Breast milk is a biological fluid secreted by the mammary glands after delivery.The newborns have a weak immune system and will require support from the mother. Nutritional requirements after delivery are best fulfilled by breast milk as it contains various macronutrients (proteins, lipids, carbohydrates), micronutrients (vitamins and minerals), and various biologically active substances.
Sometimes, a mother may have an infectious disease at delivery. Under such circumstances breastfeeding for every newborn needs appropriate protocols to protect the infants from the transmission of disease. If there is a maternal infection in the postpartum phase, the doctor decides to suspend temporarily or stop breastfeeding permanently.
What Are Some of the Commonly Known Contraindications to Breastfeeding?
Breast milk protects against infections but is also known to cause transmission of some infections to infants. The occurrence of infectious diseases creates fear and anxiety among breastfeeding mothers.
Some commonly associated infectious risks from mothers to newborns are:
The transmission of tuberculosis through breast milk has not been reported with tuberculosis breast infections. The temporary separation of infant and mother is needed until complete evaluation and adequate therapy are completed for both the mother and newborn. However, expressed breast milk can be given to the infant during this short separation. Breastfeeding can be safely continued even if the mother, infant or both receive anti-tuberculosis therapy.
2. Chlamydial Infections:
It is one of the most common sexually transmitted diseases (STD) and is a frequent cause of conjunctivitis and pneumonitis in infants from perinatal infection. Specific chlamydial IgA (immunoglobulin A) has been found in colostrum and breast milk in some postpartum women suffering from this infection.
However, it is not believed that chlamydia is transmitted via breast milk, and separating infants from mothers with chlamydial infections or stopping breastfeeding is not indicated. Antibiotics are recommended to treat infections in mothers and newborns.
3. Gonococcal Infections:
Maternal infection with Neisseria gonorrhoeae can cause serious illness. The risk for transmission from mother to infant occurs during delivery while passing through the infected vaginal canal and occasionally from postpartum contact with the mother.
However, the risk of transmission from breast milk is negligible. Ophthalmia neonatorum scalp abscess or disseminated infection occurs more often in infants. All mothers infected with gonococcal infections need revaluation for gonococcal conditions and screening for other sexually transmitted diseases.
Leprosy is not a contraindication to breastfeeding. It is a chronic disease, and transmission occurs through long-term contact with untreated or multibacillary infection individuals. However, no mother-infant contact is permissible except for breastfeeding.
5. Human Immunodeficiency Virus (HIV):
HIV infection needs standard precautions, including avoiding breast milk consumption and breastfeeding from infected mothers. In such cases, newborns could be fed with the stored breast milk from human milk banking.
These infections are commonly reported to be transmitted to newborns, and appropriate precaution is needed while breastfeeding under these conditions.
How Could We Control the Transmission of Infection Through Breastfeeding?
A lack of knowledge and uncertainty often affects breastfeeding. Hence, the newborns can be deprived of the protective, nutritional, and emotional benefits of breastfeeding. In case of maternal illness, the appropriate decisions concerning breastfeeding should be based on the balance between the breastfeeding benefits with the known or estimated risk for the infant. There is a tendency for the infant to acquire a clinically significant infection through breastfeeding.
To rule out any transmissible infection, your healthcare professional would make you undergo appropriate investigations during the pregnancy and make a proper case-to-case assessment to detect your environmental exposure, underlying medical condition, or the medical condition of the infant. The doctor's suggestive tests help determine whether there is a need for the interruption, stoppage or never start breastfeeding. The investigation isolates or identifies the infectious agent from the colostrum, breast milk, or any contagious breast lesion. The transmission of infectious organisms can occur through the breast milk either by secretion in the mammary fluid or by cellular components of the breast milk. The environmental and chemical contamination of breast milk can occur by improper handling at the time or after the breast milk expression.
What Are the Standard Precautions to Be Taken While Breastfeeding?
The transmission of the newborn infection could be controlled by understanding the transmission of microorganisms from a known infection. It is also essential to detect unknown sources of infection. Some recommendations have been made to be applied to all patients to protect them from potentially infectious body fluid.
Additionally, precautions based on the previous modes of transmission are needed to protect against infection that can occur through the airborne route, direct contact, or contact with droplets.
Some standard precautions are recommended for all mothers, including preventing contact with blood, all body fluids, secretions and excretions, and nonintact skin. It can be done by following these measures:
Careful hand washing before and after expression of the breast milk.
Prevention of direct contact with non-intact skin or secretions is needed while handling clothing or a mother's gown.
Infant contact with maternal mucous membranes should be avoided. Mothers should be aware of this, perceive the risks, and make a conscious effort to prevent this type of contact.
Proper disposal of these materials is essential.
Using gloves, gowns, and masks on infants for protection can be done.
Mothers with chronic disease usually initiate and continue some form of breastfeeding for up to six months. However, some mothers are known for ceasing breastfeeding before the recommended six months. Some investigations are needed to detect the reasons for this disparity to ensure that appropriate breastfeeding support is available for newborns and women with chronic diseases.