Obstetrics & Gynecology>>>>>The Puerperium, Lactation, and Immediate Care of the Newborn
Question 5#

A 30-year-old G5P3 has undergone a repeat cesarean delivery. She wants to breastfeed. Her past medical history is significant for hepatitis B infection, hypothyroidism, depression, and breast reduction. She is receiving intravenous antibiotics for endometritis. The baby latches on appropriately and begins to suckle.  

Which of the following aspects of her history might prevent this patient from breastfeeding?

A) Maternal reduction mammoplasty with transplantation of the nipples
B) Maternal treatment with ampicillin
C) Maternal treatment with fluoxetine
D) Maternal treatment with levothyroxine
E) Past hepatitis B infection

Correct Answer is A

Comment:

There are very few contraindications to breastfeeding. Most medications taken by the mother enter into breast milk to some degree. Breastfeeding is inadvisable when the mother is being treated with antimitotic drugs, tetracyclines, diagnostic or therapeutic radioactive substances, or lithium carbonate. Acute puerperal mastitis may be managed quite successfully while the mother continues to breastfeed. Reduction mammoplasty with autotransplantation of the nipple makes breastfeeding impossible.

However, there are reduction mammoplasty techniques that do potentially allow for some amount of breastfeeding; this would be most likely in patients who underwent a surgery where the areola and nipple were not completely severed. Ampicillin or levothyroxine can be safely used by breastfeeding mothers. A past history of hepatitis B is not a contraindication to breastfeeding. With some acute viral infections such as hepatitis B, there is the possibility of transmitting the virus in milk.