When a Nursing Mother Gets Sick

by Nancy Mohrbacher, IBCLC

When a mother gets sick, the whole household may be disrupted. And when the mother is also breastfeeding, she not only has her own health problems to contend with, but she may worry about how her illness or her medication will affect her nursing baby.

BREAST IS STILL BEST

Even during the mother’s illness, both mother and baby almost always benefit from continuing to breastfeed. When a nursing mother is exposed to an illness, her body begins producing specific antibodies to protect her breastfeeding baby from it. By the time the mother begins to feel sick, her baby has already been exposed to her illness. Continuing to breastfeed helps a baby fend off the mother’s illness, and if he does get sick, he almost always has a milder case, due to the antibodies and other immune factors he receives from his mother’s milk. By washing her hands regularly and limiting face-to-face contact with her baby, a mother can further decrease her baby’s chances of catching her illness.

Continuing to breastfeed also has advantages for the mother. She can conserve her strength by tucking the baby into bed with her and breastfeeding lying down when the baby gets hungry. If she must care for her baby alone, she is also spared the necessity of buying or preparing formula. Breastfeeding also adds to a mother’s feeling of normalcy through a difficult time, and it may be the one way she can contribute to her baby’s well-being when she can do little else for him.

On the other hand, abrupt weaning during an illness can compound a mother’s physical problems by causing uncomfortable breast fullness, engorgement, or even a breast infection. Sudden weaning can also be emotionally difficult, because in addition to being a method of feeding, breastfeeding is also a way of giving and receiving love. Abrupt weaning can also be difficult for a baby. If his familiar source of nourishment and comfort is suddenly taken away, the baby may be difficult to console, disrupting the household even more. Also, weaning will deprive the baby of the mother’s antibodies and immune factors that protect him from illness. There is also the chance that the baby will have an adverse reaction to the formula.

Breastfeeding can continue through most illnesses: colds, the flu, infections, food poisoning, measles, rubella, Lyme disease, chickenpox, cholera, typhoid fever, parasites (such as giardia and malaria), leprosy, hepatitis, even cancer, if chemotherapy is not used. Many mothers have also breastfed through chronic illnesses, such as arthritis, asthma, diabetes, lupus, cystic fibrosis, multiple sclerosis, epilepsy, and thyroid disease.

THE RARE EXCEPTIONS

Although breastfeeding can continue through most illnesses, there are exceptions. Chickenpox or measles do not usually interefere with breastfeeding, but when the mother contracts either of them within five days before childbirth, some doctors recommend that mother and baby be separated at birth to minimize the chances that the baby will become infected. (About half of babies will develop a mild case of these diseases despite the separation.) Both chickenpox and measles are potentially more serious for the newborn than they are for the older baby. Despite the separation, the mother can provide her milk for her baby until they are reunited.

Tuberculosis is another illness that may preclude breastfeeding, depending upon the mother’s condition. If the mother is allowed to be with her baby, she may be able to breastfeed. But if her tuberculosis is active in the lungs and can be transmitted by close nose-and-mouth contact, she will probably be separated from her baby until treatment has rendered her noninfectious. In countries where tuberculosis is prevalent, many women breastfeed without incident.

Herpes sores do not affect breastfeeding unless they are near or on the mother’s nipple. In this case, the mother can express her milk from the breast with the sore, discarding the milk until the sore has healed, and the baby can nurse from the other breast in the meantime. If a herpes sore develops anywhere else on the mother’s body, she will need to keep it covered when handling her baby and to wash her hands often to minimize the chances of infecting her baby. Cold sores in the mouth are a type of herpes, too, so the mother with a cold sore should wash her hands regularly and avoid kissing her baby until her sore is healed.

HIV and breastfeeding is a controversial topic. Research indicates that HIV can be transmitted by breastfeeding, so the World Health Organization and the US Centers for Disease Control currently recommend that mothers testing HIV-positive not breastfeed where safe alternatives are available. In order to make an informed choice, mothers need to discuss the pros and cons of breastfeeding with their families and health-care providers, weighing what is known about the benefits of breastfeeding and human milk and the risks of infant formula against the unknown risks of breastfeeding with HIV.

MEDICATIONS

The overwhelming majority of prescription and over-the-counter medications are compatible with breastfeeding, even though small amounts of the drug may pass into the mother’s milk. Most medical authorities agree that the benefits of breastfeeding far outweigh any risks to the baby from the drug. Cheston Berlin, Jr., head of the American Academy of Pediatrics’ Committee on Nutrition and contributor to the Academy’s guidelines for doctors on drugs and breastfeeding, wrote in 1989:

Drug therapy of the mother should rarely interrupt breastfeeding. A supportive approach by the pediatrician buttressed by available data can reassure nursing mothers that they can safely nurse while giving themselves necessary therapy, and everyone wins.

Before a nursing mother begins taking a drug, she should always consult with a doctor first, preferably her baby’s doctor, because he or she probably knows more about the drug’s effects on the baby. When evaluating the drug, the doctor will need to take into account the baby’s age, weight, medical history, and how much mother’s milk the baby is getting, as a baby receiving other foods will receive less of the drug than an exclusively breastfed baby. Some drugs that are considered compatible with breastfeeding for the mother of an older nursing baby are not the best choice for the mother of a premature, ill, or newborn baby.

Usually a drug that is given to babies is a good choice for a breastfeeding mother, because the amount the baby would receive through the mother’s milk is far less than he would receive if he were given the drug directly. Also, a time-tested drug that many breastfeeding mothers have taken over the years is usually a wiser choice than a new drug.

If a nursing mother is told that a particular drug that has been prescribed for her is incompatible with breastfeeding and she is not ready to wean, she has several choices. First, she can tell her doctor that she would like to continue breastfeeding. She can also ask:

Why does the doctor think the drug is unsafe? Is there research indicating this, or is the doctor’s recommendation based on an absence of research or personal opinion?

What do the reports in the medical literature say about the drug, and would it be helpful to obtain more information? Lactation consultants and La Leche League Leaders may have resources on hand on medications and breastfeeding and can also tap into La Leche League’s network of information. Also available is La Leche League International’s Center for Breastfeeding Information, which offers current and reliable reference texts on drugs and breastfeeding, as well as a comprehensive collection of articles from professional journals. This service can be used by the general public for a small fee. (Call 847-519-7730 8 am to 5 pm Central Time.)

Is there a more compatible drug that would allow for continued breastfeeding? When one drug is questionable, there are usually time-tested alternatives available. Second, the mother can get another opinion. Doctors differ in their attitudes about drugs and breastfeeding. Some doctors believe that breastfeeding mothers should not take any drug, despite objective research to the contrary. Other doctors make certain exceptions but are extremely conservative. Reasons for this include concerns about legal liability and an ignorance of the health risks of artificial feeding and abrupt weaning. Also, some doctors rely on written resources provided by the drug companies, which tend to take an overly cautious approach based more on fear of litigation than an objective weighing of the benefits of breastfeeding with the risks of the drug. When seeking a second opinion, ask a lactation consultant or a La Leche League Leader if she knows of any doctors in the area who are knowledgeable about breastfeeding.

If a nursing mother must take a drug that is not compatible with breastfeeding, she still has the option of temporarily weaning her baby and going back to breastfeeding after the drug treatment ends. To do this, she can pump and discard her milk about as often as her baby was nursing in order to minimize her own discomfort and keep up her milk supply. When all feedings must be replaced with pumping, the easiest and most effective type of breast pump to use is an automatic double pump, either a rental pump or the Medela Pump In Style or Hollister Purely Yours. Double pumping allows the mother to pump both breasts at the same time, cutting pumping time in half.

If returning to breastfeeding is not possible (for example, the mother with cancer, who will be on chemotherapy for an extended time), the best alternative may be to wean as gradually as time allows, giving the baby lots of extra love, cuddling, and attention and pumping or expressing milk whenever the mother’s breasts feel overly full so that her milk supply can decrease slowly and comfortably.

Although in rare cases a mother may have to wean her baby due to illness or medication, it is almost always possible to continue breastfeeding. Even during illness, mother and baby benefit in countless ways from nursing’s closeness and comfort.