CONTRAINDICATIONS
TO BREASTFEEDING
When women should not breastfeed
There are times when a woman should not breastfeed. If a woman
-
Has
HIV, the virus that causes AIDS, because there
is a risk of passing the virus through human milk. Women
should know their HIV status before deciding to breastfeed.
-
Has
active, untreated tuberculosis. If the
mother has been treated, it is safe to breastfeed. If
it is safe for the mother to be in contact with her infant,
she may breastfeed.
-
Has
HTLV-1, The Human T-cell leukemia virus
type 1. Current recommendations are that women in the
United States with HTLV-1 disease not breastfeed.
When mothers should temporarily
stop breastfeeding
There are times when breastfeeding should stop temporarily.
The mother should express or pump her milk
as often as baby would be nursing to maintain
her milk supply. This milk should be discarded.
Women
should not breastfeed until these situations have passed:
Source: Lawrence RA. 1997. A Review of the
Medical Benefits and Contraindications to Breastfeeding in the
United States (Maternal and Child Health Technical Information
Bulletin). Arlington, VA: National Center for Education in Maternal
and Child Health.
MAINTAINING
YOUR MILK SUPPLY
Tips for mothers who temporarily stop breastfeeding
Mothers
who must temporarily stop breastfeeding can maintain their milk
supply until it is safe to resume breastfeeding. Women who take
certain medications or radioactive agents will need to pump
and discard their milk until the unwanted substance is clear
from the milk. When breastfeeding is temporarily withheld while
awaiting a galactosemia or PKU diagnosis, the mother may want
to save the milk for her baby or donate it to a milk bank.
Milk
supply is determined by how often and how well milk is removed
from the breast and by how much time is spent expressing or
pumping the milk. The most efficient way to remove milk is to
use a large electric pump with a double set up. Pumping both
breasts at the same time makes pumping sessions shorter and
increases prolactin, an important lactation hormone. Other options
include single pumping (one breast at a time) with an electric,
battery or manual pump, and hand expression. A mother can make
any pump more effective by briefly massaging her breasts and
hand expressing several times during a pumping session. It is
helpful if the mother follows a pumping routine.
If
the temporary weaning occurs after breastfeeding has been well
established, the mother should express or pump as often as the
baby was breastfeeding. For example, if the baby was breastfeeding
ten times a day, mom should try to pump ten times a day. The
mother should begin expressing or pumping as soon as possible
whenever breastfeeding is interrupted. Some women have been
able to maintain their milk supply by pumping 5 - 8 times per
24 hours for a total of 90-125 minutes.
If
breastfeeding must be withheld when the baby is less than two
weeks old, the mother should start with at least eight pumping
sessions in 24 hours, including one between midnight and 4 AM.
Colostrum, the first milk, is concentrated and comes in small
quantities, so the mother should not become discouraged. About
a teaspoon to a tablespoon per pumping is excellent. Milk production
gradually increases during the first week. Mothers should pump
for time, not quantity, pumping each breast for ten to fifteen
minutes at each session. The purpose of pumping at this time
is to minimize engorgement and to stimulate milk production.
Any
woman who must withhold breastfeeding or wean temporarily should
be referred to a lactation consultant or breastfeeding support
group. After temporary weaning, the baby may need some coaxing
to resume feeding at the breast. Lactation consultants have
techniques to help babies make the transition back to the breast.
PUMPING
AND STORING HUMAN MILK
To Store Human milk for Later Use:
-
Breastmilk
from different pumping sessions can be combined as long as
the sessions were on the same day and all the milk is cold.
Refrigerate breastmilk immediately after pumping.
-
If the milk will be frozen, leave space for it to expand.
Freeze the milk on the same day it was pumped.
-
If your refrigerator has a separate door for the freezer,
breastmilk can stay in the freezer up to 3 months. Place breastmilk
in the back of the freezer but not near the fan.
-
Breastmilk can stay in a chest-type deep freezer (0° F.)
for up to six months.
General Guidelines:
-
Read and follow the instructions that came with your collection
kit.
-
Before pumping, wash your hands thoroughly using water and
soap (an antibacterial is good), and clean your nails with
a nailbrush. Rinse well.
-
Immediately after pumping, use cold water to rinse all pump
parts that touched your milk. Then clean them in hot soapy
water and rinse well, or wash in the dishwasher. Make sure
your hands are clean before assembling the parts.
-
Use clean containers; they do not have to be sterilized unless
you have been instructed to do so. It is best to collect the
milk, store, and feed from the same container so that the
milk is not handled much.
-
The best containers for breastmilk are glass or hard plastic.
Plastic bags specially made for breastmilk storage are also
available.
-
For newborn babies, put only 1½-2 ounces of milk in
each container. For older babies, the bottles can contain
3-4 ounces. This will reduce waste if baby does not take the
whole amount. Small quantities thaw faster.
-
Put the date the milk was pumped and your baby’s name
on a label on each bottle of breastmilk.
-
Breastmilk is not homogenized, so the cream will rise to the
top as it sits. Shake the bottle gently to mix the cream with
the rest of the milk.
-
Once breastmilk has been warmed or baby has started drinking
from the container, whatever milk is not used within one hour
should be discarded.
Thawing
Breastmilk:
-
To thaw it fast, hold it under cool running water.
-
To thaw it slowly, put it in the refrigerator. Once thawed,
use within 24 hours or throw it out.
-
Do not thaw breastmilk at room temperature. Do not refreeze
thawed breastmilk.
To
Warm Breastmilk:
-
Hold
the container under lukewarm running water or set it in a
container of warm water.
-
Never warm breastmilk on the stove or in the microwave.
-
Do not make breastmilk hot. Babies can drink cool breastmilk.
Getting
Ready to Pump:
-
Get something to drink and maybe a healthy snack.
-
Get comfortable. Try to pump in a warm, quiet, private place.
-
Put a sweater or blanket around your shoulders for warmth and
privacy.
-
Massage your breasts before pumping to help the milk to flow.
-
Place a pillow on your lap; imagine nursing.
-
Look at a picture of your baby; think about your baby (soft,
warm and cuddly).
Tips to Help You Pump:
-
Cup the breast shield in your hand and support your arm with
pillows.
-
To make the breast shield form a better seal on your breast,
moisten the edge of the shield with water or breastmilk.
-
Start pumping at minimum suction, then increase suction to
as high as is comfortable. Reduce suction if there is any
discomfort. Call your breastfeeding counselor if pumping continues
to hurt. Do not use a pump that hurts.
-
While pumping, don't watch the bottle fill; just check occasionally
to be sure it is not too full.
-
Talk on the phone, watch TV, listen to music or a relaxation
tape, read, or just relax.
Pumping One Breast at a Time (Single Pumping):
Pump each breast for about five minutes. Then pump each breast
for about three minutes, then each breast for about two minutes.
Each breast is pumped a total of ten minutes but you will get
more milk if you go back and forth than if you pump each breast
for ten minutes straight. Follow this schedule even if you are
not getting much milk. This will help you build your milk supply.
Keep on pumping even if the milk stops flowing before 20 minutes
is up.
Pumping for a Preterm or Hospitalized Baby:
-
Follow
the instructions the hospital has given you. Use the containers
the hospital recommends or provides. The hospital will tell
you whether to freeze or refrigerate the breastmilk and how
to transport it.
-
Pump at least eight times a day, including at least once at
night. To make more milk, pump 10?12 times every 24 hours.
-
During the day, never go more than three hours without pumping.
If you are pumping enough milk, you may sleep as long as five
hours between nighttime pumping sessions.
-
If you will be pumping for more than a week, you might want
to pump both breasts at the same time. Double-pumping sessions
are ten to fifteen minutes long.
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