Lecture for breastfeeding course

1. SESSION 13
MATERNAL HEALTH CONCERN
Breastfeeding Promotion and Support
A Training Course for Health Professionals
Adapted from the Baby Friendly Hospital Initiative:
Revised, Updated and Expanded for Integrated Care (Section 3)
WHO/UNICEF 2009

2. Session Objectives:
At the end of this session, participants will
be able to:
1. Discuss the nutritional needs of breastfeeding
women
2. Outline how breastfeeding assists in child
spacing
3. Discuss breastfeeding management when the
mother is ill
4. Review basic information on medication and
breastfeeding
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3. 2. How Breastfeeding Assists in
Child Spacing
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4. What can you tell a mother about how
breastfeeding helps to space children?
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5. Breastfeeding and spacing of
pregnancy
• BF can delay the return of ovulation and
menstruation
– Can help to space pregnancies
• The Lactation Amenorrhea method (LAM)
helps women who wish to use BF for child
spacing
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Session 13 : Maternal Health Concerns Ministry of
Health Malaysia

6. The LAM method is 98% effective in preventing
conception IF 3 conditions are met:
1. Mother is not
menstruating, and
2. Mother is exclusively BF,
(day and night) with no
very long intervals
between feeds, and
3. Baby is <6 months old.
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7. LAM
• If any of these 3 conditions are
not met, it is advisable for the
mother to use another method of
family planning to achieve
pregnancy delay.
• Most family planning methods
are compatible with BF with
exception of estrogen containing
contraceptive pills.
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8. 3. Breastfeeding Management
When Mother is ill
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9. What can you tell a mother about
breastfeeding if she is ill?
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10. Breastfeeding when mother is ill
• Women can continue to BF in nearly all cases
when they are ill
• There are many benefits to continuing BF
during illness
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11. Benefits of continuing breastfeeding
when mother is ill
• Baby may show signs of distress if BF
suddenly stops
• May be difficult to return to BF after the mother
has recovered
• Stopping BF leaves baby exposed to hazards
of artificial feeding
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Session 13 : Maternal Health Concerns Ministry of
Health Malaysia

12. Benefits of continuing breastfeeding
when mother is ill
• BF is less work than preparing formula
— Baby can lie beside mother and feed prn without her moving
• Mother and baby can stay together
— knows baby is safe, feels happy
• Baby continues to receive benefits of BF
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Session 13 : Maternal Health Concerns Ministry of
Health Malaysia

13. Mothers with chronic illness
• may need extra help to establish breastfeeding
—E.g mother with diabetes may experience
complications during delivery
—Can interfere with establishing BF
—With appropriate help, can BF
normally
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Session 13 : Maternal Health Concerns Ministry
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14. What kind of help with breastfeeding
may be needed if a mother is ill?
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15. Assisting with breastfeeding when
mother is ill
• Explain the value of continuing to BF
• Minimise separation
• Give plenty of fluids, esp if she has fever
• Assist mother to find comfortable position for
feeding
• If too difficult/unwell, help to express and cup
feed baby
• Choose treatment and medications that are safe
for BF
• Assist mother to re-establish BF after recovery
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16. Are there any situations related to the
mother’s health that may require the use
of foods other than breastmilk?
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Session 13 : Maternal Health Concerns Ministry of
Health Malaysia

17. Use of Artificial Feeds
• Very few situations related to maternal
health that require the use of artificial
feeds
• Distinguish between:
– illness that is contraindication
for BF
– situation surrounding the
illness that makes
BF difficult
Session 13 : Maternal Health Concerns Ministry of
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18. Hospitalisation
• Hospitalisation is NOT a contraindication
to breastfeed
• Baby should be kept with mother
• If mother not able to take care of infant
– Ask family member to stay and help
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19. Maternal Addiction
• BF remains the feeding method of choice
for majority of infants
– even in tobacco, alcohol and drug use
• For hard-drug users
– Decisions on case by case basis
• BF not recommended for IV drug users
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20. Contagious illness
• With common contagious illness (chest infection,
sore throat, GI)
– Baby is at risk of being exposed to the infection
through contact
– When mother continue to BF, baby receives
protection from the infection
• For most maternal infections: (TB, Hep B)
– BF not contraindicated
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21. Maternal conditions
Mother who should avoid BF
• HIV infection :
For replacement feeding if it is acceptable, feasible,
affordable, sustainable and safe (AFASS);
• HTLV-I (Human T-cell Leukemia virus)
• On chemotherapy /radiotherapy

22. Maternal conditions
• Mother who should avoid BF TEMPORARILY
• Severe illness that prevent a mother from caring for her
infant, for example sepsis;
• Herpes simplex virus type 1 (HSV-1):
Direct contact between lesions on the mother’s breasts
and the infant’s mouth should be avoided until all active
lesions have resolved;

23. Maternal conditions
Mother who CAN CONTINUE BF
• Tuberculosis ( Except active , untreated PTB)
• Hepatitis B : Give baby hepatitis B vaccine, within first 48 hours or
ASAP
• Hepatitis C;
• Mastitis : If BF is very painful, milk must be removed by expression
• Breast abscess:
BF should continue on the unaffected breast; feeding from the
affected breast can resume once the abscess has been drained

24. 4. Medications and Breastfeeding
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25. Maternal Medications and BF
1. If a mother requires medication, it is often
possible for the doctor to prescribe a drug
that may be safely taken during BF.
—Most drugs pass into breastmilk only in
small amounts and few affect the baby.
—In most cases, stopping BF may be
more dangerous to the baby than the drug.
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Session 13 : Maternal Health Concerns Ministry of
Health Malaysia

26. Maternal Medications and Breastfeeding
2. A medication the mother takes is more likely to
affect a premature / baby < 2 months old .
– If there is a concern, it is usually possible to
find a drug or treatment that is more
compatible with breastfeeding.
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27. Maternal Medications and Breastfeeding
3. If a BF mother is taking a drug that you are not
sure about:
Encourage mother to continue BF while you find out
more.
Watch the baby for side effects
Check the WHO list
Ask Dr/ pharmacist for more information
If baby has side effects and mother’s medication
cannot be changed, consider a replacement feeding
method, temporarily if possible.
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Session 13 : Maternal Health Concerns Ministry of
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28. Maternal Medications and BF
4. Traditional treatments, herbal medicines
and other treatments may have effects on
the baby.
– Try to find out more about them if they are commonly
used in your area.
– Meantime encourage the mother to continue BF and
to observe the baby for side effects.
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Session 13 : Maternal Health Concerns Ministry of
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29. Other substances that can adversely
affect breastfed infants
• Alcohol
– taken before BF >>> infant sedation
and reduced milk intake
• Smoking
– Maternal use of nicotine often decrease the
duration of BF, and can
adversely affect the infant, but
BF is preferable to formula feeding in
smoking mothers.
– Infants should not be exposed to tabacco smoke.
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30. Other substances that can adversely
affect breastfed infants
• Abuse of amphetamines, cocaine and
related stimulants may produce harmful
effects on BF babies, especially if the
infant is additionally exposed to the drugs
by inhalation of smoked drugs
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31. Breastfeeding and Mother’s Medication - Summary
Safe in usual dosage:
Most commonly used drugs:
Analgesics and antipyretics:
short courses of paracetamol, acetylsalicylic acid, ibuprofen;
occasional doses of morphine and pethidine.
Antibiotics:
ampicillin, amoxicillin, cloxacillin and other penicillins, erythromycin
Antituberculosis drugs( Except streptomycin )
Antimalarials (except mefloquine, fansidar), anthelminthics,
antifungals.
Bronchodilators (e.g. salbutamol), corticosteroids, antihistamines,
Antacids, drugs for diabetes, most antihypertensives, digoxin
Nutritional supplements of iodine, iron and vitamins.

32. Breastfeeding and Mother’s Medication - Summary
BF contraindicated:
• Anticancer drugs (antimetabolites);
• Radioactive substances (stop breastfeeding temporarily)
Continue BF:
Side-effects possible; monitor baby for drowsiness:
psychiatric drugs and anticonvulsants
Use alternative drug if possible:
Chloramphenicol, tetracyclines, metronidazole
Monitor baby for jaundice:
Sulfonamides, dapsone, sulfamethoxazole+trimethoprim
(cotrimoxazole), sulfadoxine+pyrimethamine (fansidar)
Use alternative drug (may decrease milk supply):
Estrogens, including estrogen-containing contraceptives,
thiazide diuretics, ergometrine

33. Maternal Medications and BF
Excessive use of topical iodine
(e.g povidone-iodine )
 Esp. on open wounds or mucous membrane
 Can >>>>> thyroid suppression or electrolyte
abnormalities in breastfed newborn
 Should be avoided.
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34. Summary
1. Nutritional needs of BF women
• All mothers need to eat enough foods so that they will
feel well and be able to care for their families.
• Mothers do not need to eat special foods or avoid certain
foods when breastfeeding.
• If the food supply is limited, it is better for the health and
nutrition of both mother and baby and less expensive to
give the mother food so that she can care for her baby
than to give artificial feeds to the baby.
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35. 2. How breastfeeding helps to space births
The LAM method is 98% effective if three conditions are
met:
1
2
3
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Session 13 : Maternal Health Concerns Ministry of
Health Malaysia
Session 13 : Maternal Health Concerns Ministry of
Health Malaysia

36. 2. How breastfeeding helps to space births
The LAM method is 98% effective if three conditions are
met:
- The mother is not menstruating,
- The mother is exclusively breastfeeding, with no very
long intervals between feeds,
- Baby is less than 6 months old.
If any of these three conditions are not met it is advisable
for the mother to use another method of family planning.
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Session 13 : Maternal Health Concerns Ministry of
Health Malaysia
Session 13 : Maternal Health Concerns Ministry of
Health Malaysia

37. 3. Breastfeeding management when the mother is ill
You can assist BF during maternal illness by:
• Explain the value of continuing to BF during illness,
• Minimising separation
• Giving plenty of fluids, especially if there is a fever,
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Session 13 : Maternal Health Concerns Ministry of
Health Malaysia
Session 13 : Maternal Health Concerns Ministry of
Health Malaysia

38. Breastfeeding management when the mother is ill
You can assist BF during maternal illness by:
• Assist mother to find comfortable position for feeding,
• Assist mother to express, and cup feeding baby if
mother is too unwell ,
• Choose medications that are safe for BF,
• Assist mother and baby to re-establish BF when the
mother recovers.
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Session 13 : Maternal Health Concerns Ministry of
Health Malaysia
Session 13 : Maternal Health Concerns Ministry of
Health Malaysia

39. 4. Medications and breastfeeding
• Use safe medications for mother.
• Watch baby for side effects
• Babies under ? months of age are more likely to show side
effects.
• Know where to get more information or advice on
medications.
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Session 13 : Maternal Health Concerns Ministry of
Health Malaysia

40. THANK YOU
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Session 13 : Maternal Health Concerns Ministry
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