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Hilary Gerber

on 17 July 2014

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Transcript of Breastfeeding

Postpartum depression
Type 2 diabetes
Breast cancer
Ovarian cancer
Health decision or lifestyle choice?

Hilary Gerber D.O.
CHI of South Florida
Obstetrics Residency
July 16, 2014

Who here has
...seen someone breastfeed?
...helped someone breastfeed?
...breastfed a baby?
...was breastfed as a baby?
...has had a patient who was breastfeeding?
ACOG Committee on Ethics Committee Opinion #439 "Informed Consent" 2012
"Patients approach medical decisions with a history of relationships, personal and social, familial and institutional."
AAFP Breastfeeding Advisory Committee Position Paper "Breastfeeding, Family Physicians Supporting" 2008
"Because breastfeeding is the physiologic norm, we will refer to the risks of
not breastfeeding
for infants, children, and mothers."
For how long?
2 years
6 months exclusively, with food up to at least 1 year
What's the health decision?
"Physicians have been used to convey this advertising and encourage brand loyalty through "free" literature and formula samples. Use of commercial literature and samples has been demonstrated to decrease breastfeeding rates and increase premature weaning."
Health effects of not breastfeeding - infant
Acute otitis media
Celiac disease
Atopic dermatitis and allergies
Severe lower respiratory infections
Necrotizing enterocolitis
Sudden infant death syndrome
Type 1 and 2 diabetes
Childhood leukemia and lymphoma
AAP Policy Statement "Breastfeeding and the Use of Human Milk" 2012
"Given the documented short- and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice."
Maximum time?
"As long as mutually desirable"
Health effects of not breastfeeding -maternal

Which of these is true?
1. Breastfeeding women who take antibiotics should stop breastfeeding, and be encouraged to "pump and dump" to maintain their supply during treatment.

2. Physicians should not weigh the risk of switching to artificial infant feeding and possible early weaning when prescribing medicine to breastfeeding moms

3. Almost all prescription and over-the-counter medications taken by the mother are safe during breastfeeding.

4. Oral contraceptives are contraindicated during breastfeeding.

Resources for medications and lactation
LactMed - free app and website from the National Library of Medicine http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT

Hale's "Medications and Mother's Milk"

Academy of Breastfeeding Medicine evidence based protocols

Tobacco and alcohol
Which of these is true?
1. Women who smoke should be counseled to offer formula instead of breastfeeding.

2. Women can reduce harm from smoking and breastfeeding by not smoking near the baby, and smoking after nursing instead of before.

3. Women can reduce harm from alcohol and breastfeeding by doing a "pump and dump" of their breastmilk.

4. There is no acceptable safe amount of alcohol while breastfeeding.
Which of these is true?
1. Exclusive breastfeeding can be an effective form of contraception.
2. Women can use Depo-provera while breastfeeding.
3. Women can use Implanon while breastfeeding.
4. Women can use the Mirena IUD while breastfeeding.
Lactational amenorrhea
1. Exclusive breastfeeding without
routine supplements or delays in
2. Infant is younger than six months
3. Menses have not returned (after 56
days postpartum)
0.45 to 2.45%
Under 6 months postpartum
Ovulation before menstruation
Exclusive breastfeeding
Healthy People 2020
16.4 %
10.6 %
25.5 %
CDC Breastfeeding Report Card 2013
Maternal Infection
Which of these is a contraindiction to breastfeeding?
1. Influenza
2. Active herpes simplex lesion
3. Hepatitis C
5. Active MDR Tuberculosis
6. Chicken pox
Other health care concerns
Most chronic illnesses and medications do not preclude breastfeeding

Exceptions include certain chemotherapy drugs, critical illness

Assist mother in maintaining supply if separation is required, if possible
Most anesthesia does not affect breastfeeding

Local agents in minute quantities

General agents leave system quickly

Timing of resumption depends on state of mother and infant
Rarely an indication to interrupt breastfeeding
Radionucleide IV contrast agents and gadolpentetate have short half lives and no oral bioavailability
For radioisotopes, duration of breastfeeding cessation is 5 times the half-life
Nuclear Regulatory Commission: http://www.nucmed.com/nucmed/ref/8_39.pdf
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