Breastfeeding provides significant health benefits for infants and mothers. However, the United States continues to fall short of the breastfeeding goals set by the Healthy People 2010 initiative. The American Academy of Family Physicians, the American Academy of Pediatrics, and the American College of Obstetrics and Gynecology have policy statements supporting breastfeeding that reflect recent advancements in understanding the mechanisms underlying the benefits of breastfeeding and in the clinical management of breastfeeding. Despite popular belief, there are few contraindications to breastfeeding. Providing maternal support and structured antenatal and postpartum breastfeeding education are the most effective means of achieving breastfeeding success. In addition, immediate skin-to-skin contact between mother and infant and early initiation of breastfeeding are shown to improve breastfeeding outcomes. When concerns about lactation arise during newborn visits, the infant must be carefully assessed for jaundice, weight loss, and signs of failure to thrive. If a work-up is required, parents should be supported in their decision to breastfeed. Certified lactation consultants can provide valuable support and education to patients. Physicians should educate working women who breastfeed about the availability of breast pumps and the proper storage of expressed breast milk. Physicians must be aware of their patients' lactation status when prescribing medications, as some may affect milk supply or be unsafe for breastfeeding infants. Through support and encouragement of breastfeeding, national breastfeeding goals can be met Contraindications to Breastfeeding The AAP aap recommends that women who have transmittable infections, such as human immunodeficiency virus, active untreated tuberculosis, or active herpes lesions on the breast, should not breastfeed.2 additionally, mothers receiving diagnostic or therapeutic radioactive isotopes, antimetabolites, or chemotherapeutic agents, and mothers using illicit street drugs should not breastfeed during periods of exposure to these agents. Iinfants with homozygous galactosemia also should not be breastfed.1,2 Women who have breast implants or who are status postreduction mammoplasty can often breastfeed. I in addition, carriers for hepatitis b or C and women who have a fever or postpartum infection, such as mastitis or endometritis, can also breastfeed.1,2,37 Although not ideal, smoking while lactating is not a contraindication.1 Tongue-tied infants38 and those with mild to moderate hyperbilirubinemia can also be breastfed.39 Table 2 lists conditions that are not contraindications to breastfeeding.2,3,8 Breastfeeding and Medications Most commonly prescribed postpartum medications are safe for breastfeeding women.40 A although a complete discussion of medication safety in lactation is beyond the scope of this article, Table 3 provides an overview of the safety of medications most often used by lactating women.40-43 Multiple studies show that breastfeeding mothers do not adhere to prescribed medications, even when the drug is considered safe. I it is important for physicians not only to discuss the safety of medication, but to reassure and support continued breastfeeding while taking medications.41
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