Introduction
The occurrence of any infectious disease intensifies fear and anxiety, especially regarding the breastfeeding mother-infant relationship. Due to uncertainty and limited knowledge, breastfeeding is often discouraged out of fear, resulting in the deprivation of the infant's essential protective, nutritional, and emotional advantages provided by breastfeeding precisely when they are most crucial. It is crucial to make informed decisions about breastfeeding when the mother has an infectious illness, considering the potential benefits of breastfeeding weighed against the known or estimated risk of the infant contracting a clinically significant infection through breastfeeding, along with the potential severity of such an infection.
What Are the Infection Control Considerations?
It is vital to take precautions based on how infections can spread, like through the air, direct contact, or droplets. These precautions are usually meant for healthcare settings to protect healthcare workers, but they can also be helpful in specific situations involving mothers and infants. They help prevent the transmission of infectious germs between them and other people in the hospital. These precautions are essential when the mother and infant remain in the hospital. It's worth noting that following these precautions at home doesn't mean you have to stop breastfeeding. The goal is to support breastfeeding in most cases and make it safe by taking extra measures when needed, like temporarily pausing breastfeeding or using expressed breast milk.
What Are the Standard Precautions for Infection Control?
Standard precautions involve measures to prevent contact with blood, body fluids, secretions, excretions, and non-intact skin and mucous membranes. These precautions include practices like thorough handwashing before and after each patient interaction, wearing gloves when coming into contact with body fluids or contaminated items, using non-sterile gowns to protect clothing from body fluids, and utilizing masks, eye protection, or face shields in situations where there may be splashing of body fluids. Proper disposal of these materials is also essential. It is recommended to apply standard precautions to all patients regardless of perceived risks. However, it's important to note that breast milk is not considered a body fluid with infectious risks, according to the Centers for Disease Control and Prevention (CDC). Therefore these precautions do not apply to breast milk.
When it comes to breastfeeding, it is important to follow standard precautions. This means we should avoid contact with body fluids other than breast milk, but breast milk itself can sometimes be avoided in certain situations. Mothers should wear appropriate clothing or gowns to prevent direct contact with non-intact skin or secretions, and bandages can be used if needed. Mothers should also be aware of and understand the risks of infant contact with their mucous membranes and try to avoid it. However, using gloves, gowns, or masks on infants for protection is not practical or suitable. The recommendations regarding breastfeeding and breast milk depend on specific infectious agents, and these are discussed throughout this chapter. An example of an infection where standard precautions, including avoiding breast milk and breastfeeding, can help prevent transmission is human immunodeficiency virus (HIV) infection.
What Are the Infections That May Be Present in Breast Milk?
1. Viral Infections and Breastfeeding:
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Human Immunodeficiency Virus (HIV) can be transmitted through breast milk. Nonetheless, the risk of transmission can be substantially mitigated by adhering to antiretroviral medications throughout pregnancy and breastfeeding. HIV-positive mothers are not advised to exclusively breastfeed their infants exclusively since introducing formula or solid foods alongside breastfeeding (known as mixed feeding) increases the risk of transmission.
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Hepatitis B and C: Although there is a potential risk of transmission through breast milk if the mother is a carrier, the likelihood of transmission is relatively low. To minimize the risk of infection, infants born to hepatitis B-positive mothers should receive the hepatitis B vaccine and immunoglobulin soon after birth. As for Hepatitis C, transmission through breast milk is uncommon, and breastfeeding is generally considered safe in these cases.
2. Bacterial Infections and Breastfeeding:
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Staphylococcus aureus: Infections can manifest as mastitis, affecting the breast and nipple. In these instances, there is a possibility of transmitting the bacteria to the infant through breast milk. Timely administration of antibiotics is crucial to prevent the dissemination of the infection.
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Group B Streptococcus (GBS): It is a prevalent bacterium that can inhabit the vagina and rectum of expectant mothers. While there is a possibility of transmitting GBS to the infant during delivery, breastfeeding is not considered a prominent means of transmission for this bacterium.
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Tuberculosis (TB): It can be transmitted through breast milk if the mother has an active TB infection in her lungs or other organs. However, the transmission risk is relatively low. Infants born to mothers with active TB should receive appropriate treatment and preventive measures.
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Other Bacterial Infections: Various bacterial infections, such as E. coli and Streptococcus pneumonia, can rarely be transmitted through breast milk. However, the overall risk is relatively low, and breastfeeding is generally considered safe even in the presence of these infections.
3. Parasitic and Fungal Infections and Breastfeeding:
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Parasitic Infections: Certain parasitic infections, such as toxoplasmosis and malaria, can be transmitted through breast milk. However, the transmission risk is generally low. Adequate treatment and preventive measures can further reduce the risk.
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Fungal Infections: Fungal infections, such as thrush (Candida), can occur in the breast or infant's mouth. While transmission through breast milk is possible, prompt treatment of both the mother and infant can help resolve the infection.
What Are the General Safety Measures for Breastfeeding?
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Good Hygiene Practices: Maintaining proper breast hygiene, including regular handwashing before breastfeeding and cleaning the nipple area, can help minimize the risk of infection transmission.
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Treatment and Prevention: Seeking prompt medical attention and adhering to prescribed treatments for infections are crucial. Following recommended vaccination schedules for both mother and infant can reduce the risk of certain infections.
Conclusion
Breastfeeding is generally safe and does not pose significant risks, even when the mother has an infection. The main concerns regarding breastfeeding are related to the transmission of specific viral pathogens like HIV and human T-cell lymphotropic virus-1. However, the actual risk of transmission for these pathogens has yet to be fully understood. Other viruses and pathogens may be present in breast milk, but they rarely lead to infection in the infant. This could be due to specific antibodies and antimicrobial factors in breast milk, which provide protection. Breastfeeding is considered a natural form of immunization that boosts the infant's long-term immunity to infectious diseases. Infections can be transmitted through breast milk, but the risk varies depending on the type of infection and appropriate preventive measures. In most cases, breastfeeding is safe and highly beneficial for both mother and infant.
