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MATERNAL CONTRAINDICATIONS TO BREASTFEEDING

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

  • Chemotherapy

  • Radioactive isotopes/implant

  • Clozapine

  • HTLV infection

  • Herpes lesion (contraindicated on affected breast only - cover the affected breast 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)

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

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

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

  • Lithium - the American Academy of Pediatrics advises that lithium can be used with careful blood monitoring of mother and baby

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

Breastfeeding is recommended for mothers with

  • 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 can be advised that if nipples are bleeding they should not feed from that breast, but instead express and discard the milk until healing occurs)

See separate page for more information on medication and lactation