason to eliminate it).
- Citrus fruits
- Eggs
- Gas-producing vegetables
- Peanuts
- Shellfish
- Spices
- Wheat
Links:
- “Can a Nursing Mother Eat This? FAQs” – Kellymom
- “How Long Does it Take Food to Get into My Breast Milk?” – Anne Smith, IBCLC
- “Is Formula Ever ‘Better’ Than Breast Milk?” (debunks Weston A. Price Foundation’s claim that a mother with a non-deal diet should give formula) – Kate Tietje
Also see the “Restricted Diets” section for information about dairy-free, vegan/vegetarian, crash/fad, and fasting diets for breastfeeding mothers.
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Medications
General stance on medications during breastfeeding, by Dr. Jack Newman.
- Analgesia and anesthesia
- Codeine and Morphine
- Ergot alkaloids: “Due to the dopaminergic activity of the ergot alkaloids they may have the ability to suppress prolactin and hence lactation” – AAFP
- Methadone (see Myth #5)
- Radiologic procedures
Tips:
- Try taking a medicine dose right after a feeding to minimize amounts that will reach the baby during the next feed.
- Always find alternatives for these while breastfeeding: chemotherapy drugs, radioactive drugs, extended use of sedatives, decongestants such as pseudoephedrine, ergot alkaloids, amphetamines, Lindane (Permethrin is the preferred choice to treat lice), and Parlodel (which is used to dry up milk and has resulted in deaths).
- The best choices for pain relievers are acetaminophen and ibuprofen rather than aspirin due to infant bleeding concerns.
- Be especially cautious about antidepressants and tranquilizing drugs.
Links:
- Drugs in Breastmilk Helpline at The Breastfeeding Network
- “Medications and Mother’s Milk: A Manual of Lactational Pharmacology” Searchable database for drug/lactation interactions
- “Natural treatments for nursing moms” – Kellymom
Medications and the Breastfeeding Mother
The Transfer of Drugs and Other Chemicals Into Human Milk
Breastfeeding and Maternal Medication
Drugs in Pregnancy and Lactation
“You Should Continue Breastfeeding”
Breastfeeding and Maternal Drugs
– See more at: http://www.breastfeedingonline.com/meds.shtml#sthash.bbYbN0fZ.OOIkK0RV.dpuf
Other Drugs That Can Decrease Milk Supply:
- Antihistamines
- Caffeine and alcohol in large amounts
- Cigarettes (read more here)
- Diuretics (dehydration is not good for nursing)
- Hormonal birth control (estrogen inhibits milk production)
- Labor drugs such as fentanyl and meperidine (Demerol, Pethidine) can detriment milk production
- Pseudoephedrine (decongestant)
- Vitamin B6 in very high doses
- Weight loss drugs/appetite suppressants
Other Possible Detriments to Milk Supply:
- Anemia
- “Booby Traps” (read more here)
- Bottle use (excessive), when medically unnecessary
- Alternatives to avoid nipple confusion and jaw/dental malformation: finger-feeding and cup-feeding
- Infant circumcision (interrupted nursing from surgical trauma)
- Crash dieting
- Hypothyroidism
- Insufficient glandular tissue (hypoplasia)
- Nipple shields
- Pacifiers
- Pregnancy
- Prior breast surgery or damage
- Retained placenta, or excessive postpartum bleeding
- Returning to work, especially if supply hasn’t yet been established
- Supplementation of milk alternatives
Street Drugs/Substances
Drug abuse is commonly regarded as a matter of criminal behavior, but in truth it is primarily an issue of public health crisis. In many U.S. states, parental drug abuse is considered child abuse or neglect, according to the U.S. Dept. of Health and Human Services.
Breastfeeding While Using These:
- Cocaine
- Heroin: Dr. Hale finds heroin to pose an L5 lactation risk.
- Marijuana: The AAP considers this to be contraindicated, but other credible sources list it as “low risk” in usual doses for breastfeeding. Suggested duration of interruption of breastfeeding is 24 hours, according to Dr. Tom Hale who also wrote:
“In my book I suggest that it is contraindicated, not because of a significant hazard of the drug, but rather because it is an illegal drug of abuse that passes to the breastfed infant…I think that women who consistently abuse marijuana should not breastfeed, because of the neuroleptic effect of the drug on the MOM, not so much of the effect of the drug on the infant because it is likely minimal. But if mom[‘s] judgement and function is impeded by using this drug, then she should not be breastfeeding.”
- Methamphetamines: The possession or manufacture of meth in a child’s presence is a felony in 14 states.
Fortunately, addiction support is available, and those who are affected should seek treatment as soon as possible. If you or someone you know with children is struggling to end the cycle of chemical dependency, visit the links below for help.
Links:
- “Drugs of Abuse” – Breastfeeding and Human Lactation, Third Edition by Jan Riordan, p. 158
- “Guidelines for Breastfeeding and the Drug-Dependent Woman” – The Academy of Breastfeeding Medicine Protocol Committee
- Narcotics Anonymous“Protecting Children in Families Affected by Substance Use Disorders” – Office on Child Abuse and Neglect, Children’s Bureau, ICF International
- “Opiate Addiction: Commentary for Breastfeeding Supportive Care” – Native Mothering
- Story: “Child of a Drug Addict” – The Hope Share
- See also the Links in the “Medications” section.
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