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MATERNAL/PARENTAL CONTRAINDICATIONS TO LACTATION

Maternal/parental coronavirus infection is not a contraindication to breastfeeding/chestfeeding - and antibodies will pass to the baby/child in the human milk. RCOG says "There is no evidence showing that the virus can be carried or passed on in breastmilk. The well-recognised benefits of breastfeeding and the protection it offers to babies outweigh any potential risks of transmission of coronavirus through breastmilk" - see their FAQs and information from Unicef UK Baby Friendly Initiative

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There are few absolute maternal contraindications to breastfeeding. These include the following:

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  • Chemotherapy

  • Radioactive isotopes/implant

  • Clozapine

  • HTLV infection

  • Herpes lesion (contraindicated on affected side only - cover the affected breast/chest for any contact with the baby)

  • HIV in a high-resource setting with detectable viral load or poor compliance with cART

  • Unpredictable illicit drug use (mothers on methadone with no illicit use can breastfeed/chestfeed)

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There are some relative contraindications to breastfeeding/chestfeeding. Click through for more information on these:

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  • HIV in a high-resource setting - as outlined by BHIVA guideline in 2018, if a person with undetectable viral load on cART who has made an informed decision wishes to breastfeed/chestfeed, they should be supported to do so with extra monitoring. These parents should be advised not to mixed feed, to breastfeed/chestfeed for as short a time as possible, to introduce complementary feeds no earlier than 6 months of age and to stop breastfeeding/chestfeeding if they get mastitis or if mother or infant have diarrhoea or vomiting (see BHIVA information leaflet)

  • Anti-psychotics - oral and non-depot antipsychotics with less sedating properties and a short half-life are preferred for use during lactation, but choice should be predominantly related to the mother/parent's needs. First generation antipsychotics should not be used for preterm babies.

  • Lithium - the American Academy of Pediatrics has previously advised that lithium can be used with careful blood monitoring of mother/parent and baby. Their current advice is to check LactMed, which has a nuanced discussion of the evidence base for lithium

  • Codeine (the Royal College of Obstetrics & Gynaecology advises that dihydrocodeine is preferred, but many UK settings continue to use codeine while warning mothers/parents of potential side effects in the infant.

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Breastfeeding/chestfeeding is recommended for those with

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  • HIV in a low or middle resource setting - for up to two years on cART and with complementary feeds introduced no earlier than 6 months of age (transmission rate 0.3% at 6 months and 0.6% at 12 months). See BHIVA guidance

  • Hepatitis B or C (as a precaution mothers/parents can be advised that if nipples are bleeding they should not feed from that side, but instead express and discard the milk until healing occurs)

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See separate page for more information on medication and lactation

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