"I can't breastfeed because I'm taking [this medicine]"
There are few medications that are incompatible with breastfeeding. LactMed, sponsored by the National Institutes of Health (NIH), is an evidence-based database of medication safety profiles in lactation, summarizing research studies of medication levels in breastmilk and infant blood, potential adverse effects, and alternative medications. Reference this database when prescribing medications to see the most up to date information. (1) Other useful resources include Dr. Thomas Hale’s Infant Risk app and hotline, which provides safety information in pregnancy and lactation, and E-lactancia, a database of medication and herbal medicine safety profiles available in English and Spanish.
"I can't breastfeed because I have [this medical condition]"
Like medications, there are few medical conditions in which breastfeeding is contraindicated. The CDC publishes information on breastfeeding considerations in special circumstances, including birth defects, breast surgery, COVID-19, Ebola, food-borne illness, waterborne illnesses, hepatitis B and C, HSV, HIV, jaundice, influenza, lyme disease, malaria, MRSA, postpartum depression, shingles, toxoplasmosis, and West Nile virus. The only contraindications to breastfeeding are infant galactosemia, maternal HIV (in the USA), maternal HTLV, maternal Ebola, or maternal illicit drug use (except those enrolled in supervised medication-assisted treatment for opioid use disorder).
"Breastfeeding is only beneficial for my baby"
Breastfeeding is beneficial for the infant and the lactating individual! Breastfeeding reduces the mother’s risk of breast and ovarian cancer, type 2 diabetes, hypertension, cardiovascular disease, stroke, heart attack, hypercholesterolemia, and central adiposity.
"My nipple(s) hurt. I think I have a yeast infection"
Nipple pain has a wide differential diagnosis: improper latch, contact dermatitis, atopic dermatitis, candidiasis, vasospasm, infection, trauma, or clogged duct. Obtain a thorough history and physical exam. If you don’t feel comfortable assessing their latch, recruit a lactation consultant for assistance. Lanolin, marketed for breastfeeding comfort, can cause contact dermatitis. Yeast infections of the breast are usually accompanied by thrush in the infant. Family physicians are uniquely qualified to assess and treat both mom and baby!
“I can’t drink alcohol while breastfeeding.”
More than two standard drinks per day can negatively impact the infant’s development. One drink per day is unlikely to have negative consequences. Alcohol crosses the BBB (blood-boob barrier), so the alcohol level in breastmilk is equal to maternal blood alcohol level. To decrease infant exposure to alcohol, wait at least 2 hours per drink before feeding or pumping. Excess alcohol exposure in breastmilk can cause infant agitation, sedation, poor sleep, and insufficient weight gain. Furthermore, alcohol inhibits milk letdown and decreases milk production.
“I’m breastfeeding, therefore I can’t get pregnant.”
Breastfeeding is a hypoestrogenic state and is associated with anovulation. The Lactation Amenorrhea Method (LAM) is a recognized form of contraception which is at least 98% effective with perfect use. To ensure protection from pregnancy, the following criteria must be met: (a) amenorrhea, (b) no interval of >4-6 hours between breastfeeds, and (c) less than 6 months postpartum. Progestin-only forms of contraception are compatible with breastfeeding after milk supply has been established (ie ~6 weeks postpartum).
"I stopped breastfeeding, so I have to use formula.”
If the mother has decreased or stopped breastfeeding, it is possible to re-establish milk production via frequent nipple stimulation and milk extraction. With the nationwide formula shortage, relactation is a viable and under-appreciated alternative to formula. Relactation can take weeks to months, depending on the infant’s age and time without breastfeeding. These infants should be monitored closely to ensure adequate intake and weight gain.