If human breastmilk came stamped with an ingredients label, it might read something like this: 4 percent fat, vitamins A, C, E and K, lactose, essential minerals, growth hormones, proteins, enzymes and antibodies. In a healthy woman, it contains 100 percent of virtually everything a baby needs to survive, plus an assortment of extras to help ward off a lifetime of diseases like diabetes and cancer. Breast milk helps disarm salmonella and E. coli. Its unique recipe of fatty acids boosts brain growth. Nursing babies suffer from fewer infections, hospitalizations and cases of sudden infant death syndrome.
But not all breastmilk was created equal. Do you really understand what is in yours?
Before I scare the life out of you, please note that I am NOT a medical professional or scientific type expert on ANY of this. I have reviewed several sources and am passing along some information as food for thought. The good news…your breastmilk is less toxic than you probably think. The bad news…well…there are some things to be aware of that you might not be!
One property of breastmilk is that its high fat and protein content attracts heavy metals and other contaminants. Pollutants that are of most concern are pesticides, organic mercury, and lead. DDT and dieldrin are apparently unavoidable, and can also be detected in infant formulas. Because breastfeeding mothers have probably been and are being exposed to varying levels of these toxic substances, technically, breastfed babies are being exposed to paint thinners, dry-cleaning fluids, wood preservatives, toilet deodorizers, cosmetic additives, gasoline byproducts, rocket fuel, termite poisons, fungicides and flame retardants. There is much debate and speculation about the concentration of toxics in breastmilk. Most experts will agree that there are detectable levels but nothing concerning enough to suggest that mothers stop breastfeeding. The best thing a woman can do to protect her breastfed baby from these and other toxic substances is to embark upon a cleanse before getting pregnant. Discussing options with your doctor and getting your system as pristine as possible before pregnancy and breastfeeding is an important thing to do. Already breastfeeding? Don't panic! Ridding your immediate environment of toxic chemicals will reduce the amount that gets into your system and in turn ends up in your breastmilk. Consider switching the natural cleaners, using ladybugs and other ecofriendly methods of pest control, using natural bug repellents, and using ecofriendly paints, etc…
What about passing along certain illnesses in breastmilk? Are there any that can be considered dangerous?
It's safe to breastfeed your baby during common infectious illnesses such as colds and flu. Such illnesses are not passed through breastmilk and in fact, your breastmilk responds to these illnesses by sending protective antibodies to your baby. Even mastitis (an infection in the breast) does not pose any risk to your baby. There are a few situations, however, in which breastfeeding is not advised. The following recommendations apply in the United States. Recommendations are often different in developing countries, where the risk of infant mortality is higher if the baby does not breastfeed.
- HIV infection or HTLV-1: The most recent recommendations with respect to breastfeeding and HIV from the WHO actually advise HIV positive mothers to breastfeed exclusively for 6 months, introduce complimentary foods, then continue breastfeeding until at least 12 months.
- Infectious (contagious) tuberculosis: Breastfeeding is safe after the mother has undergone treatment and is no longer contagious.
- Hepatitis A: Breastfeeding is safe after the mother receives a dose of gamma globulin.
- Hepatitis B: Breastfeeding is safe after the baby receives a dose of Hepatitis B immune globulin (HBIG). The baby should also be started on the first of three doses of Hepatitis B vaccine.
- Herpes simplex: Breastfeeding is safe if there are no lesions on the breast.
- Chicken pox: Breastfeeding is safe as soon as the mother is noninfectious, meaning all spots are crusted over.
- Lyme disease: Breastfeeding is safe as soon as the mother initiates treatment.
How safe are cleanses and detoxification while breastfeeding? What about natural methods of healing an imbalanced gut through the consumption of kefir, kombucha, and fermented foods?
I have reviewed studies and information about this extensively after embarking upon a nutritional lifestyle that includes the consumption of healing foods including bone broths, probiotic tonics and beverages, and fermented foods. What I discovered did cause some concern but also empowered me to continue my quest towards eating foods and consuming beverages that would aid my body in reversing years' worth of less than ideal eating habits. In a nutshell, embarking upon any sort of cleanse or eating any foods that will encourage detoxification will absolutely have an effect on your breastmilk. The toxins released as a result of eating healing foods have to go somewhere and aside from urination, defecation, sweating, breaking out with acne, and other similar modes, breastmilk will receive some of these toxins. Babies who are exclusively breastfed and NOT eating any solids (or are eating very few solids) are at a greater risk of receiving these toxins and having a negative reaction to them. Toddlers and older breastfed children are at less of a risk both in terms of the amount of breastmilk they consume and the fact that their body mass is greater and can deal with the toxins more efficiently. The best approach when embarking on any sort of cleanse or detoxification is to start extremely slow…ridiculously slow…especially if you are breastfeeding a child under one year of age. If it is suggested that you drink 8 ounces of kombucha a day, start with 1 ounce and gradually increase it by one ounce every three days once you know your breastfed baby is not being negatively impacted. Remember, it is not so much an issue with WHAT you are consuming versus the effects of what you are consuming. Which leads me to…
A small percentage of breastfeeding mothers notice an obvious difference in their baby's behavior and/or health when they eat certain foods. Cow's milk products are the most common problem foods and the only foods conclusively linked by research to fussiness/gassiness in babies, but some babies do react to other foods. Citrus, soy, gluten containing foods, cruciferous vegetables, nuts (peanuts and walnuts specifically), and caffeine containing foods and beverages are notable “foods of concern.”
Food sensitivities in breastfed babies are not nearly as common as many breastfeeding mothers have been led to think, however. The severity of a food reaction is generally related to the degree of baby's sensitivity and to the amount of the problem food that mom ate—the more food eaten and the greater baby's sensitivity, the more severe the reaction. Food reactions may occur within minutes, but symptoms in breastfed babies more commonly show up 4-24 hours after exposure. If baby has an acute reaction to a new food, or to a food that mom ate a large amount of, then he or she will probably be back to normal within a couple of hours. If baby is sensitive to a food that mom eats frequently, symptoms may be ongoing.
Which leads us to herbs!
I know from experience that herbs can cause all sorts of issues in the breastfed baby, particularly during the first 9 months to a year. Keep in mind that most herbal treatments have not been thoroughly researched, particularly in regard to lactation. “Natural” substances are not automatically safe! Herbs are drugs, so it is necessary to use caution when using them. I could inundate you with all kinds of information about herbs but instead, download this FREE ebook which will answer ALL of your questions and assist you in learning more about individual herbs and their effects on a breastfed baby/toddler.
How safe is your hormonal birth control?
It's a well-established fact that birth control options containing the synthetic hormone, estrogen, can result in a diminished milk supply, sometimes quite rapidly. While most women can use the progesterone-only contraceptives, caution should be used when choosing this birth control option as well. No hormonal birth control should be started before the 6th-8th week postpartum. This allows the body plenty of time to fully establish a milk supply before any hormones are introduced that could compromise this process. Also, the baby's liver is too immature before this time to adequately metabolize the hormones in the contraceptive. After the 6th-8th week, if a hormonal birth control is desired, begin with a progesterone pill (mini-pill). This way you can quickly stop taking it if you notice a drop in milk supply. Most lactation experts advise avoiding the Depo-Provera injection while breastfeeding since it lasts three months and thus cannot be stopped if a drop in milk supply is noted. Estrogen-containing contraceptives should be avoided till at least after the 6th month and once the baby is well-established on solid foods.
What about X-rays and scans?
Regular X-rays such as a chest X-ray or dental X-rays do not affect the milk or the baby and the mother may nurse without concern. Mammograms are harder to read when the mother is lactating, but can be done and the mother should not stop breastfeeding just to get this done. There are other ways of investigating a breast lump. Newer imaging methods such as CT scan and MRI scans are of no concern, even if contrast is used. And special X-rays using contrast media? As long as no radioactive isotope is used there is no concern and the mother should not stop even for one feed. Herein are included studies such as intravenous pyelogram, lymphangiogram, venogram, arteriogram, myelogram etc. What about studies using radioactive nucleotides (bone scans, lung scans, etc.)? The baby will get a little radioactive nucleotide. However, as we often do these very same tests on children, even small babies, and the potential loss of benefits if the mother stops breastfeeding are considerable, the mother should continue breastfeeding. The exception is the thyroid scan. This test must be avoided in breastfeeding mothers. There are many ways of evaluating the thyroid, and only very occasionally does a thyroid scan truly have to be done. Check first before taking the radioactive iodine—the test can wait until you know for sure. In many cases where the scan must be done, it can be put off for several months.
How safe is breastmilk after a mother receives immunizations (tetanus, rubella, hepatitis B, hepatitis A, etc.)?
There is no risk for the baby although my thoughts on vaccinations are a whole other post. The rare exception is the baby who has an immune deficiency. In that case the mother should not receive an immunization with a weakened live virus (e.g. oral, but not injectable polio, or measles, mumps, rubella) even if the baby is being fed artificially.
What if you have to have surgery and it requires anesthesia (general or local)?
Anesthetic drugs are administered for a short period of nearly always less than two hours. The total doses of these drugs ingested by an infant is negligible (and even less so for an older baby or toddler), and intestinal absorption of these drugs by an infant is also negligible, which is why the advice of all experts is simply to continue breastfeeding after any operation. If a woman feels she is capable of breastfeeding her baby after an operation, she may do so in full knowledge that any in her blood will not affect her child.
And of course there is the issue of prescription drugs.
Based on EVERYTHING I have read, most medications (prescription and over the counter) are safe and compatible with breastfeeding especially if taken immediately after a baby has breastfed. Even though most medication will pass into a mother's milk, it is usually in very small quantities. But because every situation is unique, it is important to gather information about a medication and work closely with your health care provider, particularly if there is any uncertainty about a medication's suitability for you or your breastfed baby. Many health care providers may err on the side of caution when prescribing a medication for a breastfeeding mother. Some use resources such as The Physicians' Desk Reference, which takes a rather conservative view regarding safety, as the majority of the information is provided by drug companies that are concerned about lawsuits. If your doctor says the medication he/she is prescribing isn't compatible with breastfeeding and that you need to wean, it is worthwhile asking which resources he or she is using. Fortunately, there is information available that provides a more objective view on medications and breastfeeding. For example, Dr. Thomas Hale's Medications and Mothers' Milk is a professional book that contains reviews of the scientific literature regarding a vast range of medications (categorized by safety), and provides alternatives if there are known concerns regarding a particular drug.
One area of concern for certain medications is the possibility of it leading to a low milk supply. All of the following have been associated with lowering milk supply: antihistamines and some decongestants, some weight loss medications or appetite suppressants, very high doses of vitamin B-6, diuretics, etc.
Looking for information about a particular drug? Check out the links over at the La Leche League and KellyMom.
One question I always get asked is “how in the world have you managed to avoid alcohol for over two years?”
First, I haven't. Second, I am not a big drinker anyway so it is not big deal to steer clear of alcohol. However, I have had the occasional drink starting with a champagne toast 5 days after Tiny was born.
The American Academy of Pediatrics Committee on Drugs classifies alcohol (ethanol) as a “Maternal Medication Usually Compatible With Breastfeeding” yet he American Academy of Pediatrics Section on Breastfeeding notes: “Breastfeeding mothers should avoid the use of alcoholic beverages, because alcohol is concentrated in breast milk and its use can inhibit milk production. An occasional celebratory single, small alcoholic drink is acceptable, but breastfeeding should be avoided for 2 hours after the drink.” Clearly there is a difference of opinion on this issue even within the same professional organization.
Here is what I have unearthed regarding alcohol and breastfeeding:
- Current research says that occasional use of alcohol (1-2 drinks) does not appear to be harmful to the nursing baby.
- Per Dr. Hale (above references), “mothers who ingest alcohol in moderate amounts can generally return to breastfeeding as soon as they feel neurologically normal.”
- There is no need to pump & dump milk after drinking alcohol, other than for mom's comfort — pumping & dumping does not speed the elimination of alcohol from the milk.
- Alcohol does not increase milk production, and has been shown to inhibit let-down and decrease milk production. In fact, babies nurse more frequently but take in less milk in the 3-4 hours after mom has had a drink, and one study showed a 23% decrease in milk volume with one drink. 2+ drinks may inhibit letdown.
- One big risk – daily consumption of alcohol has been shown in the research to increase the risk for slow weight gain in the infant.
In general, if you are sober enough to drive, you are sober enough to breastfeed. Less than 2% of the alcohol consumed by the mother reaches her blood and milk. Alcohol peaks in mom's blood and milk approximately 1/2-1 hour after drinking (but there is considerable variation from person to person, depending upon how much food was eaten in the same time period, mom's body weight and percentage of body fat, etc.). Alcohol does not accumulate in breastmilk, but leaves the milk as it leaves the blood; so when your blood alcohol levels are back down, so are your milk alcohol levels. Always keep in mind the baby's age when considering the effect of alcohol. A newborn has a very immature liver, so minute amounts of alcohol would be more of a burden. Up until around 3 months of age, infants detoxify alcohol at around half the rate of an adult. An older baby or toddler can metabolize the alcohol more quickly.
Smoking and “illegal drug” use – this is where you need to get seriously concerned!
Let's start with smoking. This topic can get pretty controversial and my personal stance is to NEVER smoke if you are breastfeeding however, many professionals are adamant that the benefits of breastfeeding, even while smoking up to 20 cigarettes a day, far outweigh the risks associated with the chemicals that enter breastmilk after smoking. The more cigarettes a mother smokes, the more dangerous it is for both mother and baby no matter how the baby is fed.
The current recommendation for breastfeeding mothers who smoke cigarettes is to continue to breastfeed and cut down on the amount smoked and do NOT expose babies to second-hand smoke. Nicotine levels in the breastfeeding mother's blood and milk first increase and then decrease over time. It takes is 95 minutes for half of the nicotine to be eliminated from the body, otherwise known as half-life. Breastfeeding mothers should avoid smoking just before nursing and should never smoke while feeding her baby.
Risks of breastfeeding and smoking are as follows:
- Heavy smoking can reduce milk supply. A study done on breastfeeding and smoking states that cigarette smoking significantly reduces breast milk production.
- On rare occasions cigarette smoke has caused symptoms in the breastfeeding baby such as nausea, vomiting, abdominal cramps, and diarrhea.
- Smoking can stop or inhibit the milk let-down reflex.
- Smoking has been linked to early weaning and poor weight gain.
- Smoking can cause fussiness and colic.
Finally, we have come to a VERY loaded topic. Illegal drug use and breastfeeding. Here we go!
All illegal drug-use, including amphetamines, cocaine, heroin, PCP or angel dust, and marijuana, pose serious risks to a breastfed baby/toddler. Marijuana is in a different category from cocaine, heroin, and PCP which put babies in extreme danger of serious side effects, addiction, and even death. Mothers who use cocaine, heroine or PCP should not breastfeed AT ALL. EVER. END OF STORY. In fact, in California, a mother has been charged with second degree murder for breastfeeding her baby while taking methamphetamines.
Marijuana is categorized by the American Academy of Pediatrics Committee on Drugs as a drug that is contraindicated for breastfeeding mothers. The American Academy of Pediatrics published an article providing data on drugs including marijuana and breastfeeding.
While the use of marijuana can decrease milk supply, and produce sedation and growth delays when used in large doses, there have not been reports of health problems in babies that were caused solely by use of marijuana and breastfeeding. Due to inconclusive reports, the current recommendations for mothers who smoke marijuana are very similar to those regarding smoking cigarettes – continue to breastfeed and cut down on the amount smoked and do NOT expose babies to second-hand smoke.
Marijuana can cause lowered milk production by lowering levels of the hormone, prolactin, in a woman's body. Marijuana and breastfeeding leads to babies who show signs of sedation, weakness and poor feeding patterns. The combination of decreased milk supply and a weak, lethargic baby are cause for concern on behalf of the well-being and growth of the baby. Beyond the health risk of the actual drug for the baby, mothers who smoke marijuana enter a hallucinogenic state, impairing her ability to care for her baby. After the high wears off, deep sleep may further prevent the mother from caring for her baby.
Other issues :
- Babies exposed to second-hand smoke, and marijuana in breast milk, are at a higher risk of SIDS or Cot Death.
- Babies exposed to marijuana through breast milk will test positive in urine tests for two to three weeks.
- Breastfeeding and marijuana use often ends in double exposure for the baby – through second-hand smoke AND in the breast milk.
- The effects of marijuana may damage brain cells and genetic material, (DNA and RNA).
- Marijuana and other street drugs are often impure, and may be laced with other drugs or substances that can also be damaging to babies.
The analysis of breast milk in habitual heavy marijuana users shows an eightfold buildup in breast milk. The active ingredient of marijuana, delta-9-tetrahydrocannabinol or THC is fat soluble and is quickly circulated into brain and fatty tissue. Breastfeeding babies of mothers who use pot absorb and metabolize THC at a critical time of major brain growth and one of the fears is that marijuana alters brain cells.
A number of studies have been done on marijuana and breastfeeding. One study showed that babies who were exposed to marijuana via breast milk at one month of age had delayed motor development at 12 months of age. The same study showed structural changes in the brain cells of newborn animals exposed to marijuana through their mother's milk. Alterations to DNA and RNA were also observed. Though the long-term effects of early exposure to marijuana, especially on brain are still unknown, results observed in humans suggest serious and long lasting effects.
My thoughts on this subject? Smoking marijuana in any amount is not worth the risk to your baby. Period.
I hope that you have found this information helpful. There is so much more I could discuss but I will save that for another time!
Stay healthy and keep that breastmilk safe!
Sources consulted for this post include the La Leche League, KellyMom, Dr. Jack Newman, Dr. Thomas Hale, Becky Flora IBCLC and RLC, the Weston A. Price Foundation, and the American Academy of Pediatrics.