Breastfeeding Contraindications: An Evidence-Based Guide

In certain situations, breastfeeding is contraindicated because the risks of transmitting infection, toxin exposure, or inherited metabolic complications outweigh the benefits. Breastfeeding is contraindicated in only a few rare conditions. Most maternal illnesses, medications, and common infections are not reasons to stop breastfeeding; however, it is important to consult with healthcare providers for individualized guidance.

Absolute Contraindications in USA

Few conditions are considered to be absolute contraindications, and in these cases, your baby should be fed formula or human donor milk if available.

• Infant Galactosemia: a rare condition where the baby cannot digest lactose (sugar in milk), which is found in human breast milk and the standard formulas. Infants with galactosemia will need a special lactose-free formula, such as soy based formula, prescribed by a doctor. 

• HIV positive: mothers who are HIV positive and not receiving treatment refrain from breastfeeding as HIV can pass to a baby through breast milk. If the mother and baby receive antiviral medication, and there is a minimal viral load, breastfeeding may be supported when certain criteria is met. If these guidelines are not achievable, it recommended that the infant receive formula or human donor milk. 

• Human T-cell lymphotropic virus Type 1 or type II infection: rare viruses that can spread through breast milk. Mothers who are positive should not breastfeed. 

• Active, untreated tuberculosis (TB): spreads through the air so giving the baby pumped breast milk is an option, but individuals should refrain from nursing directly until they are treated and no longer contagious. 

• Active herpetic lesions on the breast: should lead to refraining from breastfeeding on affected breast until the lesions have fully healed, however it is safe to nurse or pump from the unaffected breast if no sores are present. 

• Certain drugs: are unsafe for breastfeeding such as cocaine, PCP, methamphetamines. Prescribed opioid medications require careful consideration during breastfeeding, with specific agents carrying different risk profiles. Short-term opioid use for acute postpartum pain is generally compatible with breastfeeding, with most opioids transferring into breast milk at low levels that result in minimal infant exposure. Codeine and tramadol are not recommended during breastfeeding due to reports of excessive sedation and respiratory depression. Oxycodone, hydromorphone, and morphine are more preferred and can be safe in standard doses for a short period of time with monitoring. In addition, methadone and buprenorphine are acceptable during breastfeeding for women who are stable on opioid agonist therapy, regardless of maternal dose, as transfer of these medications into breast milk is minimal. Monitoring for excessive sedation and respiratory depression in both parent and infant is essential when taking opiates.

• Certain treatments:  Women receiving active chemotherapy or radioactive treatments for cancer should consult with medical professionals before resuming nursing. Individuals can develop a pumping schedule to maintain milk supply for when they are able to provide breastmilk again. 

Special Considerations

• Hepatitis C: individuals can breastfeed safely, however, avoid breastfeeding if nipples are cracked or bleeding. 

• COVID-19: it is safe to breastfeed, as the virus doesn’t spread in breast milk. Mothers may choose to wear a mask while nursing to limit exposure to baby. 

• Varicella (chickenpox): it is possible to pump and feed breastmilk if there are no sores on the breasts. If individuals get sick before or right after delivery, separation from the infant while contagious may be necessary. 

• Certain medications: ask a medical professional (i.e. doctor, pharmacist, or lactation consultant) if it is ok to breastfeed while on medication. Certain medications such as particular antidepressants and anti-anxiety medications are preferred over others while pregnant and lactating. 

Conditions That Are OK to Breastfeed 

You can still safely breastfeed if you:

• Have a cold, flu, fever, or mild illness

• Have mastitis (breast infection): nursing can help the healing. If infection progresses or abscess develops it is important to consult with a healthcare professional promptly. 

• Take antibiotics: most are safe, but make sure to consult with healthcare professional

• Had vaccines: aside from the Yellow Fever vaccine. 

• Smoke cigarettes (though quitting is best for both of you)

What To Do If You Can’t Breastfeed

If breastfeeding is not possible, it is recommended to use human donor milk or infant formula. There are various forms of formula– powder, concentrate and ready-to-feed– that may be suitable for your needs. It is important to follow the label instructions for preparation, and safe storage and consumption. Ask your medical team about your options and develop a plan with a lactation consultant if breastfeeding is a goal in the future. Remember, skin-to-skin contact is still extremely beneficial for infants and parents to support bonding and comfort.

When To Ask for Help

Talk with your doctor or a lactation consultant if you:

• Are told you have an infection or need a new medication.

• Aren’t sure whether your treatment is safe for breastfeeding.

• Need help choosing the right formula or maintaining your milk supply.

Disclaimer: The information on Mone does not replace professional medical assessment, diagnosis, treatment, or advice. Please seek medical advice from your physician or other qualified health care providers.