Pocket ObGyn – Breast Feeding
See Abbreviations
Physiology and Initiation
- Copious milk secretion begins w/ progesterone withdrawal 2–7 d Longer in primiparas & after cesarean deliv (Pediatrics 2003;112:607). Maint of lactation depends on adequate frequency of breastfeeding &/or pumping (Obstet Gynecol 2007;109:479). During the 1st 2 w, feeding initiated on infant demand (8–12´ daily).
- Initiation of successful breastfeeding (unless medical issues take precedence; Pediatrics
2012;129:e827):
Maintain direct skin-to-skin contact btw mother & infant until 1st feeding is completed. Avoid commercial formulas & sugar water.
Avoid use of pacifier.
Room-in newborns w/ mother.
Discharge w/ contact information for breastfeeding support.
Benefits (AHRQ Pub No. 07-E007)
- Full-term infant: ¯ incid of otitis media; atopic dermatitis, & asthma; GI & lower respiratory tract infections; diabetes (weak association); childhood leukemia; SIDS
- Preterm infant: ¯ incid of nec enterocolitis, sev retinopathy of prematurity Improved neurodevelopmental outcomes (Pediatrics 2012;129:e827)
- Mat: ¯ incid of breast & ovarian cancer; & dev of type II diabetes
Relative Contraindications (ACOG Clin Rev 2007;12:1S; Obstet Gynecol 2007;109:479; Pediatrics
2012;129:e827)
- Contraindicated:
Mat use of illicit drugs or uncontrolled EtOH use Mat infxn w/ brucella, HIV, HTLV-I, or HTLV-II
Mat active, untreated varicella, TB, or herpes simplex w/ breast lesions Infant galactosemia
- Breastfeeding does NOT the risk of vertical transmission of hepatitis C (Clin Infect Dis
1999;29:1327)
- Infants born to hepatitis B positive mothers should receive HepBIg & be vaccinated at birth; breastfeeding is safe thereafter (Obstet Gynecol 2002;99:1049)
Lactational Mastitis
- Dx: Fever >3°C + swollen, red, indurated breast in breastfeeding mother
- Labs not necessary, milk culture only in sev or refrac case US only if abscess suspected
- Typical pathogens are group A streptococci & MSSA
- 1st-line antibiotic: Dicloxacillin (500 mg QID) ´ 10–14 d
PCN-allergic or MRSA: Clindamycin (300 mg QID) or TMP/SMX (1–2 BID)
- Continue breastfeeding, w/ NSAID & warm compresses as needed
- Diff includes: Obstructed milk duct, galactocele, inflamm breast cancer
Breastfeeding and Maternal Medications
- LactMed: Comprehensive database on pharmaceuticals & lactation http://toxnet.nlm. gov/cgi-bin/sis/htmlgen?LACT